Medical Indications
Beneficence and Nonmaleficence
James experienced high blood pressure, fluid buildup, and glomerulonephritis due to a streptococcus infection.
- Beneficence: immediate dialysis would alleviate the patient’s high blood pressure and fluid buildup. The delay in dialysis due to the patient’s parents’ preferences resulted in complete kidney failure. James needs of an immediate kidney transplant to restore normal kidney function and the patient’s health.
- Nonmaleficence: the kidney transplant could likely worsen Samuel’s quality of life, as he would have to undergo a complicated surgery at a young age.
Patient Preferences
Autonomy
James is a minor and is, thus, not legally competent. James’s parents, Mike and Joanne, rejected immediate dialysis as they believed it would cause James unnecessary suffering. Instead, they opted to take James to a healing service based on their Christian faith. The physicians respected the parent’s autonomy in making decisions regarding their child’s treatment and did not place the patient on immediate dialysis.
As a result, James’ condition worsened, and the physicians subsequently placed him on dialysis. Mike is considering whether to agree to the patient’s twin brother Samuel becoming the kidney donor or hope for a miracle. He believes it could be a “true testament to his faith,” as now the matter involves life or death.
Notably, it is unknown how the patient’s mother and brother feel about the procedure. Perhaps, the physicians should consider their opinions on the matter, especially since the brother could become the potential donor.
Quality of Life
Beneficence, Nonmaleficence, Autonomy
Nonmaleficence: the physician strongly believes that without a kidney transplant, the patient is likely to die after a year. James’ quality of life has already significantly deteriorated due to the failure to administer treatment early on. The kidney donor would not suffer significant changes to life expectancy, although the surgery does pose potential life risks (Kiberd & Tennankore, 2017).
Beneficence: a kidney transplant would ensure the patient survives and restore his quality of life.
The principles of beneficence and non-maleficence contradict each other as acting in James’ interest could mean harming Samuel.
Contextual Features
Justice and Fairness
The faith of the patient’s guardians comes into conflict with the treatment plan, as they believe that this is a testament to their faith, and a miracle could save James’ life. Notably, the parents are willing to give up their kidneys but not that of their other son.
One could argue that it is not the parents’ decision but the brothers’. Samuel might prefer not to lose his brother and live with one kidney. However, one could also argue that since they are minors, they might not understand the full complexity and the consequences of such decisions. Donating Samuel’s kidney to James’ would be unfair and unjust towards the former.
According to the Christian worldview, how would each of the principles be specified and weighted in this case?
Based on a Christian moral beliefs, the principles of beneficence and non-maleficence hold the most weight, followed by justice and fairness, and lastly, autonomy. According to the first two principles, parents should ensure the best for their children and not harm them. The two principles conflict because following the medical advice would benefit one child and potentially hurt the other (Butler et al., 2016). One could argue that the parents did not act according to the non-maleficence principle, as their actions harmed James
The justice and fairness principle would mean that each person receives equal benefits. In this case, it is fair toward James to give him his brother’s kidney but unfair to Samuel to take his kidney away from him (Butler et al., 2016). One could argue that opting for spiritual healing over medical advice resulted in the worsening of James’ condition, which is unfair.
The last principle is autonomy, instructing Christians to respect each other’s point of view, thereby granting freedom to act in one’s best interest. The parents exercised their right to autonomy by choosing faith-based healing. However, it is unclear if Mike and Joanne considered James’ opinion in making the decision, thereby obstructing his right. Furthermore, it is unclear if the parents weighted Samuel’s opinion in becoming a kidney donor, as the child might want to risk his life to save his brother’s.
According to the Christian worldview, how might a Christian balance each of the four principles in this case?
The above principles conflict with each other, as benefiting one child results in harming the other. According to Christian beliefs, all life is sacred, and low quality of life is preferential to no existence at all (Orr, 2015). Based on this belief, saving James’ life is of uttermost importance and goes above the suffering he might receive from the operation. Similarly, since Samuel is likely to survive the surgery without major complications, the best option would be to donate his kidney to his brother (Kiberd & Tennankore, 2017). The likelihood of survival for both children outweighs the potential risks of the operations. However, obtaining a kidney from Samuel is neither just nor fair toward him.
To exercise the right to autonomy of his two children, a Christian parent should consider their opinion and beliefs. Samuel might not wish to give up his kidney, or James might not want to put his brother under risk. Therefore, beneficence and non-maleficence should balance the principles of autonomy and justice and fairness (Sorajjakool et al., 2017). A Christian might decide that maintaining life is superior to staying true to the other principles. A kidney transplant increases the chances of survival and, thus, outweighs the risk of reducing Samuel’s quality of life. However, before making this decision, a Christian might first consult his or her family to ensure to reach a unanimous agreement first.
References
Butler, C. R., Mehrotra, R., Tonelli, M. R., & Lam, D. Y. (2016). The evolving ethics of dialysis in the United States: A principlist bioethics approach. Clinical Journal of the American Society of Nephrology, 11(4), 704-709.
Kiberd, B. A., & Tennankore, K. K. (2017). Lifetime risks of kidney donation: A medical decision analysis. BMJ Open, 7(8), e016490. Web.
Orr, R.D. (2015). Incorporating spirituality into patient care. AMA Journal of Ethics, 17(5), 409–415.
Sorajjakool, S., Carr, M., & Bursey, E. (2017). World religions for healthcare professionals. Routledge.