PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Sample Answer for PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative Included After Question

Assessment Description

This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles and four boxes approach.

Based on the “Case Study: Healing and Autonomy” and other required topic Resources, you will complete the “Applying the Four Principles: Case Study” document that includes the following:

Part 1: Chart

This chart will formalize the four principles and four boxes approach and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.

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Remember to support your responses with the topic Resources.

APA style is not required, but solid academic writing is expected.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Part 2: Evaluation

Answer each of the following questions about how the four principles and four boxes approach would be applied:

1. In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)

A Sample Answer For the Assignment: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Title: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

The Christian worldview advances that an individual’s best interest should stand in any medical situation. Those involved in the process should do their best and make critical sacrifices like Jesus Christ to save lives. As such, each of the principles needs to be specified and weighted based on its significance to the individual patient’s life. In this situation, beneficence is based on the best interest of James and not the parents. However, the parents exercise autonomy on his behalf and should consider his best intentions and interests (Gillon, 2018). They should engage him and allow him to understand the current process and the decisions or actions by the medical team in the hospital. Everything must be based on informed consent. James’ autonomy is critical and those exercising it must do so in his best interest. The third principle is non-maleficence as all decisions and actions should demonstrate the need to offer benefits and not harm to the boy. The surgeon’s suggestions are important in assisting the parents to make better decisions that will confer benefits to James. Justice should be considered as a critical principle for better decisions and equal access to health care resources (Schwab, 2017). The parents should demonstrate fairness to James and even Samuel by sharing with them the entire process and what it will mean for the rest of their lives. The core aspect is that the parents should consent to Samuel’s donation of a kidney to his brother. Through this action, the parents will be illustrating all the principles in a distinct manner for better outcomes for the boy.

2. In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles? Explain why. (45 points)

The four principles are very critical and form the basis of ethical conduct in healthcare settings. The Christian worldview is categorical that one’s best interests should override any contrary decision or choice. The implication is that a Christian has the capability to balance each of the principles for better outcomes and effective patient management. Further, Christians must understand their obligation to protect lives and make sacrifices for others. The first principle is beneficence which means that every decision and action should focus on attainment of better outcomes for James (Gillon, 2018). The church members expressed their intent and desire to make kidney donations but none had a matching kidney for James. Their sacrificial and selfless action intended to offer benefits to James and were in his best interests.

Secondly, Christians consider non-maleficence or not doing harm to any patient in their care. In this situation, the parents should ascertain that their actions and decisions do not lead to more harm than good for James. When they took James to church, they had good intentions but the decision led to the delay of treatment interventions (Schwab, 2017). The implication is that they must ensure that James gets better treatment for his condition.

Thirdly, justice and fairness are critical for Christians as they believe in equity and equality since all are equal and created in God’s image. justice implies that James and even his brother should be treated with equal dignity inherent to their status as human beings.
Autonomy is essential and Christians like other human beings are born with freewill and can make effective independent decisions about their health and bodies. However, James is a minor and cannot make decisions. While autonomy is critical it must be balanced by need to uphold the other principles.

PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Write a 1,200-1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

  • Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?
  • Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James?
  • According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?
  • According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and treating James?

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Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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A Sample Answer 2 For the Assignment: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Title: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then. PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”

A Sample Answer 3 For the Assignment: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Title: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Biomedical Ethics in the Christian Narrative

Introduction

Bioethics is a subfield of ethics that concerns the ethics of medicine and ethical issues in the life sciences raised by the advance of technology. The issues dealt with tend to be complex and controversial (i.e., abortion, stem cell research, euthanasia). There have been several approaches to the theory and methodology of ethical decision-making in bioethics, but this discussion will focus on what is likely the most influential approach called principlism, which stresses the application of four moral principles to all ethical decisions in health care. A practical tool, commonly used by ethicists and hospital ethic committees, known as the “four-boxes approach” will be introduced as a way to organize hard cases and appropriately apply the four principles. Principlism and the four-boxes approach will be used and interpreted in light of the Christian worldview and the overarching narrative presented in the Bible.

Principlism

Principlism is often referred to as the “four-principle approach” because of its view that there are four ethical principles that are the framework of bioethics. These four principles are the following, as spelled out by Tom L. Beauchamp and David DeGrazia (2004):

1.      Respect for autonomy – A principle that requires respect for the decision- making capacities of autonomous persons.

