Benchmark - Patient's Spiritual Needs - Case Analysis
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Benchmark - Patient's Spiritual Needs: Case Analysis
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Benchmark - Patient's Spiritual Needs: Case Analysis
Introduction
Mike is the father of twin boys, James and Samuel. James was diagnosed with acute
glomerulonephritis, resulting in kidney failure following the A streptococcus infection. James’s
attending physician proposed temporary dialysis as an early intervention at James’s initial
appointment to relieve hypertension and fluid buildup and get James’s kidney function to return
to baseline. James’s father, Mike, declined this proposal based on his religious convictions and
took James to a trusted faith healer instead. The faith healing was not as successful as Mike had
hoped, leaving the family feeling betrayed and questioning their faith, and prolonging the
proposed treatment resulted in James requiring a kidney transplant within one year. Finding a
compatible kidney donor is challenging and is high risk for both James and the kidney donor.
Mike struggled through personal torment, questioning his ethics and volunteering to donate a
kidney to their son alongside many church members and friends, unable to find a tissue match.
The physician informs Mike that James’s twin brother, Samuel, is the ideal kidney donor
candidate. Mike is balancing whether his other son and James’s twin brother should donate a
kidney and determine if it is an injustice to put Samuel at risk to save James, putting both
children at risk. Mike is hopeful faith healing might be successful in a life-or-death scenario with
both children involved. If faith healing does not go as anticipated by Mike the second time, the
result could be fatal for James. This paper evaluates if it is appropriate for James’s physician to
continue to let Mike delay treatment and seek faith healing, how Mike should reason about
trusting God and treating James in relation to what is truly honoring the principles of beneficence
and nonmaleficence in James's care based on his Christian worldview and whether a spiritual
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needs assessment may be necessary in order for the physician to approach Mike in assisting him
with making appropriate intervention for James and Samuel.
Decision-Making and Principle of Autonomy
The physician caring for James initially respected his father’s wishes to seek faith healing
without influencing or coercing other options, even though this decision contradicted the
attending physician's recommendation of temporary dialysis to treat James’s acute
glomerulonephritis. The case study does not have enough evidence to determine if the physician
provided additional education about James’s diagnosis and the risks of delaying temporary
dialysis. However, since the physician did not intervene when Mike decided to withhold
temporary dialysis, resulting in James’s condition worsening, it would not be appropriate for the
physician to continue allowing Mike to make decisions that may harm James. The physician is
responsible for James’s care, and while he is a minor, he is still the patient, whereas Mike is not,
so the physician needs to assist Mike in making decisions that will be beneficial for James.
Practicing autonomy includes teaching the patient and their primary healthcare decision-maker
about the risks and benefits of receiving temporary dialysis and the potential complications
associated with delaying the proposed intervention (Sedig, 2016). The physician is still able to
respect patient autonomy by recognizing that Mike is struggling through personal torment,
questioning his ethics, and taking the initiative to provide additional information and education.
The physician could also incorporate the family’s religious beliefs in the teaching. It is revealed
in the case study that Mike questions whether God is punishing himself or his son, which may
lead to Mike being resistant to treatment (Evans, 2022). For example, the physician can explain
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in detail why withholding treatment could be viewed as irrational and harmful to James but
support the family in prayer and offer to invite a Pastor or church leader to the case as additional
support in an effort to practice autonomy, as well as adhere to other ethical principles such as
beneficence and non-maleficence.
