Discussion and child osyc

Running head: ETHICAL DILEMMA 1

Ethical Dilemma: Autonomy versus Beneficence

Leslie Giffin

Minnesota School of Business

Author Note:

This paper was prepared for PD225 Applied Ethics taught by Instructor Jon Stambaugh.

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Ethical Dilemma: Autonomy versus Beneficence

The ethical dilemma presented in this case study is whether or not it is ethical for the

emergency department to interfere with the patient’s religious beliefs. The father and the son

needed a blood transfusion after their car wreck to replace the immense amount of blood they

lost. The mother refused this transfusion due to religious beliefs. The hospital has the ethical

dilemma of honoring their beliefs or honoring their obligation to treat those that are in dire need

of medical treatment.

Jehovah’s Witnesses are one religion that refuses blood products. “Doctors are bound in

their practice by codes of ethics as to their professional conduct. When it comes to lifesaving

situations where transfusion is absolutely needed, a conflict arises between the doctor’s

professional duty to save lives and the right of autonomy of the patient to his body” (Wong,

2012). That is where the ethical dilemma of autonomy of beneficence comes into play.

Autonomy is the right of a patient to make their own choices. “In conversation, we speak

of people as autonomous when they can think and act independently and take care of

themselves” (Goree, Manias, & Till, 2011). Beneficence is the obligation to help others. In

health care, that means the obligation to help patients. “The modern terms beneficence

and nonmalfeasance can be directly tied back to the Hippocratic Oath. These principles

summarize the commitment of the physician to consider the benefit of any treatment against

potential risks and to first “do no harm” in any medical-related endeavor” (Goree, Manias, &

Till, 2011). That is where the ethical dilemma comes to a head. Does the physician honor the

patient’s autonomy or the Hippocratic Oath?

There are two main stakeholders in this dilemma. The woman is responsible for her

husband and her son. It is also her religious belief and that of her family’s that she is voicing.

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The other stakeholder is the physician. The physician has taken the Hippocratic Oath to do no

harm and to take care of patients. Their medical license is on the line if they violate that oath.

The hospital also has some stake in this issue as they also could be held liable for violating their

duties to protect and care for patients.

From a legal perspective, doctors are generally not to intermingle with the wishes or

beliefs of their patients. An adult of sound mind is allowed to decide which treatment they wish

to receive and which they wish to refuse. “A decision to refuse medical treatment by a patient

capable of making the decision does not have to be sensible, rational or well-considered.

Whether the patient comes to a sensible decision is thus outside the remit of the doctor’s

consideration” (Wong, 2012). Thereby, the hospital would not be at risk for legal trouble if they

honored the patient’s beliefs.

Even though they may not be a legal need to treat these patients, the issue is whether

there is an ethical need. In the medical field, the practice of nonmalfeasance is important.

Nonmalfeasance is the theory of “to do no harm”. Again, this is the fundamental focus of the

Hippocratic Oath. Since there is the potential for these types of ethical dilemmas in the medical

field, paternalism has to exist. “In this medical context, paternalism is the practice of doctors

taking on a parental role with other autonomous persons and making decisions for them that they

would normally be expected to make for themselves” (Goree, Manias, & Till, 2011). This case

presents a particularly challenging moral dilemma as a four year old child is also a victim of this

car accident. It is expected that parents make the best choices for their children and their health.

But what happens when that choice is not viewed as medically sound?

This ethical dilemma is intensified due to the fact that one of the patients is only four

years old. While the parents are adults, capable of the autonomous decisions of their medical

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care; they are also making life and death decisions for their child. “The consensus that parent’s

rights to consent must be limited to decisions that are in the child’s best interests, is

overwhelming and it is incorporated not just in national, but international accords on the rights of

children at the highest levels” (Birchley, 2010). So the physicians and the hospital must evaluate

if the decision the mother is making is the best for the child. In this case, it does not appear to be

so.

My personal values affect how I view this ethical dilemma. First of all, I am a licensed

practical nurse. Although we do not take the Hippocratic Oath, we do take a nursing oath to care

for all patients. While I understand and support the right for religious freedom in the United

States, I also believe strongly in the medical treatment that we have available to us. My career

goals include becoming an administrator in a health care facility. Administrators hold even more

responsibility in these types of situations. They are responsible for the facility as a whole and

put their licenses on the line. When issues happen at a medical facility, the administrators are the

first people that get looked at. They are not only responsible for holding up legal standards but

the ethical and moral standards as well. Since I have experience in this field already, I have

some conflicting thoughts on this issue. I side with beneficence over autonomy, especially when

it comes to children.

My first recommendation for dealing with this issue is that the ethics committee at the

hospital meets. It is important to get a general consensus from the entire committee before

taking any action. It is also important that a hospital has policies and procedures on how to deal

with situations such as this. I believe that the committee must examine what is best for the

patients and tries their best to come up with a solution that comes as closely to honoring their

autonomy while still caring for the patient. I also think it is important to closely examine the

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father and the child separately as an adult can make decisions for themselves while the child

cannot. My recommendation would involve a compromise.

Although blood transfusion was deemed necessary in this case, my second

recommendation is to explore alternatives. “In extreme situations, ventilation and hyperbaric

oxygen have been reported to be useful…Volume expanders, such as gelatins and dextrans,

might also be lifesaving” (Wong, 2012). I would try this route first to see if the blood

transfusion is absolutely necessary. If this method does not help the patients, I believe it is time

to explore other options.

If the alternative medical options do not work, I would try to appeal to the mother again

on behalf of her child. “Decision-making in paediatric medicine is characterised by a ‘shared’

approach where, in the ideal setting, all parties (patient, family and health-care team) strive to

reach consensus on decisions in the best interests of the child” (Alessandri, 2011). If a consensus

cannot be reached, I would explore paternalism and seeking legal assistance to override the

mother’s decision. There are other issues involved here as well. The four year old was riding in

the front seat and was not wearing a seat belt. A child of that age should be in a child seat in the

back seat. This can be looked at as negligence on the parent’s part. This can contribute to the

fact that the parents do not have the child’s best interests and well-being in mind.

“Parents, acting on behalf of their children, have authority to decide among reasonable treatment

choices; they do not, however, have authority to deny lifesaving or medically necessary care. On the

contrary, they are generally required by law to provide adequate health care” (Hill, 2014). Although,

there is some risk involved; with most states having laws requiring parents to provide adequate health

care, there should not be issues with getting a judge to grant rights for the hospital to treat. The father

and mother are adults and capable of practicing their religious freedom and medical autonomy.

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However, the child is only four years old and the hospital must practice beneficence

and nonmalfeasance. The hospital is ethically and morally responsible for caring for the child.

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References

Alessandri, A. J. (2011). Parents know best: Or do they? Treatment refusals in paediatric

oncology. Journal of Paediatrics & Child Health , 628-632.

Birchley, G. (2010). What limits, if any, should be placed on a parent’s right to consent and/or

refuse to consent to medical treatment for their child? Nursing Philosophy , 280-286.

Goree, K., Manias, N., & Till, J. E. (2011). Ethics Applied. Boston: Pearsons Learning Solutions.

Hill, J. (2014). Medical Decision-Making on Behalf of Children and Adolescents . Retrieved 27

February, 2015, from The Doctor Will See You Now:

http://www.thedoctorwillseeyounow.com/content/kids/art3772.html?getPage=2

Wong, D. (2012). Blood transfusion and Jehovah’s Witnesses revisited: Implications for

surgeons. Surgical Practice, 128-133.