Ethical dilemma
The ethical dilemma in this case is that a child has been diagnosed with a potentially life-threatening illness, which requires urgent treatment. However, the child’s primary guardian would not consent to the treatment on account of her religious beliefs that forbids medical treatment. While the child’s father agrees that the treatment should proceed, he does not have primary custody over the child, and lives out of state to sign the requisite papers.
Component Parts
The physician’s professional autonomy and the patient’s autonomy are not only in conflict thus legally/ethically barring treatment, but there also is a conflict between the guardians. On their part, healthcare practitioners are expected to act in accordance with their judgment and knowledge, offering care as defined by existing regulatory, organizational and professional rules. However, the doctrine of patient autonomy (and informed consent) demands that patients or their guardians have reasonable knowledge of the diagnosis, proposed treatment, medically recognized alternatives, consequences of different decisions, and above all, the ability to make decisions without undue influence from the practitioners. There are limited exceptions to the informed consent rules applicable to emergency care situations, including the presumption of consent for treatments that address the said emergencies (British Medical Association, 2013; Jonsen, Siegler, & Winslade, 2010). In this case, the physician may choose to (i) withhold treatment in accordance with the mother’s wishes; (ii) proceed with the treatment since emergency treatment may be legally exempt from informed consent, and (iii) go around the mother and secure the father’s consent, especially since the mother is not biologically-related to the child.
Informed consent serves a critical role in encouraging shared decision-making, while at once ensuring patient-centered care. The patient’s sufficient comprehension of the professional advice should lead to a reasoned choice or decision, but the patients’ decisions are limited to the options presented by the practitioners as medically reasonable. Patients reserve nearly unconstrained freedom to refuse interventions and a limited ability to demand interventions that are not medically recommended. However, such freedom may be curtailed to prevent harm to other people in cases where there is a distinct and assignable obligation to other parties. For instance, a patient with an infectious disease may be compelled to accept treatment in the interest of public health. However, it is not clear as to whether other people include charges in the care of guardians. Other than autonomy, there are principles i.e. beneficence, justice, and nonmaleficence, which are considered necessary for ethical medical care, and must be satisfied.
Ethical decision-making models may also be helpful. Consequentialist ethical theories, particularly the utilitarian theory, provide that the moral value of actions lies in the results of the said actions. Utilitarianism holds that no single act (including theft or murder) or rule is intrinsically wrong or right, because their respective moral value is solely dependent on the resultant good (happiness, health, pleasure, satisfaction, and knowledge, etc.) resulting from the or observance of the rule. Morality is therefore a function of the total good created. Moral duty is a tool for maximizing utility, and it is, therefore instrumental as against intrinsic. Effectively, morality can only be a means of achieving greater utility as against an end in itself, and the greater the utility created from an act/rule, the greater its moral value.
Critical Analysis and Decision
Dialogue
Me: Thank you so much for being here. It is clear to me that you both care deeply about the welfare of your child. As healthcare practitioner, I take my patients’ preferences about treatment extremely seriously, and by law, I am also compelled to abide by them. However, I also required to let you know about the medically viable options available to you and me.
Mother: Listen, you already explained to me the situation, and I am very aware of my options. However, there is no greater power than God’s and no greater healer than him. I have also explained that my beliefs cannot allow me to do this, much as I wish to see my child get better. It is God’s will.
Dad: Really, it is God’s will for the child to be sick and suffer
Mother: Let me finishI do not appreciate that
Dad: Enough of it already, this is my child and I will not suffer anybody telling me to let him suffer
Me: We need to remember why we are all here. I personally would not want to interfere in what is clearly a family decision, but I must tell you mum, that your child needs this treatment. The alternative is simply not an option, at least not for now. The two of you clearly need to talk, but your child has no time for that. Am sorry, but I am going to take the dad’s consent to proceed.
References
British Medical Association. (2013). A Practical Approach to Ethics, in Everyday Medical Ethics and Law: British Medical Association Ethics Department. Chichester, UK: John Wiley & Sons, Ltd.
Entwistle, V., Carter, S., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine , 25 (7), 741-745.
Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Sixth Edition. New York: McGraw-Hill Professional.
Pelto-PiriEmail, V., Engström, K., & Engström, I. (2013). Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care. BMC Medical Ethics , 14 (49).