2.      Nonmaleficence – A principle requiring that people not cause harm to others.

3.      Beneficence – A group of principles requiring that people prevent harm, provide benefits, and balance benefits against risks and costs.

4.      Justice – A group of principles requiring fair distribution of benefits, risks, and costs. (p. 57)

While these principles will guide ethical decision-making, they only provide a general and abstract framework for thinking about particular ethical cases. Other information is required before one can make a concrete ethical decision. First, one must specify the particular context and details of a case or dilemma in order to concretely apply these principles and arrive at concrete action-guiding results (i.e., individuals need to know how to apply these principles to specific cases and circumstances).

Second, one must figure out how each of the four principles ought to be weighed in a particular case. One needs to determine which of the four principles deserves the most priority in any given case, especially in cases in which there are conflicts between the principles. The details of a specific case as well as the way in which principles are weighed and prioritized necessarily involves discussion of worldview. This is because a patient’s preferences will involve his or her worldview, and because different worldviews would rank the importance and priority of principles differently. Thus, one might approach the four principles from a Buddhist perspective, or an Islamic perspective, or an atheistic perspective and achieve vastly different results. When one utilizes the principlist approach to bioethical dilemmas, it will always also incorporate broader worldview considerations and never be purely neutral or unbiased. In order to understand how the Christian worldview would apply the principles, it is important to understand the grand story told in the Bible that Christians believe describes reality. PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

The Christian Biblical Narrative

While it is not possible to survey every possible religion, the description below will at least attempt to do justice to the biblical narrative and Judeo-Christian tradition.

The Bible is a collection of 66 books written over thousands of years in several different languages and in different genres (e.g., historical narrative, poetry, letters, prophecy), yet there is an overarching story, or big picture, which is referred to as the Christian biblical narrative. The Christian biblical narrative is often summarized as the story of the creation, fall, redemption, and restoration of human beings (and more accurately this includes the entire created order). Concepts such as sin, righteousness, and shalom provide a framework by which the Christian worldview understands the concepts of health and disease.

Briefly, consider the following summary of each of the four parts of the grand Christian story:

Creation

According to Christianity, the Christian God is the creator of everything that exists (Gen. 1-2 NIV). There is nothing that exists that does not have God as its creator. In Christianity, there is a clear distinction between God and the creation. Creation includes anything that is not God—the universe and everything in it, including human beings.

Thus, the universe itself and all human beings were created. The act of creating by God was intentional. In this original act of creation, everything exists on purpose, not accidentally or purely randomly, and it is good. When God describes his act of creating, and the creation itself as good—among other things—it not only means that it is valuable and that God cares for it, but that everything is the way it is supposed to be. There is an order to creation, so to speak, and everything is how it ought to be. This state of order and peace is described by the term Shalom. Yale theologian Nicholas Wolterstorff (1994) describes Shalom as, “the human being dwelling at peace in all his or her relationships: With God, with self, with fellows, with nature” (p. 251).

The Fall

Sometime after the creation, there occurred an event in human history in which this created order was broken. In Genesis 3, the Bible describes this event as a fundamental act of disobedience to God. The disobedience of Adam and Eve is referred to as the fall, because, among other things, it was their rejection of God’s rule over them and it resulted in a break in Shalom. According to the Bible, the fall had universal implications. Sin entered into the world through the fall, and with it, spiritual and physical death. This break in Shalom has affected the creation ever since; death, disease, suffering, and, most fundamentally, estrangement from God, has been characteristic of human existence.

Redemption

The rest of the story in the Bible after Genesis 3 is a record of humanity’s continual struggle and corruption after the fall, and God’s plan for its redemption. This plan of redemption spans the Old and New Testaments in the Bible and culminates in the life, death, and resurrection of Jesus Christ. The climax of the Christian biblical narrative is the atoning sacrificial death of Jesus Christ, by which God makes available forgiveness and salvation by grace alone, through faith alone. The death of Christ is the means by which this estrangement caused by sin and corruption is made right. Thus, two parties, which were previously estranged, are brought into unity (i.e., “at-one-ment”). For the Christian, salvation fundamentally means the restoration of a right and proper relationship with God, which not only has consequences in the afterlife, but here and now.

