According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

Case Study on Biomedical Ethics in the Christian Narrative

This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles of principlism.

Based on the \”Case Study: Healing and Autonomy\” and other required topic study materials, you will complete the \”Applying the Four Principles: Case Study\” document that includes the following:

Part 1: Chart

This chart will formalize principlism and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.

Remember to support your responses with the topic study materials.

APA style is not required, but solid academic writing is expected.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”

Expert Answer and Explanation

Applying the Four Principles: Case Study

Part 1: Chart

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

· The decision to take temporary dialysis to relieve the symptoms associated with acute glomerulonephritis. This is a common evidence-based intervention for patients with glomerulonephritis as is the case for James, which is usually done to avoid fluid buildup (Pesce et al., 2021).

· Given the worsening condition of the patient, the physician saw it wise to immediately put the patient into dialysis with the hope that he will get a kidney transplant within a year.

· The decision by Mike and Joanne to return James to the clinic could also be viewed to conform with the principle of beneficence and nonmaleficence. Their earlier decision or reluctance to put James into dialysis as suggested by the doctor goes contrary to this principle.

· The decision by Mike and Joanne to return James to the clinic after one week also conformed to the principle of beneficence and nonmaleficence, which showed that regardless of their choice, they still intended to see James get better.

· The decision by the physician to recommend a transplant for James given the worsened condition also conforms to the principle of beneficence and nonmaleficence.

· The decision to consider Samuel as a potential donor after consideration of other alternatives

· The decision to bring James for treatment for strep throat infection.

· Mike’s choice to forego temporary dialysis instead of choosing to believe in his faith that God will heal James.

· The decision to return to the hospital one week after the faith healing

· The decision to return James to the facility for dialysis after his condition got worse

· The decision by Mike and Joanne to be donors for James’s kidney, which was unfortunately not a match

· The decision to consider Samuel as a potential donor or continue faith-based healing after weighing the implications of the decision

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

· Patient autonomy is clearly seen when the physician recommends, that they put James under temporary dialysis, only for Mike and Joanne to refuse, instead opting for faith-based healing. The physician had to respect their choice, albeit with reservations and agreement that James will be returned one week later for a checkup. The decision to discharge the patient from James’s parents was detrimental to James’s health which goes contrary to the principle of non-maleficence.

· Another aspect of autonomy can be seen when Mike and Joanne decided to be tested first as donors in the event that they would be found to be suitable matches for James for the sake of improving James’s condition

· The decision to consider Samuel as a donor could also be seen as respect for patient autonomy by the physician, where Mike and Joanne were given the option and information but the decision was theirs to make.

· The decision to consider Samuel as a potential donor given the long-term health implications of the procedure. From Mike and Joanne’s perspective, this is considered too much for Samuel to bear.

Part 2: Evaluation

According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

The case presents various ethical principles, some of which collide with the patient’s Christian values. Various principles are discussed namely; beneficence and nonmaleficence, justice and fairness, and patient autonomy. Based on the presented merits of the case scenario, The principle that principle of autonomy gives James’s parents the right to make individual decisions after being presented the information concerning the patient’s condition (Martin & Muller, 2021). In this case, we see two world views conflicting when it comes to Mike and Joanne’s decision-making process; that is their Christian beliefs and their trust in modern medicine. Their decision to consider modern medicine from their perspective is to question their faith in God. This is especially true after having observed a miracle in their church, where a congregant with a serious stroke was healed by faith and regained their mobility.

Secondary to the principle of autonomy, the principle of beneficence and nonmaleficence also seemed to play a dominant role. The principle of beneficence and nonmaleficence explains that whatever decision one makes, they make for the benefit of the patient and with no primary intention of harming them (Avant, L. C., & Swetz, 2020), This principle can be seen from both the physician decisions and the decisions made by the patient’s parents. From a Christian worldview, one is expected to have faith in God, and through that faith, one can be healed (Campbell, 2017). Mike and Joanne question their faith every time they decide to engage in modern medicine. We see the two question whether they made the right choice by coming to the hospital the first time, and the question of whether to opt for faith-based healing also arises when they evaluate the implication of kidney transplant on Samuel and James.

