The health care practice has always been confronted by many ethical challenges owing to the diversity of the values of individuals within a pluralistic society characterized by different cultures. This brings about a moral conflict with respect to what should be done in various situations. It is due to this that guidelines have been formulated to deal with ethical issues in a manner that is universally acceptable. The context of clinical cases is quite complex as there are many variables involved and this makes the applicability of ethical principles situation dependent.
Ethical principles
In healthcare provision, there are four fundamental principles that have been developed to guide medical practitioners carry out their moral obligations in different ethical situations within the practice. The application of these ethical principles sometimes brings about conflict among themselves in that applying one may appear as a violation of another. It is therefore paramount that when the principles are being applied, the process be accompanied by effective balancing between benefits and risks. The weight of each of the principles depends on the particular case under consideration (McCormick, 2013).
The four ethical principles
Autonomy
This principle is based on the fact that all competent people have the right to make their own decisions after being provided with the relevant information with respect to the risks and benefits associated with a certain treatment. This principle provides that the rights of the patient to make decisions be respected irrespective of whether they are harmful to the patient or not. This implies that the patient has the right to act voluntarily and freely.
Nonmaleficence
This principle dictates that the actions of the health care provider be so as not to cause harm to the patient. Considering the existence of double effects, the principle is specific on avoiding intentional infliction of harm to patients. Competence is key in ensuring that this principle is upheld as it reduces clinical mistakes that could be harmful to the well-being of patients.
Beneficence
Under the principle of beneficence, the health care provider is expected to work towards the improvement of the patient’s health by ensuring that they provide the best possible benefit to the patient. The application of this principle requires situational consideration as there is a great diversity in people’s preferences and one person’s good may be another person’s bad.
Justice
The principle of justice requires that fairness be exercised to all patients with respect to provision of health care. This involves situations of limited resources that are required by several patients. Equity in provision of health care is a key component of this principle (Runzheimer and Larsen, 2014).
Health care issue involving refusal of care: Blood Transfusion
Blood transfusion just like any other form of medical treatment faces ethical challenges. However, the ethical issues surrounding blood transfusion today have been compounded by the emergence of HIV which generates fear of infection with the disease upon receiving blood from another person. There has therefore been an increase in the significance of consent to the procedure.
Ethical issues associated with blood transfusion and how the ethical principles
Risk
People perceive the risk associated with blood transfusion to be to higher than how it really is. Anonymity of the blood donors as is the case with the traditional source of blood for transfusion raises many questions as to the safety of the procedure.
Informed consent and depression
Ethical issues arise when a patient is incapable of providing informed consent to blood transfusion due to underlying depression. A depressed patient may reject blood transfusion, something he would not have done in the absence of the depression (Grainger, Margolese and Partington, 1997).
Cultural and religious issues
Diversity in cultural and religious backgrounds among patients, makes it challenging to apply certain standards as people from different cultures have different believes and values. For instance, Jehovah’s Witness adherents do not agree to have blood transfusions due to their religious beliefs. These beliefs emanate from ideological diversity and they result to ethical challenges when it comes to certain treatment procedures (Perez, et al., 2006).
Access to alternatives to anonymous donor-based blood
The alternative sources of blood for blood transfusion such as autologous blood and directed donations which have a lower risk of contamination are available. Despite this fact, these alternatives are not readily accessible to all patients due to their higher costs as compared to traditional blood sources (Grainger, Margolese and Partington, 1997).
.
Application of ethical principles to refusal of blood transfusion.
The four basic principles of medical ethics can be applied to this case in different ways depending on the specific situation of refusal to blood transfusion. Some of these principles are conflicting when it comes to their application in this case. The principle of autonomy seems to conflict with the principles of beneficence and nonmaleficence. Respect for autonomy demands that the patient’s wishes be respected while upholding this principle will the principles of beneficence and nonmaleficence which provide that the patient be protected from harm and his/her well-being be safeguarded (Carrese, 2006).
In this case the health care provider should carry out screening of the patient to ascertain the mental condition of the patient and rule out underlying depression which might be interfering with judgment. If this is found to be the case, then the principles of beneficence and nonmaleficence should be applied and the blood transfusion carried out for the benefit of the patient.
For the principle of autonomy to be applied, in addition to ascertaining competence of the patient, the physician is supposed to provide the patient with all the relevant information regarding the potential risks and the expected benefits so that the decision of the patient to reject treatment can qualify to be fully informed (Crookston, 2013).
The principle of justice will apply to this case after ascertaining that the patient refuses blood transfusion due to inaccessibility to the preferred alternative to the traditional blood transfusion system. Access to alternative blood transfusion should be provided to all people. This should come as a realization of the cost that could be saved by preventing harm to the patient. This realization supports the principle of justice, the principle of nonmaleficence and beneficence (Grainger, Margolese and Partington, 1997).
Conclusion
Refusal to blood transfusion is a challenging situation posing many ethical issues with regard to potential risks, access to alternative blood sources, informed consent and cultural and religious beliefs. It is important for the care provider to carefully assess the facts surrounding the refusal for treatment and be able to arrive at the most applicable decision depending on the situation. It is recommended that the physician makes decisions based on both legal and ethical provisions while at the same time empathetically understanding the feelings of the patient with respect to the situation at hand.
References
Carrese, J. A. (2006). Refusal of Care: Patients’ Well-being and Physicians’ Ethical Obligations: American Medical Association.
Crookston, K. P. (2013). The Approach to the Patient who Refuses Blood Transfusion: Retrieved from. http://www.uptodate.com/contents/the-approach-to-the-patient-who-refuses-blood- transfusion
Grainger, B., Margolese, E. and Partington, E. (1997). Legal and Ethical Considerations in Blood Transfusion: Canadian Medical Association. Ottawa.
McCormick, T. R. (2013). Principles of Bioethics: University of Washington.
Perez, et al. (2006). Jehovah’s Witnesses Refusal of Blood: Religious, Legal and Ethical Aspects and Considerations for Anesthetic Management: Retrieved from. http://www.ncbi.nlm.nih.gov/pubmed/16475637
Runzheimer, J. and Larsen, L. J. (2014). Basic Principles of Medical Ethics: Retrieved from. http://www.dummies.com/how-to/content/basic-principles-of-medical-ethics.html
