APPLYING ETHICAL FRAMEWORKS IN PRACTICE 1
ApplyingEthical Frameworks in Practice
The ethical dilemmapresented in the case is whether it is ethical for the physician toconsider the mother who has the primary custody of the child orconsider the recommendation from the biological father. The hospitalhas the ethical dilemma of breaking the law regarding custody of thechild and honoring its duty to treat the child who has medicalattention. Since the parents were divorced (are co-parenting), theyhave joint and shared legal custody of the child, thus, should begiven the autonomy over the child’s health. However, the father hasreduced contact with the child since he lives in a far state. Sincethe woman lives with the child, she has the autonomy to be the soledecision maker for their child (Madden-Derdich & Leonard, 2000).
The decision-making model to be used in such a scenario is the oneadopted to be the American Counselling Association. The model wasdeveloped by the UNESCO and is used by many organizations. The modelrecommends a step by sequential step strategies to solve the dilemmaso as to achieve reasonable results. The first step in the model isto determine dimensions of the ethical dilemma. The next step is toconsider the available option so as to develop a course of action.After developing the best course of action, the decisions are areview so as to ensure it demonstrates a harmonious resolution of thedilemma. The physicians should apply their test of justice byassessing their sense of fairness by determining if they will listento the custodian mother or listen to the biological father and treatthe child. For publicity, the physicians should consider if they whatthey behavior reported in the press. The test of universalismenquiries if the physicians will recommend the same approach to othernurses in the same situation. The last step of the decision making isto execute the decided course of action.
Signs and symptomssuggestive of meningitis are divided into three stages. Stage one isnonspecific features such as personality change, irritability,anorexia, listlessness and fever as a result of meningealinflammation. The stage 2 present in one or two weeks with featuresof increased intracranial pressure and neurological signs andsymptoms such as drowsiness, neck stiffness, cranial nerve palsies,vomiting and focal or generalized convulsion. Stage three isassociated with neurological server defects such as coma, atomicinstability, and a rising fever. The child in the scenario is atstage one, where treatment can result in the normal outcome. At stagethree, the child will have high chances of fatality or severeneurological sequelae if the child survives.
Both the parentshave exercised their autonomy in deciding how they want their childbe treated. Autonomy is the critical tenant in physician’s decisionmaking enforced by both law and ethics. The U.S. Bill of RightAmendment 1 allows for the free exercise of religious beliefs. MostStates allow people to request for religious exemptions in treatmentbased on the religious beliefs an objection (CDC, 2010). According toa report produced by the Children’s Hospital of Philadelphia(2012), religious beliefs are based on the nation that the illness isan act of God. The custodian mother has devoted her time caring forthe child than the father, and her is responsible the health care ofthe child. The illness of the child coupled with lingering maternalconflict from the divorce could impact the ability of the co-parentsto work together to make a better treatment for the child. Accordingto Children’s Law Reform Act, a primary custodian parent is allowedto make a major decision impacting children’s life such religiousupbringing, health care and education. However, the family law courtsprovide rights for the biological father to challenge any challengemade by the custodian mother if he believes the decision is harmfulto the child. For example, in the case of Frize v. Frize, the motherwas provided a primary custody and the father was given adecision-making authority to the education of the child. However,until the court permits decision-making authority, the father has noright to control such decision.
The extent of thecustodian mother’s understanding and knowledge of the medical factslinked to meningitis as well as the stages of the diseases should beestablished before she exercises her freedom in the decision-makingprocess. Besides, the physician should explain to the custodianmother of the legal implications limiting her to make decisionsregarding the child.
The custodian motheris acting by her religious beliefs. However, the risk of medicalcomplications and physical risk of suffering from meningitis arelikely caused the death of the child without medical intervention. Anexample of such incident includes Swan, the founder of CHILD. Swanand her husband were Christian Scientist, who had strong religiousbeliefs. Thier two-year-old child was diagnosed with HemophiliaInfluenza Meningitis. The parents treated their son according totenets of faith and prayer. The son lived for a few weeks before hisdeath. The bacterial form of meningitis that resulted in the death ofthe child was nearly 100% fatal without treatment and 95% treatablewith antibiotics. After the death of the child, Swan left herChristian Science Church and founded CHILD.
The custodian mothershould be informed of all the consequences of her religious beliefsand requested to make a decision according to the best interest ofthe child. If this does not change her perception, the physicianshould report to his superiors who conduct the biological father tointervene through the court.
“I have taken thetime to review your decision for not wanting to administer treatmentto the child. We have also conducted the father who has recommendedtreatment for the child. However, since you are the sole custodian ofthe child, you have all the powers regarding the health of the child.Basing on my decision, I will like you understand that the child isstill in his initial stages of meningitis. The child will soondemonstrate specific features such as personality change,irritability, anorexia, listlessness and fever as a result ofmeningeal inflammation. Later, the child will have symptoms such asdrowsiness, neck stiffness, cranial nerve palsies, vomiting and focalor generalized convulsion. If we do not take early measures, thechild will end in a coma and later death. I understanding yourbonding with the child since you have been living together for long.Me as physician, I must act to the best interest of the child.
Therefore, if youcare for the child, will permit us to administer immediate treatment.We hope you will not place us in a position to run to the father tointervene.”
Centers for Disease Control and Prevention. (2010). VaccineSafety. Retrieved fromhttp://www.cdc.gov/vaccinesafety/Vaccine_Monitoring/history.html#ref1
Madden-Derdich, D. A., & Leonard, S. A. (2000). Parental roleidentity and fathers’ involvement in coparental interaction afterdivorce: Fathers’ perspectives. Family Relations, 49: 311-318.
Sector for social and human sciences, division of ethics of scienceand technology: Syllabus for ethics education program. (2008). In J.Cheftel (Comp.), Bioethics Core Curriculum. Geneva: UNESCO.
Swan, R. (1998). On statutes depriving a class of children of rightsto medical care: can this discrimination be litigated? QuinnipiacHealth Law Journal 2: 73-95.