Chaplaincy and Medical Ethics

¶ … Ethics

Abe and Mary had an extremely difficult decision to make. The couple did indeed have a child to save the life of Annisa. It could be possible that in the future Marissa-Eve's relationship could be harmed by this truth. Eve may feel as though her sister's life is more important than her own. In many ways Eve was treated as a means to an end because her life was the only way to save Annisa. Her parents had exhausted other possibilities and did not want their child to die. However this does not mean that Abe and Mary don't also love Eve. Just because Eve's life was utilized to save her sister, this does not mean she will not be loved or appreciated within the family unit. This situation is not black and white in that manner. One child saving the life of the other has both positive and negative outcomes associated with the relationship they have with one another and their parents.

It is true that Eve had no choice in whether or not her bone marrow was utilized for the operation. Under these circumstances it does seem that her parents had a right to decide to perform the operation. The parents were not in a position wait until eve was old enough to make the decision on her own. There are many instances in which bone marrow donors are young children and there are few reports of any ill effects from such young donors. As such it seems that the parents took the appropriate risk in allowing the operation to be performed on the daughter. The parents also had an obligation to eve to do all that they could to assist her in the battle against the disease. If they had not tried using the bone marrow, Annissa might not have lived and Eve might have felt guilty about that at some time in the future.

In my opinion it is permissible to use one child to save another. This practice has been widely excepted. For the most part parents do not automatically have another child until they have considered all the possibilities associated with finding an existing donor. In most instances having another child is the last resort and people choose this when they have exhausted all other options. As a result of this action being permissible there are also other actions that might be seen as permissible. For instance in many cases when a child is conceived for the purposes of giving bone marrow to a sibling, the doctors know prior to the child's birth whether he/she will be a bone marrow match. It is likely that people will use this type of technology to create designer babies, this might become a permissible act in the eyes of some parents. In fact in some countries parents are allowed to choose which embryos to implant based on traits and genetic markers.

I do not believe that this type of action should be permissible because it can become an extremely slippery slope. People might begin to have embryos destroyed based on the sex pf the child or whether or not the child is handicapped or as some other type of challenge. The possibility for wide scale eugenics practice comes to service and therefore a line should be drawn. In addition some parents might decide that they want to utilize the kidneys of one child to save another. This type of donation would be unfathomable because there is a significant medical difference between bone marrow transplant and a kidney transplant. Bone marrow regenerates and other than the pain associated with the donation there are no lasting side effects. On the other hand a kidney transplant could be much more dangerous and painful because it requires major surgery and could result in death.

3. In This instance the virtue ethicists would grapple with whether to teel the lie or not tell the lie to the family members and what this decision says about his or her personal character. In this instance I think that a virtue ethicists would not keep this a secret because of the lives that could be destroyed if such a secret were kept. In this case an entire family could be affected. The wife is at particular risk for getting the disease or may have already acquired the disease. HIV is a disease that if diagnosed easrly enough can be treated and people can live for a long time with the virus. As such telling the wife that her husband is HI V positive would very likely ensure that she will have many more years with her children. Not telling the information and keeping it a secret will likely end in the extremely premature death of the wife.

Not relaying this information is also detrimental because it means that the children will likely lose both parents in a short amount of time. These are all issues that need to be taken into consideration as it pertains to the issue of whether to keep the HIV status of this man private.

In addition to benefitting the immediate family the virtue ethicists must also take into consideration that the man might also still be engaging in homosexual activity. If this is the case he could also infect people besides his wife if the truth is not told. The man must also face the truth about his own sexuality. In doing so he will likely free others in similar situations and save their lives in the process.

If I was a chaplain and I made a death bed promise I don't think I would give an answer that is different than one that a doctor would give. This is the case because doing the right thing is important regardless of your title in life. If I were a chaplain or priest I would want to be a liar and I wouldn't want the guilt of knowing that I could have saved or prolonged someone's life but I didn't simply because I chose not to tell the truth. In this scenario it would matter if I was a priest or chaplain I would not keep a promise of this sort.

