Balancing Legal and Professional Contemplations

It would be unfortunate for a beautiful house to burn down because the fire department fears being accused of trespass. Similarly, it is an unfortunate world where children die of treatable diseases because a single lawsuit by an aggrieved parent can bring an entire hospital down even when the hospital eventually wins the case. The combination of seeking to treat patients while adhering to their wishes and interests has created a complicated balancing act for practitioners who often face complicated decisions. The complicated decisions become ethical dilemmas when they fall within the grey areas of the law, yet the patient, a minor might die unless the dilemma is resolved. (Birchley, 2016; Lipstein et al., 2015). The instant case study presents a complex ethical dilemma where the interests of the parents collide with those of the doctors. This places the CEO in a quagmire that can only best be solved through reference to a third party, such as a court, to avoid inordinate liability to the hospital. 

Whether Religious Doctrine Trump Sound Medical Advice 

The modern healthcare approach is holistic in nature and goes beyond curative attention hence the religious views of the patient should to some extent trump clinical advice. At any moment in time, there is an individual spending all their courage and finances in an effort to stay alive and healthy just a few more moments while struggling with a terminal condition . At the very same time, there is someone who is almost 100% healthy blowing their brains out in search of death. The importance of life and its meaning is, therefore, an individual decision based purely on the owner of the life itself. It is on this basis that modern nursing is based on the concept of care from a holistic approach. Under this approach, the nurse gives the patient what the patient needs as opposed to what the nurse believes is right (Moss et al., 2015). Similarly, medical advice is based on what the medical practitioner believes is right but it may not necessarily be right for the patient. What is right or wrong for the patient must be based unequivocally on what the patient wants as long as the patient is in a position to be qualified, rational, and sober in making the decision (Lipstein et al., 2015). It is the obligation of the practitioner to determine if the patient is qualified to make the decision at the time it is being made. 

If the Girl is Old Enough to Make the Decision 

The determination on whether or not the girl in the case study is able to make medical decisions depends on her reasoning capacity not just the number of years in her age. Some children are capable of making rational and responsible decisions at a much younger age than others. One of the most complex elements of the ethical dilemma in the instant case study is the age of the patient. “ Normally, young children under the age of 12 have no formal right to be involved in the informed consent process with their parents ” (Hein et al., 2015). The age of 12, therefore, falls within a supposed grey area where the child is not too young to be considered yet not old enough to be taken seriously. Under the circumstances, determining whether or not the 12-year-old patient herein can competently make a medical decision will vary from case to case and circumstance to circumstance. If the patient was a Muslim being forced into marriage against her will, most would argue that she has a right to choose for herself but if she was refusing school, most would argue that she is too young to make any serious decisions. For the purposes of the ethical dilemma, the age of the patient must be considered not based on the number of years but the level of maturity of the patient (Hickey, 2007). The thinking and reasoning capacity of the child should be carefully assessed to establish if the child is capable of making a mature decision. As this is a hospital setting, the safest way to do so is have a child assessed by a child psychologist who would be able to give a formal written assessment of the capacity of the child and the child’s ability to make the right decision. If the child is found to be sober and rational, more weight would be added to the choices of the child as opposed to those of the parents (Hein et al., 2015). 

Seeking Third-Party Intervention 

The instant dilemma unequivocally calls for reference to a third party from a legal and a social perspective. From a social perspective, a 12-year-old girl from a family of one of the most stringent religious affiliations in the world has made a decision that is contrary to that of the parents. A holistic approach to healthcare includes being mindful of the social welfare of the patient (Lipstein et al., 2015). Whatever happens, the little girl might be a victim of the wrath of her parents for the apparent betrayal of the faith. For example, it is common for parents with the support of their church to either shun or punish the girl, ostensibly for betraying the faith as has happened in families that practice religious extremism. Social services would be necessary to smooth out the differences between the girl and her parents. Secondly, officers from the social services might be able to convince the parents to acquiesce to some form of transfusion so as to make the surgery possible. From a legal perspective, the hospital needs to protect itself from legal liability, which might arise from any decision it makes (Maqsood et al., 2017). If the operation takes place, the parents might sue and if it does not, the girl might sue. To be on the safe side, the hospital should collect all available information, including a report about the mental capacity of the girl and place it before a judge for consideration. Taking decision-making away from the hospital diminishes the potential negatives in each of the two possible decisions involved. 

Pro et Contra of Both Sides of the Argument From CEO’s Perspective 

Argument for Transfusion 

Advantages 

As a human being, saving the life of the child is important to the CEO and creates the first advantage of arguing for the operation with blood transfusion. For example, even if declining the transfusion would be the right professional decision, the conscience of the CEO as a human may be haunted by the death of the child. The second advantage of the decision is the satisfaction of being able to give the patient what she wants. Finally, deciding to give a go-ahead for the operation would endear the CEO to the medical team which is eager to save the life of the child. 

