This case is about a five-year-old girl who has had regular visits to a medical facility due to renal failure secondary to glomerulonephritis. The patient had been through a chronic renal dialysis, and this led the staff to think of renal transplant though its effectiveness to the girl was not certain. The staff, however, had a clear understanding that the kidney would not undergo the same disease course. After a thorough discussion with the parents, the transplant was arranged. Her two siblings were too small to act as donors, and the mother was not histocompatible, and the dad was found to be compatible with the daughter. The physician informed the father that his daughters prognosis was uncertain. Being brought to light on this, he refused to be the donor since he feared the daughter might undergo the same degree of pain as before in the case of a cadaver kidney. He went ahead and made an uncomfortable request to the physician not to disclose his histocompatibility with his family for reasons he deemed might destroy the family. The essay aims to indulge on the various principles of biomedical ethics coming to play here, whether they are conflicting and what framework can best resolve the case.
The father should be given the option of making his decision as a prospective donor and as the father of the child. He has taken into account the pain his daughter has experienced over such a long period and with the uncertainty of the transplant, he does not wish to put the child at any risk of going through the same whatsoever. Moreover, the father has a right as a possible donor to either go through with the transplant or not. The physician must do as the father says and report to the family that he is not histocompatible. This decision can best be validated by the majority of principles of biomedical ethics. There are various principles coming to play here. These principles are respect for autonomy, beneficence ad non-maleficence, balancing and specification of norms (Tom, 1994).
First, respect for autonomy is seen in the broad aspect in this case. It entails the physician taking into full consideration the decisions of the autonomous persons. Autonomy is not an all or nothing concept. The father should be given the right to make an informed choice that is beneficial to all of them. He has his daughters and his familys interest at heart (James, 1994). Secondly, beneficence considers the risks and costs of treatment together with the benefits. This principle entails the doctor to act in such a manner as to ensure the benefits of the patients are put first and are met. In this case, the physician should lay down the pros and cons of the transplant process and decide for himself what best suits the child. Putting in mind that there is a risk that the treatment might not work, it is up to him to either do as the father asks or what he deems best for the child.
The third principle is non-maleficence which states that the doctor should act in a way that no harm comes to the patient. It is well understood in the medical field that all treatments presents itself with some form of harm; some are minimal while some are heightened (Richardson, 2002). The mode of treatment should always bring more benefits than harm. In this instance, the physician should lay down the effects of the treatment and its possibility to bring about healing to the patient.
The principle of beneficence and respect for autonomy is seen to clash in this case since while the doctor may put the patients interest at heart, he should respect the autonomy of his father. Beneficence requires that he perform the transplant since the chances of it working is very high compared to it not working. Moreover, the patient will lose her life if the operation is not done and on time. However, respect for autonomy means the doctor cannot perform any transplant without the fathers interests in as much as he may deem right. The physician has an option of rejecting the father's request to refuse to donate a kidney yet in doing this; he will be violating yet another principle of body autonomy. Another issue is of not disclosing his compatibility with the daughter to the other members of the family. Yet in so doing he will be considered as a lair, this, however, is not the case as there is a patient-doctor confidentiality where he is not allowed to disclose any information pertaining the patient unless given consent(Richardson,2007). There are instances where physicians can dispute this principle if the decision made by the patient is not morally correct. The issue of moral correctness, in this case, is wide. Therefore, any attempt by the physician to use it as an excuse to disclose the information is futile and inappropriate.
The theory to be put into consideration, in this case, is utilitarianism. This theory states that all decisions should be made based on the interests of the patient and the people directly affected by the outcome such as the patients closest family. In as much as it will lead to some harm to a few individuals, the maximum good is achieved. In this case, the decision made by the father is for the best interest of all the family members though the daughters life will be lost (David, 2007). Kantianism is contrary to this theory since it states that the morality of an action depends on the nature of the action. In this case, the transplant should be done since failure to do it will lead to loss of life therefore morally incorrect.
The theory of Kantianism is wrong and cannot be applied in this case since the doctor will be acting in a morally correct manner if he fails to inform the other members of the family about the donor capacity of the father. This is because the doctor will not be violating the rights of the father and the decision will be for the best interest of the child as it will ensure she does not get exposed to any pain. The father is acting on the decision that is best for her daughter and the other three members. The family undergoes some form of psychological trauma seeing their daughter and sister in unending pain and putting them through the same with no possible benefits for the daughter is torture and unacceptable unless they all agree to it. I believe the best cause of action, in this case, is to let the father make the decision for his family and for the doctor to honor his requests.
Tom, L & James, F. (1994). Principles of Biomedical Ethics. 4th Ed. New York. Oxford University Press.
David, D. (2007). Moving Forward in Ethical Theory: Theories, Cases, and Specified Principles. Journal of Medicine and Philosophy 17:511-539
Richardson, H. (2002). Specifying Norms as a Way to Resolve Concrete Ethical Problems. Philosophy and Public Affairs19:279-310
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