Also if I were a chaplain or a priest I would be compelled to tell the truth in accordance with scripture. I would not stand idly by and allow someone to get hurt or sick because an HIV positive iindividual does not want to own up to his past and the problems his reckless behavior produced. I would also reveal the information because I want to treat people in the same manner that I would want to be treated. I would also attempt to be compassionate in the situation and persuade the HIV patient to reveal the truth to his family so that the appropriate steps can be taken to assist them. Keeping the HIV status a secret would do a great deal of harm to everyone involved.

The virtue ethics approach is different in that it takes into consideration the lie and whether or not the lie will cause harm. This type of ethics also allows the individual to decide how to conduct themselves based on a case by case basis. Other ethics theories do not allow for individualizing. They instead have clear cut ways of dealing with one action's regardless of the scenario. The virtue ethic approach really causes an individual to give pause before they decide how they are going to react in any given situation. In this situation it seems that sound judgment would be needed to ensure that all the individuals are properly taken care of and can stay well for as long as possible.

4. A cancer prognosis and the cancer treatlmments that follow can be a difficult scenario to confron for patients and their families. In the two cases presented there are slightly different views that the patients have. The first patient seems to be fine with not knowing her prognosis. She seemed to content that her children were aware of her health status. In the first case it seems that the family's request to withhold the truth from the patient was consistent with what the patient wanted. It wasn't as if she was kept in the dark about her prognosis even though she was extremely ill. In the second case it is apparent that the patient already knows that the prognosis is terrible and wants to talk about it with the family. In both instances the patients should have the ultimate say in what information is told unless the patient is incapacitated.

The physician can respect the family's decision not to disclose the information in certain situations. For the most part disclosure issues are a matter of law for physicians. In many instances doctors can not disclose patient health information to anyone but the patient. Unless a family member has guardianship over a patient or the power of attorney they cannot make disclosure or non-disclosure request.

Patients do have the right not to know their prognosis. Some people believe that knowing negating information about one's health will only make them more ill. In some instances this is the reason why patients do not want to know their prognosis. Not having information about ones prognosis can also hinder people from getting the proper medical attention, which can be a major problem and reduce life expectancy.

In both case the family member had reservations about truth telling because they feared that doing so would be harmful to the patient. The physicians on the other hand had a duty to tell the patients the truth because doing so is of benefit to the patients. In some cases this beneficence that doctors have a duty to honor is in conflict with what family members might view as being beneficial to the patient. In some ways what the family members feel in terms of disclosure should be taken into consideration. After all the family of a patient knows the patient better than the doctor and as such the family knows how the patient will react to information and how a negative prognosis might affect them.

In cases where there is confusion concerning what is maleficent and what is beneficent both doctors and families have to make difficult choices. On the one hand the doctor has the duty to do no harm to the patient. Therefore if telling the patient that the prognosis is poor is going to do harm to them emotionally to the point that they may lose their will to live all together, perhaps not offering them all of the information may not be the wisest choice. On the other hand families also have to recognize that terminally ill patients often need to discuss their illnesses and prepare themselves for facing end of life decisions. When these facie principles conflict with each other the best plan of action would be for the doctors and the families to have a meeting to flush out a compromise that will allow the doctor to interact with the patient in a way that is beneficial while also conforming to the wishes and desires of both the patient and the family. This type of compromise will assist in ensuring that everyone involved will be able to deal with the outcome.

The cultural and ethnic differences are not necessarily the reason for why the female patient does not want to know her prognosis. In addition "The complexity of the truth-telling task is more acute in end-of-life decision making, when decisions must be made in a timely manner, under highly emotional circumstances, without the benefit of retrospection (Turner, 2003)." There are many people who are not from that region of the world who might take the same stance. Even if it were a cultural or ethnic issue, the people involved are living in American and there are certain disclosures that are mandated under American law as it pertains to the patient/doctor relationship.

