Law and Ethics in Healthcare (1)
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Laws and Ethics in a Healthcare System
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Laws and Ethics in a Healthcare System
Introduction
Over the past years, there have been multiple changes and reforms in the healthcare
sector that have revolutionized the field of medical practice. These developments have enhanced
the delivery of quality care in line with the stipulated laws and ethics governing the healthcare
system. However, as new interventions or treatments continue to emerge, field changes are
making healthcare providers experience new legal and ethical challenges. Worldwide, the
healthcare system runs under sets of rules, regulations, laws, and ethical standards. Laws protect
individuals (patients) and care providers when making decisions about various treatments or
medications. In addition, these laws and ethics guide the responsibilities of healthcare experts.
Legal standards help patients and care providers understand what they are not allowed to do,
whereas ethical standards guide them on what is right or wrong (Nittari et al., 2020, 1430). With
laws in place, hospitals are permitted to implement rules when nurses, physicians, or doctors do
something illegal, but ethical standards lack such regulation. In the context of healthcare, the
primary legal issues relate to medical negligence, the right to healthcare, informed consent, and
confidentiality. Some of the legal issues affecting the current healthcare system include the
Equality Act 2010, which protects patients from discrimination due to their religion (Mason &
Minerva, 2022, p.433). Ethics in healthcare involve issues relating to confidentiality, informed
consent, and patient-nurse relationships. The current ethical issues arising in the care system
include organ transplants anchored on the faith-based preferences of patients. Organ
transplantation is the practice of receiving a healthy organ from a donor to save the life of a
critically ill patient. In this organ transplantation scenario, the ethical dilemma arises when a
patient hinders a physician's efforts to comply with the ethical principle of beneficence. A patient
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has the right (autonomy) to make treatment decisions, but this right clashes with a physician’s
duty to do good to a patient to save life since a professional care provider must obey and respect
a patient’s decision. From the perspective of religion and healthcare, these laws and ethical
standards guide the decisions that healthcare providers and patients make. Primarily, they help
overcome ethical dilemmas in the course of providing quality care. Among patients who are faith
members, specifically Jehovah Witness (JW) members, organ transplantation is highly
discouraged because of the belief that the treatment is against God’s will (Garoufalia et al., 2022,
p.9). However, a physician is obliged to save lives by making the best decisions in the patient's
best interest. Under such circumstances, the principles of autonomy and beneficence clash,
leading to an ethical dilemma. For instance, when providing a dilemma case, it is critical to
provide protected characteristics connected to the case. This paper analyzes how the Equality Act
2010 (religion, gender, and age) influence the patient-nurse relationship, with a significant
emphasis on consideration of ethical principles of autonomy and beneficence, which allow care
providers to uphold ethical standards when providing care to patients who embrace their
religious beliefs even when undertaking critical care in the hospital.
Description of the Scenario: Organ Transplant among Patients Who Are Jehovah Witness
Faith Members
X, a 41-year-old female patient, is listed for a liver transplant. This treatment decision by
the doctors came after I was diagnosed with hepatitis C cirrhosis complicated by
hepatopulmonary syndrome. However, patient X is a member of the Jehovah's Witnesses and
observes that organ transplants are against her religious faith and are highly discouraged. This
patient believes that blood "consumption" is forbidden, as revealed in Genesis 9:3–4. This verse
says, "Only flesh with its soul—its blood—you must not eat." Leviticus 17:13-14 "You must
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pour its blood out and cover it with dust" (Costanzo et al., 2020, p.5). Patient X understands
these verses as prohibitions against the transfusion of whole blood.
The fact that she is an adult with the needed decision-making capacity to express her
autonomy via the informed consent process means that the care providers will find themselves in
an ethical dilemma when trying to save her life. A care provider must demonstrate respect for the
autonomy of patient X by accepting her informed decision to refuse organ transplantation
(Molina-Mula et al., 2020, p.835). If patient X accepts the treatment, she says that an organ must
be fully drained of blood before transplantation. Draining will make the organ ineffective in
saving her life. This belief implies that she cannot accept organ transplants if the surgery does
not have to be performed on a bloodless basis. If a nurse recommends liver transplantation,
patient X is likely to reject it because a donor’s blood would then flow through her. Despite care
practitioners trying their best to do good to a patient, they must comply with patient autonomy
(Molina-Mula et al., 2020, p.835). In United Kingdom, respect for patient autonomy is a
fundamental ethical principle because it supports the concept that an adult, competent patient has
the right to reject blood transfusions resulting from any organ transplantation (Warner, 2022,
p.141). As a result of this religious and ethical dilemma, the Equality Act is violated through
healthcare discrimination on a religious basis.