Restoration

The final chapter of this narrative is yet to fully be realized. While God has made available a way to salvation, ultimately the end goal is the restoration of all creation to a state of Shalom. The return of Jesus, the final judgment of all people, and the restoration of all creation will inaugurate final restoration.

Summary: The Christian Ethical Approach

While the principlist approach may be used by the Christian as a general methodological tool for bioethical reflection, the general contours of a Christian approach to ethics (not only bioethics) include the principles and rules found in the Bible, as well as the example of Jesus Christ (Rae, 2009, p. 24). The way in which Christianity answers the worldview questions will be in the context of the above narrative. Similarly, a Christian view of health and health care will stem from the above narrative and God’s purposes. Of course, the pinnacle of this framework is the person of Jesus Christ. Thus, for Christianity, medicine is called to serve God’s call and purposes, and everything is done in remembrance of, and in light of, Jesus’s ultimate authority and kingship.

The Four-Boxes Approach

The four-boxes approach is a practical tool developed by Jonsen, Siegler and Winslade that helps clinicians identify ethical issues in medical cases and reach reasonable a conclusions that lead to ethical actions (Jonsen, Siegler, & Winslade, 2010). This approach introduced four topics that describe the way in which the four principles of principlism actually apply to a certain. These topics include (1) medical indications, (2) patient preferences, (3) quality of life, and (4) contextual features.

Medical indications refer to “those facts about the patient’s physiological or psychological condition that indicate which forms of diagnostic, therapeutic, or educational interventions are appropriate” (Jonsen et al., 2010, p. 10). This topic concerns the professional judgment of the physician and involves the concrete application of the principles of beneficence and nonmaleficence.

Patient preferences refer to “the choices that persons make when they are faced with decisions about health and medical treatment…[which] reflect the patient’s own experience, beliefs and values as informed by the physician’s recommendations” (Jonsen et al., 2010, p. 47). This topic primarily involves the concrete application of the principle of respect for autonomy.

Quality of life refers to “that degree of satisfaction that people experience and value about their lives as a whole, and in its particular aspects, such as physical health” (Jonsen et al., 2010, p. 109). This topic is difficult to define, and it involves the concrete application of beneficence, nonmaleficence and respect for autonomy. However, it seems that the most important principle here is an aspect of the principle of beneficence. Beneficence is not only acting in ways that help other persons in need by way of treating or curing illness, but it also involves “acting in ways that bring satisfaction to other persons” (Jonsen et al., 2010, p. 109). Thus, it is also part of beneficence to attempt to improve a patient’s life such that they are satisfied with their quality of life.

Contextual features refer to the context in which a particular case occurs, which includes “professional, familial, religious, financial, legal and institutional factors” which influence clinical decisions (Jonsen et al., 2010, p. 161). Thus, for example, an influential contextual feature in a case in which the medical indications for a person include a blood transfusion, would be if a patient were of the Jehovah’s Witnesses religion. This is because blood transfusions are considered to be immoral according Jehovah’s Witnesses teaching.

When considering a difficult ethical case in medicine or health care, the relevant information of that case is arranged into four boxes which correspond to the four topics above and aligns them with the key ethical principles (Jonsen et al., 2010):

·         Medical Indications (Beneficence and Nonmaleficence)

·         Patient Preferences (Autonomy)

·         Quality of Life (Beneficence, Nonmaleficence, Autonomy)

·         Contextual Features (Justice and Fairness)

The four-boxes approach is a useful tool to make sure that you have gathered all the relevant data (or as much data as possible) so as to come to an ethical decision and plan of action. Keep in mind that many times in clinical ethics, there may not be a single right course of action, but there are certainly better or worse options. This does not mean that there is no such thing as right and wrong (i.e., relativism), but simply that real life is messy and imperfect.

Applying the Principlism and the Four-Boxes Approach

Consider the following analysis from a Christian perspective of the case study, “End of Life and Sanctity of Life,” in the American Medical Associations Journal of Ethics, included in the topic readings (Reichman, 2005). That case is analyzed from a Jewish and Buddhist perspective by different commentators. This case will be analyzed by addressing the four principles in the principlist approach, and then that data will be considered in light of the Christian worldview in order to recommend a course of action in accordance to Christian values and biblical principles. As practice, begin filling the four boxes based on the information provided by the case itself, as well as the analysis below.

