Applying Ethical Principles

Health care professionals often face ethical problems during their practice that require them to use their moral values and principles when making decisions. The four fundamental principles of health care ethics—autonomy, beneficence, nonmaleficence, and justice—act as yardsticks for fair and ethical decision-making. These ethical principles are widely accepted in the field of health care. Medical practitioners and health care administrators often use these principles to make decisions when faced with complex situations involving patients.

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Overview of the Case Study

Betsy is a dedicated pediatric nurse known for the care and concern she shows her patients. Her neighbor and friend, Alice, lives with her husband and 4-year-old daughter, Shirley. Alice and her husband are followers of Christian Science, a belief that advocates spiritual healing and discourages most types of medical intervention. One day, when visiting Alice and Shirley, Betsy sees Shirley experience what seems like a seizure. The child suddenly becomes unresponsive and has a brief staring spell, with her eyes rolling upward. The episode lasts for 20 seconds, during which she seems completely unaware of her surroundings. While Shirley is having the seizure, Alice sits by her side and prays but takes no other action. Betsy is concerned about the little girl’s condition and probes her friend for details. Alice tells Betsy that Shirley used to have around 15–20 such episodes a day until a few months ago; this has now reduced to about 12. Alice attributes the improvement in Shirley’s health to her prayers and faith. However, this does not help Betsy feel comfortable about Shirley’s condition. She is almost certain that Shirley has epilepsy, which, if not treated on time, could have profound health implications. At the very least, she thinks Alice should have Shirley’s symptoms accurately diagnosed.

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Understanding the gravity of the situation, Betsy sets up a meeting with Shirley’s parents and Dr. Campbell, director of the neurology department at her hospital. She treats this meeting as an intervention, and both she and Dr. Campbell express their concern for Shirley’s health. They stress on the fact that the improvement in Shirley’s symptoms does not necessarily mean she will be cured. They empathize with Alice and her husband’s reluctance on account of their religious faith but reiterate the importance of getting Shirley’s symptoms diagnosed. To prove their point, they present studies that describe how seizures can be indicative of illnesses such as epilepsy, which could negatively affect her cognition and behavior. Shirley’s parents are grateful that Betsy and Dr. Campbell are concerned about their daughter’s health but remain resolute about going against their faith. They believe that prayer will cure her. Betsy is faced with an ethical dilemma of whether she should respect the parents’ religious beliefs and not intervene in the matter or perform her moral obligation as a health care professional.

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Analysis of Ethical Issues in the Betsy Case Study

In the case study, the main factor that led to Betsy’s ethical dilemma is Shirley’s parents’ refusal of medical assistance for their daughter owing to their Christian Science beliefs. When Betsy notices Shirley’s seizures, she thinks it is her duty to make sure Shirley receives medical attention. As she respects the religious faith and belief of Shirley’s parents, she decides to explain the risks that seizures could involve. She also includes Dr. Campbell in the conversation so that he could provide an objective opinion to make them understand the need for medical intervention. However, Shirley’s parents are certain that prayer will cure her seizures. Considering that their attitude could result in serious health implication for Shirley, Betsy is concerned about the little girl receiving appropriate medical attention (Baumrucker, et al., 2017).

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Using the Ethical Decision-Making Model to Analyze the Case Study

The three components of the ethical decision-making model—moral awareness, moral judgment, and ethical behavior—can help analyze the ethical issue outlined in the case study. Whereas moral awareness is knowledge of the existence of an ethical dilemma, moral judgment involves choosing between the right and wrong actions when posed with such a dilemma. Both moral awareness and moral judgment lead to ethical behavior. Ethical behavior is taking the right action to resolve a dilemma. Betsy’s moral awareness is reflected by the fact that she recognizes the circumstances surrounding Shirley’s condition. Her moral judgment is reflected by her decision to try to convince Shirley’s parents to get Shirley medical help because she believed that it was the right thing to do. Betsy’s ethical behavior constitutes the action she takes to resolve the dilemma. This, in turn, depends on her personal judgment and the four principles of health care ethics (autonomy, beneficence, nonmaleficence, and justice) she should abide by as a health care professional.

Effectiveness of Communication Approaches in the Case Study

Listening plays an important role in patient–physician communication. By listening to Alice, Betsy learns of the frequency of Shirley’s seizures and the reduction in their occurrence. She also learns that Alice and her husband believe that this reduction is due to their prayers and faith in Christian Science. Therefore, active listening helps Betsy understand the situation better. Betsy is aware that if she decides to get medical help for Shirley without the consent of Shirley’s parents, she would be violating their right to informed consent and overstepping her boundaries as a health care professional. So, she decides to present them with the information they need to make an informed decision. She maintains an open communication with Shirley’s parents while explaining the impact of seizures on their daughter’s health. She stresses the importance of immediate diagnosis of Shirley’s seizures. Thus, by being respectful of Shirley’s parents’ emotions and providing them with complete information about the problem, Betsy communicates the situation to them in an effective manner.

During the discussion with Shirley’s parents, both Betsy and Dr. Campbell are empathetic toward Alice and her husband’s reluctance to get the necessary medical help for their daughter on account of their religious faith. Betsy seems to have involved Dr. Campbell so that he could share his objective expert opinion based on his experience in dealing with patients who have similar symptoms. She probably thought that Shirley’s parents would change their decision if Dr. Campbell reiterated that Shirley could develop severe cognitive problems (such as learning difficulties and memory deficits) or behavioral problems (such as irritability, anxiety, hyperactivity, and mood swings) if her seizures are neglected. However, they were unable to convince Shirley’s parents to get Shirley medically diagnosed.

Although Betsy followed a systematic approach while dealing with the issue at hand, it seems to have been ineffective as Shirley’s parents continued to stand by their faith in prayer. However, listening patiently to patients’ problems and showing empathy and genuine care while communicating with them are some lessons that health care professionals can take back from this case study.

Resolving the Ethical Dilemma by Applying Ethical Principles

The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are often employed to resolve ethical dilemmas related to health care. Autonomy refers to accepting and understanding patients’ values, beneficence refers to acting for the welfare of patients, nonmaleficence refers to not doing harm to the patient, and justice refers to treating patients fairly without bias.

The ethical dilemma that Betsy faces in this case involves three of the four basic principles of medical ethics. In the case study, the ethical dilemma is caused by the conflict between the principles of autonomy on the one hand and beneficence and nonmaleficence on the other. Betsy preserves the autonomy of Shirley’s parents by respecting their religious beliefs and not coercing them to get the girl correctly diagnosed. She further ropes in Dr. Campbell to try to explain to them the importance of getting an accurate diagnosis.

Approaching Child Protective Services—a social service agency run by the government to counsel and support children and their families and promote child welfare—could be considered by Betsy as an ethical means to resolve the dilemma. As Betsy is obligated to help Shirley get medical care (beneficence) and prevent any harm that might be caused from ignoring her seizures (nonmaleficence), she could seek intervention from Child Protective Services.

Although involving Child Protective Services could result in overriding the ethical principle of autonomy, Betsy might have to take this decision keeping Shirley’s best interests in mind (Baumrucker et al., 2017).

Conclusion

The four ethical principles of health care can be applied by health care professionals to analyze and resolve ethical dilemmas. In the case study, Betsy has to decide between respecting Shirley’s parents’ religious beliefs and performing her moral obligation as a health care professional by helping Shirley seek medical care. The proposed solution involves upholding the principles of autonomy, beneficence, and nonmaleficence to resolve Betsy’s ethical dilemma.

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