Question 5

Facts: The patient is Sherry, she is 38 years old. She was diagnosed with Leukemia. She was a bone marrow recipient but it was a mismatched unrelated donor, which can cause graft vs. host disease (GVHD) of the gut. This has a negative impact on the absorption of nutrition and causes severe diarrhea. Her organs are failing and it is likely that she will die soon. Opinions: Sherry will likely not survive much longer, it is better for her to know the truth about her condition, she will be a burden to her mother if she returns home.

The features of this case that are good include the patient's willingness to take the advice of doctors although there was some apprehension at times. The fact that the patient is alive and still fighting to live are also good aspects of the care. The patient seemed to have a strong will and fight through her health issues as much as she could. Even when doctors did not think her condition would improve she had bouts of improvement. At the end of the case it was also good that the patient understood what hospice care meant and that she could go home if she so desired. For this particular patient it was essential that she understood that hospice did not mean that she had to give up her fight.

The bad features of the case include the patient not wanting to face the possibility that she could die and make the needed end of life decisions. She did, however give her mother power of attorney. Sherry's son also seemed to be in denial and having a hard time accepting his mother's illness which complicated matters. In addition doctors were slow to tell her how sick she was. They did not tell her for some time that she would probably never eat again. All of these issues affected her care and her attitude towards the care.

As it relates to outcomes, Sherry did put into place a Do not resuscitate which means that if here organs continue to shut down, she will likely be in distress and die. Sherry's mother has been put in the position that she will have to carry some amount of burden when Sherry goes back home. However, the mother seems to understand the difficulty and is willing to have Sherry at home.

Prudential Reasoning

As it pertains to Sherry's case it is obvious that she is a young woman who really has the desire to continue to live. However her condition is severe and her organs are failing. Doctors and the other healthcare professional tending to her treatment understand how sick she is and while there is always hope, the chances that she will survive are limited. In this instance it seems reasonable for Sherry to go home and have a hospice provider. In doing this she can be in a more comfortable environment and although she might die at least she will be surrounded by things that are familiar to her. On the other hand being at home may also assist her in getting well again and getting off of hospice. Although it may be difficult for her mother, having the hospice care will also take some of the burden off of Sherry's mother. The doctors have done all they can to assist Sherry and to save her life, however further treatment will likely not benefit her at this point. As such the most reasonable step to take is to return home with the assistance of hospice care.

Question 6

In the case of a patient who is not able to make his/her own decisions it is important that a chaplain or anyone else be respectful of the surrogate. In most cases when there is a surrogate that person was chosen by the patient. As such the patient trusted their judgment and trusted them. Perhaps the chaplain might be able to talk to the surrogate in a manner that is not intimidating and fully explain the gravity of the situation. It is not clear how much information that the Chaplain knows or understands about the condition of the patient but if the surrogate is not taking the advice of physicians based on religious beliefs it may be difficult for the chaplain to change the mind of the surrogate.

The chaplain will need to collaborate with the medical team and the surrogate to see of there is some type of compromise that can occur as it pertains to the patient's care and how to treat the patient in a way that is dignified and does not prolong suffering. For instance the chaplain can meet with the medical team and the surrogate individually and determine what a compromise might be composed of. Both the doctor and the surrogate must agree that whatever decision is made is in the best interest of the patient. For instance the patient is likely in a great deal of pain, there must be a concerted effort to ensure the patient is comfortable. If the patient is still taking chemotherapy or radiation it is important to explain and assist the surrogate in understanding the situation that the patient is in as it pertains to continued treatment. Failure to take these steps can lead to making decisions that are hasty and may not be in the best interests of the patient. In this situation the chaplain can serve as a neutral party who desires to ensure that the problem is resolved.

While it would be acceptable for the chaplain to speak to both parties involved and serve as a neutral voice, it would be unethical for the chaplain to be disrespectful toward the surrogate or to be condescending toward the beliefs of the surrogate. It is important that Chaplin be aware of his/her boundaries and handles the situation with the utmost care and compassion. In this instance the chaplain has to possess the right type of temperament and handle the situation accordingly. Failure to do so might lead to a situation that does not get resolved because the surrogate feels offended.