Depending on the case, different principles will come to have greater prominence in deciding an ethical course of action. At times there may be conflicts among the principles themselves, in which it will have to be determined which principle will have the greater priority. For example, a common conflict is that between a patient’s autonomy and what a physician considers to be beneficent, or in the best interests of the patient. A physician might see that a particular course of treatment will be beneficial for a patient (beneficence), and yet the patient refuses the treatment (autonomy).

Should the physician simply allow patients to choose for themselves a course of action that will knowingly bring them harm? Is it right for the physician to coerce or force a patient to undergo a treatment against his or her will and violate autonomy, even if it will bring about some medical benefit?

How do the four principles apply to the case of 82-year-old Mrs. Jones as described by Reichman’s case study (2005)?

Autonomy: In this case, Mrs. Jones is incapacitated; she has been unconscious for two days and has no ability to communicate her desires for or against treatment. This is further complicated by the fact that she left no advance directive (a legal document that details her wishes for or against certain kinds of medical treatment should she ever become incapacitated such as a living will or a health care power of attorney). While Mrs. Jones’s family and the physian disagree about the appropriate treatment for her, it seems that determining what Mrs. Jones would have wanted is not possible. Thus, while her autonomy is certainly to be respected, in this case, it is not something that is able to be obtained given her condition (she would technically be considered incompetent and unable to exercise autonomy in her current condition).

Beneficence: Dr. Rosenberg believes that it will be in Mrs. Jones’s best interest medically to be put on temporary dialysis. He believes it to be the beneficent course of action: that which will bring about her good. Mrs. Jones’s family believes that dialysis will be a cause of undue suffering for her, and, thus, do not consider it to be the beneficent course of action. The fundamental disagreement lies here. Two parties, who are not Mrs. Jones herself, and who presumably do not have information about how she would have decided for herself, disagree about whether or not an action is truly beneficent for her. The principle of nonmaleficence is closely related.

Nonmaleficence: Not only does Dr. Rosenberg have a moral duty to promote Mrs. Jones’s good, but he has a corresponding negative duty to not inflict evil or harm upon her. Mrs. Jones’s family believes that to place her on dialysis would inflict harm and suffering on her. Dr. Rosenberg believes it to be his duty to place her on dialysis and that to not do so would be harmful to her. Dr. Rosenberg’s dilemma involves the belief that withholding treatment that has a good chance of restoring Mrs. Jones back to health with little risk is immoral.

Justice: Questions of justice usually come to the forefront in terms of the equal and fair distribution/allocation of medical goods and services (i.e., organ donation, health insurance. In this case, this principle does not play a major role. It might be said that it is unjust or unfair for Mrs. Jones to not decide for herself. But in the terms of this course, that concern would more appropriately be a question of autonomy, beneficence and nonmaleficence.

The above discussion sketches out how each principle would be relevant to or apply to Mrs. Jones’s case. But notice that you do not automatically have an answer to this dilemma. What should be done ethically? To answer this question, it is necessary to consider the four principles in light of an overarching worldview. Thus, how ought a Christian think about this dilemma?

To begin with, it is important to note that the Bible holds that all life is sacred (Gen. 2:7; Ps. 139:13-16; Exod. 20:13). Thus, whether a life is at its beginning or end, it is valuable and sacred.

The dilemma in Mrs. Jones’s case is directly related to her perceived quality of life. Her family (presumably if they are being honest) does not desire that she remain alive and suffer. They perceive it better for her to stop living than for her to continue living in a poor quality of life in which she would suffer. Dr. Rosenberg believes that her life is sacred and that her quality of life is not so bad as to warrant ending her life early, if it can be saved with reasonable effort and low risk. For the Christian, while quality of life certainly matters, it does not determine the value of a life, or the worthiness of living for a person. PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

You might ask why exactly Mrs. Jones’s family is so ready to give up on a treatment modality (temporary dialysis) that will likely succeed? Meilaender notes the importance of taking care of those in need and accepting their dependence upon those who love them and vice versa, accepting your own dependence when you are incapacitated, upon those who love you (2013, pp. 85-88). The reticence on the part of Mrs. Jones’s family seems to communicate a lack of willingness to deal with her care. It seems as if they want it to be over with, instead of fulfilling their duty to care for her and be active partners with Dr. Rosenberg in deciding what is in her best interest.