A patient’s family and church elders agreed using the beneficence model on the best
intervention. The physicians agreed to eliminate the conflict between patient and surgeon
overarching goals, but the family members rejected the use of an organ that was not completely
drained of blood. Patient X represents a significant clinical challenge when indicated for liver
transplantation because she refuses blood transfusions. In her hospital bed, she explained to
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doctors that it is against God's will to receive blood. Therefore, she cannot accept the transplant,
and if she does, her decision will lead to expulsion from the church by her religious community.
Laws and Ethics Linked To Religion and Healthcare
Under the Equality Act 2010, a healthcare provider cannot discriminate against adult
patients in the provision of care services. The provisions of this 2010 Act ban, which were
enacted on October 1, 2012, made it unlawful to discriminate against anyone on the basis of
religion, gender, or age (Mason & Minerva, 2022, p.436). However, discrimination may apply in
circumstances where the treatment practice is covered by an exception from the ban. Irrespective
of the medication decisions that physicians make, there should be no decision to discriminate
against specific religious groups that do not match the decisions. For instance, organ
transplantation decisions may not favor Jehovah Witness faith members; hence, a physician has
no legal authority to discriminate against them. As a result, ethical standards such as autonomy
will help such physicians respect the patients’ religious beliefs during the treatment.
From a general viewpoint, organ transplant has become one of the religious elements of
medical ethics, which makes it difficult for a healthcare provider to practice beneficence since
the ethical principle of autonomy must be followed. The violation of autonomy, especially when
a patient refuses an organ transplant due to their religious beliefs, implies that a care provider is
disenabling a patient to enjoy the right to access the care services they need through
discrimination on the grounds of religion, which is against the Equality Act 2010 (Mason &
Minerva, 2022, p.440). The medically indicated intervention modalities reflect a nurse’s best
intentions for a patient, but the patient with faith-based treatment preferences does not believe
that "a nurse knows best" in this instance. Only God does. As a result, religious beliefs that
remain significant to a patient influence treatment decision-making, coping interventions, health
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support networks, and commitment to prescribed treatment. Due to this influence, patients
develop specific preferences for the given treatments, which undermines a care practitioner’s
efforts to deliver quality care since patients expect health professionals to acknowledge, respect,
and support their religious beliefs while they are in the hospital (Warner, 2022, p.139). Instead of
nurses or other care providers discriminating against these patients, they should embrace cultural
diversity to accommodate all patients, irrespective of their religious beliefs.
Dismissing a patient because of their religious beliefs that appear to conflict with the
physician’s suggested treatment interventions amounts to discrimination by association. Under
the Equality Act 2010, such a patient is protected if healthcare providers treat them unfairly
because they are affiliated with religious doctrines that discourage some medical interventions.
For instance, if at a hospital the patients are discriminated against because they are members of
the Jehovah's Witness faith, Under the Equality Act 2010, religion is one of the covered
characteristics, which involves every recognized faith group and people who do not subscribe to
any religious belief system (Mason & Minerva, 2022, p.429). From a healthcare perspective, the
religious practices of members of Jehovah's Witnesses, which discourage organ transplantation,
act as motivation for extremist behavior. However, it is critical for healthcare professionals to
remember that people who are not part of such religious practices do not represent the majority
within that faith group.
A Jehovah Witness patient who refuses an organ transplant is still under the protection of
the Equality Act 2010. This healthcare service user believes that a care provider must not treat
him unfavorably. For instance, being removed from a patient care list because you do not support
the organ transplantation care services that the hospital offers. From a professional perspective, a
physician should not act aggressively toward such a patient. Instead, there is a need to find a way
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of overcoming an impending ethical dilemma to avoid violating the nursing ethical principles of
autonomy and beneficence (Molina-Mula et al., 2020, p.835). The inflexible application of a
procedural policy requiring patients to forcefully sign the surgery consent form for organ
transplants places the healthcare service user at a detriment.