2. According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points)

The interpretation of the Christian worldview may change from person to person. However, when it comes to decision-making, the guiding rule always rests on the saying that “we should do to others what we want to be done to us.” This quote from the Bible resonates well with the principle of justice and fairness, beneficence and nonmaleficence, and finally autonomy. As such, the four principles have almost equal importance from the Christian perspective. Nonetheless, autonomy could be ranked slightly higher since everything comes back to the decisions we make. The decision to choose to engage in faith-based healing or modern medicine will be pegged on how one understands the concept of faith. The second in rank would be beneficence and nonmaleficence. Christians believe that they will ultimately be answerable for their actions. That is why Mike and Joanne feel like they were punished in the first instance since they did not have enough faith Secondly, from a physician’s perspective, they have to do their best to preserve the patient’s life and well-being as founded on the Christian values of love, compassion and empathy (Rego et al., 2020) This principle could be said to share the same ranking as justice and fairness since they both explain the intention of the decision-maker. We can see this from the consideration given to Samuel based on the implications related to kidney transplant and his future life. Similarly, as care providers, we ought to also be fair when it comes to patient transactions

References:

Avant, L. C., & Swetz, K. M. (2020). Revisiting Beneficence: What Is a ‘Benefit’, and by What Criteria?. The American Journal of Bioethics, 20(3), 75-77.

Campbell, C. S. (2017). Religion and moral meaning in bioethics. In Ethics and Medical Decision-Making (pp. 75-81). Routledge.

Martin, D. E., & Muller, E. (2021). In defense of patient autonomy in kidney failure care when treatment choices are limited. In Seminars in Nephrology (Vol. 41, No. 3, pp. 242-252). WB Saunders.

Pesce, F., Stea, E. D., Rossini, M., Fiorentino, M., Piancone, F., Infante, B., Stallone, G., Castellano, G., & Gesualdo, L. (2021). Glomerulonephritis in AKI: From Pathogenesis to Therapeutic Intervention. Frontiers in Medicine, 7, 582272. https://doi.org/10.3389/fmed.2020.582272

Rego, F., Gonçalves, F., Moutinho, S., Castro, L., & Nunes, R. (2020). The influence of spirituality on decision-making in palliative care outpatients: a cross-sectional study. BMC palliative care, 19(1), 1-14.

Grading Rubric

Course Code	Class Code	Assignment Title	Total Points
PHI-413V	PHI-413V-O503	Benchmark – Patient’s Spiritual Needs: Case Analysis	200.0

Criteria	Percentage	Unsatisfactory (0.00%)	Less Than Satisfactory (65.00%)	Satisfactory (75.00%)	Good (85.00%)	Excellent (100.00%)
Content	90.0%
Decision-Making and Principle of Autonomy	30.0%	Decisions that need to be made by the physician and the father are not analyzed according to the principle of autonomy.	Decisions that need to be made by the physician and the father are analyzed from both perspectives, but the analysis according to the principle of autonomy is unclear. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are clearly analyzed from both perspectives, but the analysis according to the principle of autonomy lack details. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are clearly analyzed from both perspectives with details according to the principle of autonomy. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are analyzed from both perspectives with a deep understanding of the complexity of the principle of autonomy. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.

Decision-Making, Christian Perspective, and the Principles of Beneficence and Nonmaleficence	30.0%	Decisions that need to be made by the physician and the father are not analyzed according to the Christian perspective and the principles of beneficence and nonmaleficence.	Decisions that need to be made by the physician and the father are analyzed according to the Christian perspective and the principles of beneficence and nonmaleficence, but the analysis is unclear. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are clearly analyzed according to the Christian perspective and the principles of beneficence and nonmaleficence but lacks details. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are clearly analyzed with details according to the Christian perspective and the principles of beneficence and nonmaleficence. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.	Decisions that need to be made by the physician and the father are analyzed with deep understanding of the complexity of the Christian perspective, as well as with the principles of beneficence and nonmaleficence. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.

Spiritual Needs Assessment and Intervention (C1.2, 5.2)	30.0%	How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is not analyzed.	How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is analyzed, but unclear. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is clearly analyzed but lacks details. Analysis is not supported by the case study, topic study materials, or Topic 3 assignment responses.	How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is clearly analyzed with details. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.	How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is clearly analyzed with a deep understanding of the connection between a spiritual needs assessment and providing appropriate interventions. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses.


Organization, Effectiveness, and Format	10.0%
Mechanics of Writing (includes spelling, punctuation, grammar, language use)	5.0%	Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.	Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.	Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.	Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.	Writer is clearly in command of standard, written, academic English.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)	5.0%	Sources are not documented.	Documentation of sources is inconsistent and/or incorrect, as appropriate to assignment and style, with numerous formatting errors.	Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.	Sources are documented, as appropriate to assignment and style, and format is mostly correct.	Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage	100%