From the Christian perspective, it would be true that if Mrs. Jones had a personal relationship with Christ, her quality of life or existence would be improved dramatically were she to enter into God’s presence directly by way of her earthly passing. However, it would be radically mistaken to believe that it is up to someone other than God when that time would be. Does a refusal of dialysis constitute a reasonable decision? Or does it constitute a decision that functionally denies the opportunity for healing and, thus, denies God’s prerogative? It seems more likely that it is the latter.

In brief, it seems that Dr. Rosenberg is justified in his refusal to withhold reasonable and low-risk treatment for Mrs. Jones. Ultimately, it seems that Mrs. Jones’s family does not want to take responsibility for her care and is, instead, opting to determine her worth or value based upon a perceived quality of life.

Conclusion

In your own case study, consider how each of the four principles apply and analyze those facts in terms of the Christian worldview. All ethical decision-making takes place within a worldview. The content of a worldview will determine what is valuable and what is not, as well as how a person would engage in decision-making given those values.

References

Beauchamp, T. L., & DeGrazia, D. (2004). Principles and principlism. In G. Khushf (Ed.), Philosophy and Medicine: Handbook of bioethics: Taking stock of the field from a philosophical perspective (Vol. 78). Dordrecht: Kluwer Academic Publishers.

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine (7th ed.). New York: McGraw Hill Education/Medical.

Meilaender, G. (2013). Bioethics: A primer for Christians (3rd ed.). Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.

Rae, S. B. (2009). Moral choices: An introduction to ethics (3rd ed.). Grand Rapids, MI: Zondervan.

Reichman, E. (2005). End of life and sanctity of life. American Medical Association Journal of Ethics (formerly Virtual Mentor), 7(5), 342-351. Retrieved from http://journalofethics.ama-assn.org/2005/05/ccas2-0505.html

Wolterstorff, N. (1994). For justice in Shalom. In W. G. Boulton, T. D. Kennedy, & A. Verhey (Eds.), From Christ to the world: Introductory readings in Christian ethics (pp. 251-253). Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.

A Sample Answer 2 For the Assignment: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Title: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”

The four main principles are as follows: beneficence, nonmaleficence, respect for autonomy, and justice. I feel as those each of these topics or principles is linked to the other either in that by doing one you are in turn practicing the other, or in that by neglecting one you will have to practice the other. For example, by ignoring the practice of nonmaleficence and inputting malice onto people or the world, you are creating the need for justice. So, in my opinion, nonmaleficence is ranked higher than justice. Also, while beneficence is preventing harm and providing good to others, nonmaleficence is avoiding harm towards others “above all”, so I feel that nonmaleficence once again trumps. Lastly, respect for autonomy sounds a bit like a “live and let live” principal. This entails not judging others for their perspectives, views, and opinions. It is understanding that other people have the right to live how they choose (Hoehner, 2020). If they truly follow the practice of nonmaleficence, then I believe there could be peaceful coexistence. All said, my ranking would be nonmaleficence, respect for autonomy, beneficence, and then justice. Justice falls last in the rank because if the other principals are followed, there is no need for it, and it also just sounds a bit petty to me in a colloquial sense.

In the Christian narrative, I feel that they would be ranked with beneficence, nonmaleficence, respect for autonomy, and then justice…and not because that is the order they are presented in the book! Beneficence sounds to be more selfless. The bible encourages helping others, almost in a way of giving up ones’ whole self in service of God. Almost as importantly, nonmaleficence discourages harm. At this point, people are doing good and also avoiding the placement of harm onto others. Then, respect for autonomy would encourage compassion and understanding through thought, not just action, as the first two aspects seem to encourage or discourage an action (Hoehner, 2020). Lastly, Justice would be last, because again, in practicing the first three principals, the last would be redundant.