Any claim by a Jehovah Witness faith member regarding indirect discrimination that
results from the stringent application of inflexible organ transplant policies or practices that leads
to detriment to a patient with a particular protected characteristic (religion) makes a healthcare
provider accountable for a violation of a patient's autonomy. Failure to make reasonable
treatment decisions based on the principles of autonomy and beneficence will result if a patient
needs some other form of treatment adjustment from a physician (Warner, 2022, p.140). An
organ transplant patient who upholds religious beliefs and denounces treatments that appear to go
against God’s will should not be put at a disadvantage due to their beliefs. Instead, the Equality
Act 2010 requires healthcare professionals to make critical adjustments to avoid discriminating
against such religious patients (Mason & Minerva, 2022, p.431). These adjustments, according to
the Equality Act 2010, are deemed ‘reasonable,’ hence fostering protection of religious
characteristics.
However, what is considered reasonable under the Equality Act 2010 varies on a case-by-
case basis since multiple aspects must be taken into account, including the specific religious
beliefs of the care service user and the availability of resources for the care professionals.
Further, a physician or nurse is only under a duty to make reasonable treatment adjustments
where they are aware, or should be aware, that a patient cannot accept an organ transplant due to
their religious beliefs (Ebner et al., 2020, p.e12579). For instance, a nurse's failure to make
reasonable adjustments in respect of a patient's religious beliefs on organ transplantation may
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mean that such a patient will not consider the offered care and access to the right and quality
healthcare service.
In the case of patient X, who is suffering from hepatitis C cirrhosis complicated by
hepatopulmonary syndrome, the best way to save her life is through a liver transplant. Based on
the fact that this patient is a faith member belonging to Jehovah Witnesses, a physician will
significantly experience an ethical dilemma in case they list patient X for organ transplantation.
Under the nursing ethical principle of autonomy, a nurse or physician must recognize that such
an adult patient has the right to make an independent decision whether or not to accept the
transplantation (Ebner et al., 2020, p.e12579). This patient right means that a physician will find
themselves in a situation where they must decide whether to violate autonomy to safeguard the
principle of beneficence or respect the patient right and breach beneficence (Warner, 2022,
p.139). This ethical dilemma calls for the application of the Equality Act 2010, whereby a care
provider must understand their professional obligation to respect patients’ religious beliefs to
avoid incidents of discrimination against a patient.
The accommodation of the religious beliefs of patient X calls for nurses to ensure that a
patient has every piece of information required to make an informed treatment decision about the
suggested organ transplant and educate a patient on organ transplantation and how this
intervention will save her life. A nurse cannot determine the patient's choice, and if they do, there
is a likelihood of violation of the Equality Act 2010, specifically the characteristic of religion
(Beykmirza et al., 2022, p.4). Jehovah’s Witnesses members represent a critical clinical
challenge in matters that relate to organ transplantation. Despite their religious beliefs being
protected by the Equality Act 2010, a refusal for blood transfusion on religious grounds may
hijack a physician's ability to discharge their professional duties anchored on the principle of
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beneficence. An organ transplant procedure is historically linked to massive perioperative blood
loss. As a result, healthcare providers herein describe a peri-operative management pathway with
approaches toward a transfusion-free environment with the primary goal of facilitating liver
transplants for identified Jehovah’s Witnesses patients and translating this transplantation
practice to every general surgical procedure (Costanzo et al., 2020, p.8).
Because the risk of life-threatening peri-operative bleeding in liver transplantation is
considerable and Jehovah's Witnesses discourage blood transfusion, they pose a significant
challenge that generates legal and ethical issues. Senior surgeons and anesthesiologists agree to
carry out a liver transplant on a JW patient, but the patient demands an organ that is completely
drained of blood (Costanzo et al., 2020, p.6). This patient demand must be met to ensure a
violation of the principle of autonomy, but it poses a significant clinical challenge since draining
an organ's blood makes it ineffective and cannot save a life. As a result, such a patient may not
sign a consent form because their demand or wish has not been met. Consequently, a patient will
end up refusing the liver transplant even in the case of life-threatening hepatitis C cirrhosis.
