Background: Principles in Bioethics
Principles of Biomedical Ethics, which was published in 1979, prioritized the following principles in healthcare: autonomy, beneficence, nonmaleficence, and justice (Cole et al., 2014). Autonomy shows respect for patients’ values, beliefs, and decisions while beneficence and nonmaleficence refer to doing good and not causing harm, respectively. Justice involves the fair and equitable treatment of all people (Varkey, 2020). Many philosophers labeled autonomy the most important of the four principles because “it provided a justification for the exercise of self-determination and choice for patients–that is, protecting them against the traditional unilateral power of physicians in decision making” (Cole et al., 2014, p. 257). However, autonomy can be in conflict with principles like beneficence, especially if a patient chooses not to pursue potentially life saving treatments.
A Patient Experience
The patient is a 16-year-old male with beta thalassemia major, a severe inherited blood disorder, also known as Cooley’s anemia. The patient receives frequent blood transfusions to treat his condition and, as a result, undergoes chelation therapy to remove excess iron. However, he has recently become frustrated with his situation, telling his parents and healthcare team that he no longer wants to receive chelation therapy. His parents and healthcare providers repeatedly remind him of the risks of forgoing treatment, which include organ damage and death, but he says he understands and still doesn’t want to receive the treatment. The parents request a private meeting with their son’s healthcare team and ask them to force the chelation therapy, despite his wishes.
Reflection
- What should the healthcare team do in this situation, especially given that autonomy is often prioritized over the other principles in bioethics? Does autonomy still apply since the patient is an adolescent? How does the patient’s quality of life fit into this conversation?
- Which course of action is in the patient’s best interest? If the healthcare team follows the patient’s request and doesn’t administer treatment, are they still exercising beneficence and/or nonmaleficence?
- If you were to adhere to the parents’ wishes, how would you justify this to the patient? If you were to adhere to the patient’s wishes, how would you justify this to the parents? How would you respond to any emotional responses that resulted from these conversations?
- What additional resources and/or support could you offer both parties in this scenario?
References
- Cole, T.R., Carlin, N.S., & Carson, R.A. (2014). Medical humanities: An introduction. Cambridge University Press.
- Varkey B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119