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Mudra did not act according to this principle when he ignored the warning signs of Daniel's condition.
The best course of action would therefore have been a focus on beneficence/non-maleficence rather than upon respect for autonomy. Daniel's age is also an important factor. Concomitantly with his condition, Daniel's immaturity and a desire to "prove" his independence to his parents, could have contributed to his death. When treating such young persons, it is perhaps advisable to place emphasis upon non-maleficence rather than respect for autonomy. In terms of these two principles, it would be acceptable for the parents to complain.
In terms of scope, the final principle, justice, is not as applicable to Daniel's case itself as it is to his parents. The parents feel aggrieved by the practitioner's lack of in-depth knowledge and action regarding Daniel's condition. They are seeking justice for themselves, but it is too late for such justice to extend to their son. While Daniel was alive, there was little dispute regarding this principle, as all involved were in consent to respect Daniel's autonomy. This principle is therefore not as applicable as the others where Daniel himself is concerned.
The utilitarianism framework requires the most happiness for the most amount of people involved. Although Daniel's parents did not approve of his treatment later during the six-month cycle at the end of his life, they allowed him to continue as he insisted that doing so made him happy. Clearly this was not the case, and the outcome is that all remaining parties are unhappy.
The utilitarian approach would have required that changes be made from the fifth month of Daniel's treatment. Although Daniel would not have been happy about terminating his treatment, his relative misery is outweighed by the ultimate joy of everyone to know that he was still alive.
The deontological framework requires an almost slavish obedience to a set of rules. In this case, the Ethical Code of the Institute of Medical Herbalists were followed. The medical practitioner upheld the respect for autonomy, and remained silent about any warning signs that might have appeared. The respect for autonomy and the view of Daniel as a grownup were maintained. This was done despite the fact that, in many ways, Daniel was not able to make his own decisions. The result was disaster. Deontology therefore had disastrous consequences for Daniel, but could be beneficial for the parents. In the NIMH ethical codes, specific rules are prescribed for cases against personnel. The parents can used either this or formal legal services to determine if this was indeed a case of wrongful and preventable death. While utilitarianism is no longer possible, as Daniel's death has already impacted his family, deontology can at least be used to create some form of satisfaction.
In terms of the legal framework, there are several services that can be used to enforce a relatively satisfactory outcome for Daniel's parents. On the other hand, the existing laws relating to complementary medicine and healing are inadequate to handle the many difficult ethical issues people face today. Complementary Medicine and the Law by Julie Stone and Joan Matthews for example calls for greater regulation where complementary medicine is concerned. The herbalist's charter for example dates back as far as 1542. Surely times have changed since then, as women who practice medicine are no longer burned as witches.
From a legal and ethical viewpoint, Mr. Mudra should have terminated treatment as soon as he realized that it was no longer effective for Daniel's condition. He should also have recognized his specific lack of expertise and the potential harm it could cause, even inadvertently. Concomitantly, Daniel's parents should also take some of the responsibility for their son. Nobody knew him as well as they did. It appeared that they had a good working relationship with the herbalist. They should therefore have discussed the matter with him as soon as they realized their could be a problem. Both herbalist and parents are therefore at fault for the death of Daniel. It should however also be realized that Daniel may well have committed suicide regardless of any interventions and indeed perhaps even because of them. Being unpredictable, Daniel's reaction to a change in a therapy that he preferred may have similarly led to a violent reaction. Nonetheless, this should have been closely observed by a professional in the field. The parents need to understand that it was also their shared responsibility to ensure the health of their son. On the other hand, the therapist was working with Daniel on a daily basis, and should have realized when there was a turn in events.
In conclusion, no ethical issue or legal act is every universally applicable to all cases, even if they are of the same kind. Individual factors determine the best actions to take. In Daniel's case, a number of issues can be highlighted. In terms of the four principles, beneficence and maleficence take precedence of respect for autonomy for two main reasons: the first relates to Daniel's age. Although he is legally able to make autonomous decisions, he is still very young and such decisions should receive appropriate guidance, especially in life and death situations. The second reason relates to Daniel's condition, which is mental. A mental condition typically impairs judgment. Daniel, his parents, and this therapist should all have been aware of this before changing his therapy in the first place. Deontology has been followed here, but a utilitarian approach would have been better suited. Although miserable at first, Daniel would at least have lived if he had not been allowed to continue with the herbal therapy.
Finally, any ethical issues within human society tend to be complicated. Mistakes will occur and medical professionals run a continuous risk of losing their reputation or earnings via law suits. In a case such as Daniel's it is therefore difficult to say whether it is truly ethical for the parents to sue when they played a significant part in the outcome of their son's treatment. Professionals should however understand their duties to their patients and act accordingly.
Stone, J. (2002) an ethical framework for complementary and alternative therapists.
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Gillon, R. & Lloyd, a. (eds.) (1993). Principles of health care ethics. Wiley.
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National Institute of Medical Herbalists (1991) Code of ethics: Code of practice: Disciplinary procedure. Exeter: NIMH.
Stone, J. And Matthews, J. (1996) Complementary medicine and the law.…[continue]
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