Regardless of a physician's decision on liver transplant as the best treatment for hepatitis
C cirrhosis, the acceptance of this intervention by patient X will depend on her free will and
church doctrine. In some cases, there are specific therapies, such as whole homologous blood,
which a JW patient will refuse, and some other treatments, specifically perioperative blood
salvage and transplant of solid organs, which will be accepted (Costanzo et al., 2020, p.3). All
JW patients are encouraged to use plasma substitutes that are not extracted from blood and
hemopoietic agents derived from genetic recombination.
A critical factor that pushes a physician to offer a liver transplant to a hepatitis C cirrhosis
patient, irrespective of religion or gender, is substantive experience in the transplantation
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procedure, compliance with the Equality Act 2010, and adherence to the beneficence principle
(Beykmirza et al., 2022, p.6). Most physicians utilize the beneficence model as an ethical
strategy when making surgical decisions. If these models are applied to organ transplants among
JW patients, a surgeon must embrace a bloodless surgery to attain a successful outcome without
facing rejection from the patient.
The beneficence principle stipulates four levels of good: the ultimate good, the good of
the patient as a person capable of reasoned decision-making, the patient's perception of the
patient’s best interests, and the medical good. These levels incorporate the objective of the
Equality Act 2010, hence guiding a healthcare provider from breaching any of the nine
characteristics of the Act, such as religion. A physician and the patient are each grouped
according to the levels of good to establish their respective overarching goods, and then they
discuss each other’s perspectives to reach a decision that minimizes clashes between the
identified overarching goods
(Beykmirza et al., 2022, p.2). Surgeons taking part in making
decisions about organ transplant utilize the beneficence approach to assess ethically complex
scenarios from a different legal and ethical perspective, rather than approaching a complicated
clinical case as a conflict between patient autonomy and medical good.
Furthermore, it is crucial to face a Jehovah’s Witness request for bloodless surgery with
an ethical framework in mind. Failure to think ethically will imply a significant deviation from
the nine protected characteristics, specifically religion, of the Equality Act 2010. Beneficence
and autonomy, being among the critical pillars of modern nursing ethics, dictate that a physician
can examine a JW patient’s clinical case of liver transplant via various lenses that change based
on their definition of the right course of treatment or intervention action (Zhang-Jiang &
Tredwell, 2020, p.47). Emphasizing the Equality Act 2010 means valuing today’s ethical
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philosophies of respect for adult patients and social good while maintaining the rights of
healthcare service users. A patient and physician each have specific rights, roles, and obligations
when it comes to making treatment decisions. A clinical provider must ensure social justice and
accountability when discharging their duties. While the rightness of liver transplantation is not
difficult to establish in retrospect, examining the right way to approach JW patients is not an easy
task for a physician. A significant ethical dilemma in the modern healthcare system involves
discussions on how acceptance of organ transplants that involve blood transfusions leads to
spiritual consequences.
Conclusion
The legal and ethical dilemma pose a significant clinical challenge, especially to
physicians, nurses, doctors, and surgeons offering surgical services such as organ transplant to
JW patients. These patients, despite suffering from life-threatening infections, stick to their
religious beliefs and refuse any organ transplantation linked to a blood transfusion. Under the
Equality Act 2010, healthcare providers should not discriminate against patients of the JW faith.
These patients’ religion is one of the protected characteristics under the Act. However, the
nursing ethical principle of autonomy clashes with medical beneficence, putting a physician in an
ethical dilemma when delivering care services to JW patients. Irrespective of a care provider’s
desire to do good to a patient, an adult patient's decision must remain respected. As a result, there
is a need to approach this dilemma from an ethical framework viewpoint by listing the levels of
good in descending order of importance. This listing enables a stratification of autonomy,
minimizes conflict, and encourages detailed discussion about making surgical decisions for JW
patients.
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Zhang-Jiang, S. and Tredwell, S., 2020. Using the beneficence model as an ethical approach to
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