Hoehner, P. (2020). Biomedical Ethics in the Christian Narrative. Practicing dignity: An introduction to Christian values and decision making in Health Care. Retrieved September 12, 2022, from https://lc.gcumedia.com/phi413v/practicing-dignity-an-introduction-to-christian-values-and-decision-making-in-health-care/v1.1/#/chapter/3

A Sample Answer 3 For the Assignment: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

Title: PHI-413V Week 3 Case Study On Biomedical Ethics In The Christian Narrative

I would consider that all of these principles are fundamental to understanding what ethics is all about. This means that for Christians all the principles of ethics are vital. I think I would observe them this way since if I will prioritize one over the others, I will end up weakening all of them. As such, I ponder that they should be put to use in a way that allows one concept to reinforce the others. In this regard, autonomy can protect patients from being pushed or pressured by their healthcare providers into making decisions or following treatment plans that are not right for them (Connerton & Moe, 2018).

On the other hand, the principle of beneficence can inspire medical professionals to proactively prioritize the well-being of each patient. However, the justice principle can enable doctors and nurses should carefully consider the preferences of each patient. This means that a patient can be exposed to the chance to choose among available treatment options.

As a Christian, I believe that since all moral judgments are made within the framework of some worldview, the relative weight given to different ethical principles depends on the nature of the decisions being made. Although the Bible recognizes the inherent worth and sanctity of every human existence, I ponder that discrepancies arise when trying to apply its teachings to the four tenets of Christian ethics. For instance, according to the beliefs of Jehovah’s Witnesses, receiving a blood transfusion is a sin (Varkey, 2021). However, when viewed through the lens of bioethics, blood transfusion exemplifies the values of fairness, beneficence, and non-maleficence.

Applying the Four Principles: Case Study

Healthcare providers encounter cases that implore them to navigate dilemmas in decision making because of the ethical issues involved. The case study on “Healing and Autonomy” illustrates the ethical dilemmas and type of decisions that providers should make based on the biomedical principles of beneficence, autonomy, non-maleficence, and justice (Cherry, 2019). Again, nurses and other healthcare providers can also use the “four-quadrant” approach that poses questions for a given case concerning medication indications, patient preferences, quality of life and contextual features. The purpose of this paper is to explore and discuss the case study using the four-quadrant approach and evaluate the four principles from a Christian worldview.

Part 1: Chart (60 points)

Medical IndicationsBeneficence and Nonmaleficence Patient PreferencesAutonomy
Medical indications entail the diagnosis, prognosis, and suggested measures in assessing and treating and the anticipated results of the interventions (Teven, et al., 2018). The core role of medical indications is to ensure that providers make the right decisions and prioritize patient needs. In this case, the medical indications show that James has acute glomerulonephritis which progresses due to denial of first treatment interventions by his parents. The condition worsens leading to temporary dialysis and now kidney failure that requires a transparent.The principles of beneficence and non-maleficence are essential in this quadrant since any intervention by healthcare provider is aimed at doing good and not harming the patient (Plöckinger et al., 2022). The physician demonstrates beneficence and non-maleficence by taking actions based on the diagnosis and suggests a dialysis and eventual kidney transplant. Patient preferences are essential from both a medical and ethical perspective. When a patient has decision-making abilities, his or her preferences should be respected and guide the medical care process (Teven et al., 2018). Based on the principle of autonomy, a patient’s preferences are essential to ensure that they accept the suggested treatment interventions.In this case, James is a minor and his parents, Mike and Joanne, make decisions on his behalf. They exercise autonomy when they take James to their church for a faith healing service but do not get positive results as they bring him back. The principle of autonomy requires providers to respect decisions and choices that patients make on either to receive treatment interventions or not. The parents opt for spiritual healing because they have the legal mandate to exercise autonomy on behalf of their son. The physician allows them to explore the option because of observing autonomy and patient preferences. Therefore, patient preferences are at the center of this approach that focuses on respect for patient autonomy.
Quality of LifeBeneficence, Nonmaleficence, Autonomy Contextual FeaturesJustice and Fairness
The quality of life entails one’s condition based on their living status. Illness can negatively impact the quality of life. The main goal of medicine is the preservation, restoration and improvement of the quality of life. Therefore, the principles of beneficence, non-maleficence and autonomy are critical in examining the quality of life for patients.In this case, the diagnosis of acute kidney failure and the need for temporary dialysis have negatively affected the quality of life for James. He requires dialysis daily as he awaits a kidney transplant. James needs improved quality of life that can only be guaranteed by a kidney transplant through a matching one. While Samuel, James’ twin, has a matching kidney, the parents are reluctant to have him donate it as they fear that they may lose their two sons. As such, James’ quality of life will improve through the dialysis and eventually a kidney transplant as the eventual or permanent solution. Contextual features or issues arise from different aspects that include family dynamics, financial resource, religious and cultural aspects as well as the possible legal ramifications of care and personal bias for all those involved in the care process of a patient. Justice and fairness as a biomedical principle arise in the contextual features.In this case, religious practices based on the healing service affect the treatment interventions as the parents believed in spiritual healing taking the son to their church service. Again, the parents are hesitant to allow their son donate his kidney because of the family dynamics. The implication is that these contextual features like religious beliefs and practices impact the decisions that providers make concerning the treatment interventions. The parents should demonstrate justice and fairness by allowing their son to donate the matching kidney to save the life of his brother.

