Question

Case study: Mrs X is 35 and is in need of dialysis. She is refusing treatment because she is scared of the treatment which she believes is invasive. She has been counseled about the nature of the treatment - there are no alternatives that would be of practical benefit. She is competent to make treatment decisions. She understands that if she refuses dialysis she will die. She has a daughter of 15 years who lives at home. The clinician feels very strongly that she should receive dialysis but despite numerous attempts to persuade her she refuses.

1. Identify the major ethical principles.

2. Propose an ethical decision making process that best represents the patient’s wishes.

Answer 1

1. Identify the major ethical principles.

In 1985, Tom Beauchamp and James Childress developed four main principles of health care ethics for medical practitioners with strategies to make decisions when they certainly face a complex situations connecting patients. The four principles of health care ethics are autonomy, beneficence, non-maleficence, and justice.

1. Autonomy: Here, autonomy refers to the right of the patient to retain control over his or her body. A doctor or nurse can recommend for a treatment or a diagnostic procedure, but the patient have the ultimate right to give permission for that

2. Beneficence: All health care providers must do interventions which benefit the patient in every circumstances. All interventions including procedures and treatment methods must do good things for the patient.

3. Non-Maleficence: This principle meant that medical providers must consider whether individuals or society could be affected negatively by any decision made, even if it is made for the helping of an individual patient. It simply means “to do no harm.”

4. Justice: This principle states that there should be a component of fairness in all medical choices, equal delivery of limited resources and innovative treatments. Medical practitioners needs to support and think about applicable laws and legislation when making decisions

2. Propose an ethical decision making process that best represents the patient’s wishes.

I think first of all we should see the situation from the patient's side. Then provide proper advises through proper communication and try to help her to overcome her suspicions and worries and help to take best choice potential for her care. If after so many conversations, the decision of herself is to refuse dialysis, then we must accept her decision, no matter how much we disagree with her decision. But we should explain her about the need for dialysis. But proper consent should be obtained. But don’t deny other treatments which are acceptable and needed for her. We have to consider the ethics principles when taking decision. Here the patient clearly has decision-making capacity and so we should respect that. If the patient is not much clearly aware about how to take decisions, we can involve the relatives with decision making process for patient.