Question

Major principles of health care ethics include the principles of respect for autonomy, nonmaleficence, beneficence, and justice. Consider the following ethical dilemma:

Your patient was recently diagnosed with a rare cancer that has invaded his liver. He has been given a prognosis of 6 months to live. He would like to participate in any treatment that will keep him alive. He requests to get on the list for a liver transplant but does not meet the criteria to be placed on the list.

Describe how you would apply the ethical principles to the case. Each of the ethical principles must be discussed in your answer to the question. Provide rationale for your response.

Answer 1

Applying the ethical principles to the above situation:

1. Autonomy: Autonomy requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. Therefore, the decision-making process must be free of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success. Applying this principle, the patient will be explained the criteria for liver transplant and provide him information about the other options available to him and allow him to make a decision about the treatment.

2. Beneficence: It requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers consider individual circumstances of all patients, and strive for net benefit. Applying this principle, the liver transplant that the patient requests may not benefit him and the same will be explained to the patient.

3. Non maleficence: It requires that a procedure does not harm the patient involved or others in society. Applying this principle, the patient will be explained the risks involved in the transplant and provide him information regarding the other safer treatment options available.

4. Justice: It requires that procedures uphold the spirit of existing laws and are fair to all players involved. The health care provider must consider four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation. Applying this principle, since the patient does not meet the criteria for liver transplant and has a poor prognosis, it would not be justified to include him on the list for the transplant considering all the other patients on the list who may benefit from the transplant. The best approach will be to explain to the patient all the risks involved and the available treatment options, provide him guidance and adequate time to make his own decision.