Part 2: Evaluation

Answer each of the following questions about how the four principles and four boxes approach would be applied:

  1. In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)
At the center of the Christian worldview is providing benefits to individuals as a means of protecting and preserving precious and sacred life. Christians believe that life is gift from God and should be protected, including making sacrifices like Jesus Christ did by giving His life for the sake of humanity. The Christian worldview is categorical that any decision that physicians and even family members make should focus on providing benefits to those involved based on justice and fairness (Hoehner, 2020). In this case, each of the principles is essential. However, the principle of beneficence should be specified and weighted first because it entails making efforts to protect and preserve the life of James. The next principle would be non-maleficence as all actions and decisions by those involved should focus on reducing any harm (Cherry, 2019). For instance, the decisions by James’ parents harm him as they lead to the exacerbation of his situation. Denying James immediate treatment intervention is unfair and does not demonstrate justice. As such, justice becomes the third principle that should be specified and weighted since it means that all actions must be considerate of the patient’s benefits. The last principle is autonomy as Christians advance that even when one has the decision-making powers, they should not make decisions that appear irrational as their effects will not only be on individuals but will involve other stakeholders (Hoehner, 2020). Therefore, prioritization of these principles is essential to offering beneficial care that will not harm the patient but lead to positive outcomes.
  1. In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why. (45 points)
It is important for a Christian to attain a balance between physical and spiritual life. Christian faith and beliefs have a profound impact on the health and quality of life of James and the wellbeing of the entire family. The decisions that Mike and Joanne make all emanate from their spiritual position and thoughts. The case demonstrates a conflict between medical interventions and Christian faith, especially the believe in miracle healing. Imperatively, based on James’ condition, attaining a balance of the four principles is a challenge but critical to saving his life and future treatment considerations. A Christian needs to balance these principles by considering positive outcomes for the patient. Consequently, the first consideration would be the benefits that the intervention would have on the individual (Hoehner, 2020). James should have treatment as prescribed by the physician while the parents pray that all goes well. The second consideration will be non-maleficence as the actions by the respective players in the case should focus on not harming the boy but ensuring better health for him.The principles of autonomy and justice implore healthcare professionals to support spiritual rights of patients in their care as part of patient preferences. Therefore, the physician obliged to Mike and Joanne taking their son for spiritual healing service at their church. The implication of the decision was improving the quality of life and also allow the parents to exercise their spiritual beliefs and faith (Iltis, 2020). However, it did not help much Therefore, autonomy and justice should be the last principles for the individuals in the case to weigh and consider based on the present situation.

Conclusion

The case study on healing and autonomy demonstrates the critical role of the biomedical principles in the lives of patients and the kind of decisions that providers make when faced with such ethical dilemmas. The case study shows that providers must use the four-quadrant model alongside biomedical principles to make effective and patient-centered decisions. The Christian worldview implores Christians to make decisions by weighing and specifying the four principles based on the biblical teachings. Based on these teachings, the principles of beneficence, non-maleficence, justice and autonomy are ranked by prioritizing their corresponding importance to the patients and their spiritual beliefs and faith.

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