Christian Perspectives on Principlism

Christian Perspectives on Principlism

Part One

Medical Indications

• The doctor needs to find a solution to the elevated blood pressure and relief for the fluid buildup in the patient which is in the interests of James and his parents (beneficence).

• Look for ways to ensure that James gets a kidney transplant (beneficence)

• Although having Samuel, James’ twin brother, donate one of his kidneys to his brother is the best and only choice for James to recover in this case, his parents cannot be forced to accept the procedure on their son because it would be harmful to them (non-maleficence).

Patient preferences

• The physician must work with the patient and his parents and respect the fact that they want to forego dialysis and put their faith in God (autonomy).

• The physician must also work with the patient and his parents and respect their decision regarding whether to have their son Samuel lose one of his kidneys or wait upon God to do a miracle (autonomy).

Quality of life

Come up with solutions that that impact the patient positively and improve his quality of life (beneficence)

• Assist the parents of the patient make a decision that will improve the patient’s quality of life, in this case having a kidney from his twin brother (beneficence)

• Determine if the decision made could harm other people in this case.

Contextual Features

• The doctor should consider the effects of the choices made regarding James on other patients who need dialysis/same treatment (justice).

Part Two

Question One

According to the Christian worldview, the most pressing principle in this case is autonomy. Autonomy is the right of the patient to maintain her/his body. In the first instance, the physician recommended dialysis for the patient but after discussion with the patient’s parents, they decide to forego dialysis and decide to place their faith in God. Although the doctor suggested a treatment that could benefit the patient, he/she cannot try to persuade/coerce them to take the suggestion. Coercing them would be a major violation of the principle.

From the case study, two days after foregoing dialysis, the family returns and forced to put James on dialysis because his condition by this time has worsened. This time round, the patient’s father feels tormented by his choice to not place James on dialysis earlier. As a result of the initial choices made, the worsened condition requires a kidney transplant. Despite the fact that a kidney transplant is the best choice at this point in order to save the patient’s life, his parents find it hard to accept it once more when it turns out that the only compatible donor is James’ twin brother, Samuel. Mike, the patient’s father still struggles to choose whether to have Samuel give the kidney to his ailing brother or wait upon God once more.

Although the situation is a matter of life and death, the doctor in this case has to allow them make their own choice without coercing them. Despite the fact that the physician knows that the only way for the patient to recover is to have a kidney transplant, he cannot force or persuade them to do it. The physician might expect that patient’s parent learned from their choices in the first incidence and accept the suggestion presented by the physician. However, they still struggle in making the decision and the physician has to give them the right to make their decisions anyhow. In the end, the doctor has to allow them to make their own decision regardless of whether or not the physician agrees the choices consider the patient’s best interests.

Question Two

Principlism has become a dominant ethical decision making framework in many health care facilities. A Christian can rank the importance of the four principles in Principlism in such a way that beneficence comes first. In this principle, the decisions made should be of benefit to the patient. In addition, steps to eliminate harm from the patient in this principle should be taken. Benefiting the patient is the primary need and therefore, beneficence should come first.

Non-maleficence comes in second. After ensuring that the patient benefits from the decisions made, preventing harm and injury on the patient. This principle requires that people should not intentionally cause harm to a patient by either omission or commission. It is therefore considered negligent in cases where an individual cause harm on another as a result of carelessness or lack of reasoning. Ensuring that the likelihood of causing harm is reduced is important at this point. Although a mistake might occur, the principle stresses on the commitment to protect patients from any harm.

After non-maleficence comes in justice and fairness. Justice requires that all cases that are similar be handled in the same way. In addition, resources should be distributed in a fair way. Every patient whose situations are similar deserve to receive the same level of care. It also requires that each patient should be treated with the same respect and care without considering their age, race, religion etc. from a biblical perspective, a Christian is commanded to act in a just and fair manner in all circumstances (Micah 6:8)

The last principle is autonomy. Christians should act in a way that shows love the interests of others. Autonomy is associated with the right to make decisions without being coerced. This principle comes last because, the impact of the decisions made in this principle are not crucial in restoration of health and ensuring recovery. All first two principles are a matter of life and death and therefore should come first. What matters most is that a life is saved and not lost. With autonomy as the last principle many deaths can be prevented. In the case of James in the case study, if autonomy was considered last, the parents would have allowed their son to undergo dialysis in the initial stage and maybe prevent the condition from worsening.