Disadvantages 

The primary disadvantage of the decision for blood transfusion is opening up the hospital to a protracted suit with the girl’s parents. Even a frivolous case, but with good financial support, taken all the way to the Supreme Court could create a financial burden that can cripple the hospital. The second disadvantage revolves upon the legal costs to be visited against the hospital which might be enormous as the hospital would be facing the powerful litigating machine of the Watch Tower Bible and Tract Society (Petrini, 2014). Finally, going against the wishes of a patient can create direct liability for the CEO. For example, if something went wrong with the operation table and the child dies after a transfusion is made, the parents might take legal action directly against the CEO. 

Argument against Transfusion 

Advantages 

Not performing the operation would put the hospital in the good books of the patient’s parents and the Watch Tower Bible and Tract Society. For example, in the case a third party brings legal action against the hospital, the Watch Tower Bible and Tract Society would be a valuable ally. The second advantage of the decision not to conduct blood transfusion is that it holds the highest chances of settling the ethical dilemma conclusively. The final advantage of this argument is that it gives the hospital an opportunity to adhere to the care-based philosophy of the extended definition of the patient to include the patient’s loved ones. 

Disadvantages 

The first and primary disadvantage of the decision against transfusion would be losing the patient due to the terminal nature of the illness. For example, if the surgical operation is undertaken without transfusion, the girl would die at the operation table. The second disadvantage of the argument against the CEO will eliminate an ethical dilemma by creating a medical crisis as the doctors try to figure out how to go around transfusion yet save the child’s life. This would not endear the CEO to the medical team that the CEO has to work on a regular basis. Finally, deciding against the transfusion would set a bad precedent for the hospital and its administration from the perspective of reputation, more so if the patient who could have been saved died. 

The Role of Ethics in the Making of the Decision 

The primary basis for the ethical dilemma, in this case, is that seeking to do good for the patient might amount to hurting the hospital and vice versa. For example, a CEO who lacks deference to ethics would just let the parents have their way and consider the matter settled. Ethics are commonly defined as moral principles that inform the character of the individual. Three sets of ethics come to the fore in the instant case study. First, there are the ethics of the nursing officer premised on the concept of care (Moss et al., 2015). The nurse is ethically bound to ensure that the will and informed decision of the patient is met. Secondly, there are the ethics of the doctors whose obligation is to save lives, almost at all costs (Maqsood et al., 2017). Finally, there is the ethical perspective of the CEO who is bound to protect the hospital at all costs. The three sets of ethical affiliations augment the ethical dilemma in the case study. It is mainly for this reason that some hospitals are opting for administrators who are not affiliated with the medical or nursing profession to run hospitals (Clay-Williams et al., 2017). 

From the totality of the foregoing, the life of a little girl lies in mortal danger and the legal position is vague. On the one side is the parents who are staunch Jehovah’s Witnesses and will not consent to a blood transfusion. On the other hand, there is the medical team who believe that without transfusion the life-saving surgery is not possible. The solution to the ethical dilemma that the CEO faces is tilting towards the side where the little girl will remain in mortal danger so as to save the hospital from debilitating judicial processes. However, allowing a child to die for fear of legal repercussions goes against the primary tenet of ethics that is, doing the right thing. The constant pursuit of right in the scenario demands that the CEO does the right thing for the patient, and for the hospital contemporaneously by seeking legal redress for the dilemma. The legal redress must be sought in a manner that tilts towards saving the little girl’s life. Any ethical dilemma would be an ethical disaster if it leads to the death of an innocent person. 

References 

Birchley, G. (2016). Harm is all you need? Best interests and disputes about parental decision-making.  Journal of Medical Ethics , 42(2):111-5. doi : 10.1136/medethics-2015-102893. 

Clay-Williams, R., Ludlow, K., Testa, L., Li, Z., & Braithwaite, J. (2017). Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?.  BMJ Open ,  7 (9), e014474 

Hein, I. M., Troost, P. W., Broersma, A., De Vries, M. C., Daams, J. G., & Lindauer, R. J. (2015). Why is it hard to make progress in assessing children’s decision-making competence?.  BMC Medical Ethics ,  16 (1), 1 doi : 10.1186/1472-6939-16-1. 

Hickey, K. (2007). Minors' rights in medical decision making.  JONA'S Healthcare Law, Ethics and Regulation ,  9 (3), 100-104 

Lipstein, E. A., Brinkman, W. B., Fiks, A. G., Hendrix, K. S., Kryworuchko, J., Miller, V. A., ... & Fox, D. (2015). An emerging field of research: challenges in pediatric decision making.  Medical Decision Making ,  35 (3), 403-408 

Maqsood, M., Maqsood, H., Kousar, R., Jabeen, C., Waqas, A., & Gillani, S. A. (2017). Effects of hospital service quality on patients satisfaction and behavioural intention of doctors and nurses.  Saudi Journal of Medical and Pharmaceutical Sciences , 556-560 

Moss, C., Nelson, K., Connor, M., Wensley, C., McKinlay, E., & Boulton, A. (2015). Patient experience in the emergency department: inconsistencies in the ethic and duty of care.  Journal of Clinical Nursing ,  24 (1-2), 275-288 

Petrini, C. (2014). Ethical and legal aspects of refusal of blood transfusions by Jehovah’s Witnesses, with particular reference to Italy.  Blood Transfusion ,  12 (Suppl 1), s395