Decision-Making, Christian Perspective, and the Principle of Beneficence and
Nonmaleficence
The Christian worldview considers sickness and health as a result of the fall, a test of
their faith, or the result of sin they have brought upon themselves because God does not want
people to suffer, and it was not a part of His original plan. Christians also view sickness as a way
to build or continue a close and personal relationship with God and recognize that God has
sovereignty over every day of each of His creations. Christians believe that even in sickness,
every human has intrinsic value since each person was made in the image of God. (Hoehner,
2022 pp. 131). The case study identifies that Mike is questioning whether he or James is being
punished, aligning with the view that the illness James is experiencing is a result of a sin. “Some
were fools; they rebelled and suffered for their sins” (Psalm 107:17). Mike is also questioning
whether his faith is strong enough to heal his son. This is an example of the belief that sickness
can allow for leaning into the Christian’s relationship with God to promote and strengthen the
relationship. “ 2 Dear brothers and sisters, when troubles of any kind come your way, consider it
an opportunity for great joy. 3 For you know that when your faith is tested, your endurance has a
chance to grow. 4 So let it grow, for when your endurance is fully developed, you will be perfect
and complete, needing nothing.” (James 1:2-4).
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From the Christian viewpoint, medical intervention is viewed as acceptable and
encouraged when someone is sick. Biblical teaching identifies that people with medical
knowledge are also God’s creation and intended to be a blessing to those who fall ill. “Healthy
people do not need a doctor-sick people do.” (Matthew 9:12). This does not mean medical
intervention should be the only source the Christian seeks for healing; prayer and relying on faith
are necessary in addition to the medical intervention as the Christian knows healing does come
from God, while understanding the physician and members of the healthcare team are God’s
creation as well.
Throughout the case study, James’s father, Mike, struggles through personal torment,
questioning his ethics and wavering between the physician's recommendation and adhering to
faith healing only. The case study does not identify Mike as having attempted any medical
treatment in addition to faith healing.
When Mike considers the Christian worldview, he will recognize that the triune God is
the foundation of ethics, which will assist him in his decision-making to ensure his decision is
right, good, and just. (Hoehner, 2022.).
As a Christian, he should accept that the physician has
been created and gifted with the knowledge and skill to heal James while continuing to accept
prayer and support from his church and the faith healer. By combining both options, Mike is able
to fulfill his religious obligations and beliefs while accepting appropriate treatment for his son.
Mike should gather all of the information about James’s treatment options and approve for James
to undergo the treatment in an effort to heal James while continuing to rely on his faith to heal
both of his sons after a kidney transplant is completed. This allows Mike to practice ethical
principles with shared clinical decision-making, maintain his relationship with God, and provide
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his children with the most optimal chance at a fully functioning and improved quality of life
while knowing that God has a plan for James and his brother Samuel.
In order to practice the principle of beneficence, Mike needs to be educated and aware of
the advantages of the proposed treatment and the risks of the proposed kidney transplantation.
Although James’s brother, Samuel, is the ideal match for the kidney transplant, Mike needs to be
informed that this is the optimal option for James and given additional information about how
Samuel will be affected. Mike and the physician can discuss all of the benefits and risks for both
children. Mike must ensure he is making ethical decisions that protect his children from harm
and secure their well-being. (U.S. HHS, 2022). When Mike confirms that the transplant is the
best option, he can trust God to provide a healing hand to both sons. Mike must also ensure he
makes appropriate decisions that do not harm or cause additional suffering to James to honor the
principle of nonmaleficence. This includes denying and postponing the proposed treatment plan
for James. With successful kidney transplants, both children can resume the lifestyle they
enjoyed before James contracted the infection. Mike can be thankful God has blessed the
attending physician and the nephrologist with the knowledge and skill set to be present in
James’s life-saving treatment plan and healing process. By accepting the proposal and relying on
his faith, Mike is honoring the principles of beneficence and nonmaleficence while contributing
to James’s welfare (Hoehner, 2022 p. 154), and continues to be faithful to his unwavering
relationship with God, ensuring James is receiving treatment that will give him the best
opportunity to fulfill God’s plan for him.
Spiritual Needs Assessment and Intervention
Since Mike has already shared with the physician that he attempted faith healing, and
James’s condition has declined since his initial visit, the physician should explore Mike’s beliefs
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as his spiritual decision-making is directly impacting James’s health. A spiritual assessment
considers what hope, strength, peace, love, and connection mean to Mike and his family. The
basis of their organized religion, the personal spirituality practices the family wishes to adhere to,
and the Christian worldview on the effects on medical care (Timmins & Caldeira, 2017).
