Case Study: Healing and Autonomy
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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 and four boxes approach.
Based on the “Case Study: Healing and Autonomy” and other required topic Resources, you will complete the “Applying the Four Principles: Case Study” document that includes the following:
Part 1: Chart
This chart will formalize the four principles and four boxes approach 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
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?”
Sample Solution
The four principles and four boxes approach is a useful tool for PMHNPs in examining ethical scenarios. It helps to organize data from a case study into the relevant principles of biomedical ethics, which include autonomy, beneficence, nonmaleficence, and justice (Kerridge et al., 2019). Applying this approach to the case study of Healing and Autonomy involves looking at each principle separately in order to analyze the ethical considerations involved.
Autonomy refers to respecting a patient’s right to informed consent and self-determination. In this case, Healing had no knowledge of her pregnancy until she was already six months along – which could present an ethical dilemma if she wishes not to continue with it against medical advice. Therefore it is essential that her informed consent be obtained before any decisions are made regarding what action should be taken next.
Beneficence requires PMHNPs to act in ways that will promote their patient’s health or well being; thus Healing’s best interests must be kept in mind when choosing an appropriate course of action for her situation. Nonmaleficence emphasizes doing no harm and avoiding unnecessary risks; so whatever decision is made needs to take into account any potential negative outcomes as well as benefits.
Finally, justice implies fairness for all parties involved; consequently decisions about who should bear the costs associated with any treatment option need careful consideration before being put into effect (Kerridge et al., 2019). By organizing data from the case study according to these four principles using the four box approach – practitioners can begin ethically analyzing complex cases such as this one more systematically.