Case Study: Medical Ethics

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 This essay will discuss and analyse a given case study and the ethical and theoretical implications of the case study scenario. Moreover the essay will analyse ethical principles and theoretical concepts with acknowledgment to individuality, rights, responsibilities and duty of care. The essay will also identify and discuss relevant legislation, policies and procedures.

Ethics is defined as system of moral principles that determinate human behaviour, how person makes decisions and the way they conduct activities.The concept of ethics has been shaped by cultures, creed, philosophies and it is designed to help individuals to distinguish what is “right” and what is “wrong”. The focus of ethics is what is good for the individual and society, also referred as a moral philosophy, a teaching on morals, their principles, norms, and rules of conduct. Ethics or moral philosophy examines theories of what human beings are capable of , along with what they must do to live an ethically good life.According to Beauchamp and Childress (2013), health care ethics or bioethics, requires health care professionals to adhere to four principles- respect autonomy, ensuring non-maleficence practice ,beneficence, and justice.Medical ethics, such as medical deontology, is a discipline and system of ethical principles and rules that are responsible for the application of humane, human-related, values ​​and moral views in medical and healthcare practice.

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As a scientific discipline, bioethics encompasses practice, including clinical practice and the application of these rules, as well as research in the field of medical history as well as history of medical ethics, and interdisciplinary research with philosophical and sociological focus.Therefore medical ethics is closely connected to all aspects of medical and healthcare practice, the standards it sets are encompassing across the healthcare field.Bioethics has evolved from medical ethics, and it applies to all healthcare professionals within the healthcare sector and organisations, such as doctors, nurses, clinical staff and healthcare providers and it is related to the service users and care provision. Although ethical theories provide framework and guidelines on what is ethical and how to imply ethics in decision making process, recognising what is “right” and what is “wrong” ethical decision can be difficult. Healthcare professionals can encounter complicated issues in the decision making process between two possible options, neither of which is absolutely acceptable from an ethical perspective, and it is referred as ethical dilemma.

Healthcare professionals unavoidably face difficult ethical issues and decisions during their practice for instance the case study of “Child B: a case of just care?” (Sellman, 1997) In 1995 the case emphasises the difficulties and challenges in treating patients with illnesses that could be life-threatening. Child B is a 10-year-old girl with leukaemia who was denied funding for a second bone marrow transplant in 1995.The case was widely reported at the time and brought to the fore the dilemmas of regulation at the United Kingdom National Health Service. In fact, the paediatricians who cared for child B based their decision on clinical rather than financial considerations, and media coverage of the case failed to review the complexity of the issues involved. The case also demonstrates the difficulty of determining the best interests of children and obtaining their consent to treatment. There was a disagreement between the child B father and the paediatricians, who spoke to her about how her best interests could be served, and this led to a collapse of confidence and the search for additional opinions. This highlighted the rise of consumerism in healthcare and the challenge for physicians and managers to justify their decisions and to explain the reasons for those decisions. A common theme in child B case is the need for greater openness in prioritisation decisions and stronger patient safeguards.

The case of child B raised ethical and practical dilemmas amongst other issues such as the right of the child to be involved into the decision making process to some extend, difficulties to determinate ‘best interests’ of the child and the strong legal profile of the case. Predictably the ethical arguments that emerged were predominantly deontological and utilitarian associated to duty and the greater good. Deontological ethical theory encompasses the duty-based approach to moral principles, not the morality of the results of the decision. This approach is also called ‘non-Consequentialist’, in view of the fact that ethics must be driven by duty, not consequences.Deontology was developed by the German philosopher Immanuel Kant. His theory focus on the motives of actions and whether a given action is motivated by duty even if that produces a inadequate result and consequences are irrelevant to a deontological theory. In the case of child B clinical and medical professionals involved in her care came to agreement with the decision not to continue further treatment for her progressive condition. They came to the decision in compliance with the Guidelines for Professionals Practice clause of the Code of Professional Conduct to advocacy as promoting and protecting the interest of patients or service users. (UKCC,1996)

However advocacy defined as paramount to the patient best interest personal professional judgment may differ. For instance one health care professional could have different opinion than other, and the parents of the child in this case disagreed with their decision not to continue any further treatment. However in this case the father of the child was not satisfied with the health care professionals advocacy and decided personally to advocate for his daughter rights.

On the utilitarian ethical theory side in this case health authorities denied recourse allocation for further treatment on the foundations that the resources could be used more effectively elsewhere, where a greater amount of good can be achieved. Utilitarianism is an ethical theory that determines right from wrong by focusing on results and it is a form of consequentialism. Utilitarianism holds that the most ethical choice is the one that will provide the greatest for the greatest number. In the case of child B the health care provision and decision making process can be argued that non of the ethical theories implied approaches were beneficial to the care that the child received.

Moreover according to the Convention on the Rights of the Child 1989 states that every child has the right of equal protection of their civil rights , and freedom of discrimination on the basis of the child’s race, age, gender , identity , ethnicity, sexuality or other characteristics. Furthermore the children’s rights highlight that every child has the rights to care, health care, protection from abuse.The United Kingdom Children Act 2004 main and most important purpose is to ensure and provide the best levels of care and protection. The interests of children are paramount in their welfare and safeguarding, and anyone working or caring for children has this responsibility.Therefore in relation to child B case can be said that decisions made in regards the health care provision for the child were complex and could not satisfied all parities involved.

Respecting the dignity and integrity of individuals is part of a holistic approach of health care professionals. Acknowledging the physical and emotional effects that further treatment would have on child B the medical and clinical professionals recommended palliative care approach.Their view was that in regards to the medical history of child B it was unlikely to benefit from further intensive treatment.

The child B case was a case of strong legal profile as the father of the child refused to accept the decision of the health care professional and took the Health Authority to the High Court. The courts ultimately supported the decision of the Health Authority on the grounds that any further treatment will be detrimental to the child. Due to the publicity of the case of child B an anonymous benefactor funded the experimental and costly treatment. However the treatment the child undertaken was considered experimental as only very few children underwent.

It is where can be said that the health care professionals and clinical professionals had their reasons to rase the medical issues regarding the treatment and argue the best interest of the child could be met and that the treatment will be beneficial. However evidence suggest that the treatment had prolonged the life of child B a year longer than anticipated.

Child B case raised practical issues from the health care sector such as allocation of resource of on service provision and the need for a fair, rigours relevant and regulated decision making process.  


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