This would assist the physician in educating Mike about James’s treatment options so the
application of the treatment plan can be proposed to consider the family’s Christian beliefs while
allowing the opportunity for holistic and compassionate care. Since James’s parents are
conflicted by their desire to heal their son, and their faith and spiritual needs assessment could be
a vital tool for the physician to assist Mike with his decision by directly addressing Mike’s
religious and spiritual concerns, how these beliefs affect Mike’s treatment decisions based on
spiritual history, and how the family approaches life and other difficult decisions. (Evans, 2022).
By approaching the necessary treatment plan with a spiritual assessment, the physician is still
able to honor Mike’s autonomy while trying a medical option in addition to faith healing rather
than foregoing medical treatment, which has caused James’s condition to worsen. Once the
spiritual assessment is complete, the physician will better understand what James’s diagnosis
means to Mike and can correlate Mike’s beliefs to James’s treatment plan. This may include
inviting a Pastor or church leader that Mike is familiar with to be involved in the kidney
transplant and support the belief in prayer and Mike’s relationship with God throughout James’s
treatment. This would help serve as a support system for Mike to find meaning in this stressful
situation and consider alternate coping mechanisms (Evans, 2022, p. 302), ensuring he makes
decisions that benefit his son and align with his Christian beliefs while making beneficial
medical decisions for James, Mike is still able to put God first. The Bible says, “Seek his will in
all you do, and he will show you which path to take” (Proverbs 3:6).
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References
Bogue, D. W., & Hogan, M. (2022).
Foundational Issues in Christian Spirituality and Ethics
.
BibliU- Practicing Dignity: An Introduction to Christian Values.
https://bibliu.com/app/#/view/books/1000000000591/epub/Chapter1.html#page 7
Christian Art Publishers. (2016). James 1:2-4. In
English Standard Version Bible-
Inspire
(pp. 1454). essay.
Christian Art Publishers. (2016). Proverbs 3:6. In
English Standard Version Bible-
Inspire
(pp. 745). essay.
Christian Art Publishers. (2016). Psalm 107:17. In
English Standard Version Bible-
Inspire
(pp. 711). essay.
Christian Art Publishers. (2016). Matthew 9:12. In
English Standard Version Bible-
Inspire
(pp. 1168). essay.
Evans, K. A. (2022).
Intervention, Ethical Decision-Making, and Spiritual Care
. BibliU.
https://bibliu.com/app/#/view/books/1000000000591/epub/Chapter5.html#page_274
Hoehner, P. J. (2022).
Biomedical Ethics in the Christian Narrative
. BibliU.
https://bibliu.com/app/#/view/books/1000000000591/epub/Chapter3.html#page 146-181
Hoehner, P. J. (2022).
Death, Dying, and Grief
. BibliU.
https://bibliu.com/app/#/view/books/1000000000591/epub/Chapter3.html# page 195
Sedig, L. (2016, January 1).
What’s the role of autonomy in patient- and family-centered care
when patients and family members don’t agree?
Journal of Ethics | American Medical
Association.
https://journalofethics.ama-assn.org/article/whats-role-autonomy-patient-
and-family-centered-care-when-patients-and-family-members-dont-agree/2016-01
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Timmins, F., & Caldeira, S. (2017).
Assessing the spiritual needs of
patients
.
Nursing Standard (2014+),
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(29), 47.
https://doi.org/10.7748/ns.2017.e10312
U.S. Department of Health and Human Services. (2022, September 27).
Ethical Principles and Guidelines for the Protection of Human Subjects
of Research-Part B: Basic Ethical Principles
. HHS.gov.
https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-
the-belmont-report/index.html#:~:text=Beneficence.,under%20the
%20principle%20of%20beneficence
.
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