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Applying Ethical Principles
Learner’s Name
Capella University
NHS4000: Developing a Health Care Perspective
Instructor Name
August, 2020
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Applying Ethical Principles
Health care professionals often face ethical problems during their practice that require
them to use their moral values and principles when making decisions. The four fundamental
principles of health care ethics—autonomy, beneficence, nonmaleficence, and justice—act as
yardsticks for fair and ethical decision-making. These ethical principles are widely accepted in
the field of health care. Medical practitioners and health care administrators often use these
principles to make decisions when faced with complex situations involving patients.
Overview of the Case Study
Betsy is a dedicated pediatric nurse known for the care and concern she shows her
patients. Her neighbor and friend, Alice, lives with her husband and 4-year-old daughter, Shirley.
Alice and her husband are followers of Christian Science, a belief that advocates spiritual healing
and discourages most types of medical intervention. One day, when visiting Alice and Shirley,
Betsy sees Shirley experience what seems like a seizure. The child suddenly becomes
unresponsive and has a brief staring spell, with her eyes rolling upward. The episode lasts for 20
seconds, during which she seems completely unaware of her surroundings. While Shirley is
having the seizure, Alice sits by her side and prays but takes no other action. Betsy is concerned
about the little girl’s condition and probes her friend for details. Alice tells Betsy that Shirley
used to have around 15–20 such episodes a day until a few months ago; this has now reduced to
about 12. Alice attributes the improvement in Shirley’s health to her prayers and faith. However,
this does not help Betsy feel comfortable about Shirley’s condition. She is almost certain that
Shirley has epilepsy, which, if not treated on time, could have profound health implications. At
the very least, she thinks Alice should have Shirley’s symptoms accurately diagnosed.
Understanding the gravity of the situation, Betsy sets up a meeting with Shirley’s parents
and Dr. Campbell, director of the neurology department at her hospital. She treats this meeting as
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an intervention, and both she and Dr. Campbell express their concern for Shirley’s health. They
stress on the fact that the improvement in Shirley’s symptoms does not necessarily mean she will
be cured. They empathize with Alice and her husband’s reluctance on account of their religious
faith but reiterate the importance of getting Shirley’s symptoms diagnosed. To prove their point,
they present studies that describe how seizures can be indicative of illnesses such as epilepsy,
which could negatively affect her cognition and behavior. Shirley’s parents are grateful that
Betsy and Dr. Campbell are concerned about their daughter’s health but remain resolute about
going against their faith. They believe that prayer will cure her. Betsy is faced with an ethical
dilemma of whether she should respect the parents’ religious beliefs and not intervene in the
matter or perform her moral obligation as a health care professional.
Analysis of Ethical Issues in the Case Study
In the case study, the main factor that led to Betsy’s ethical dilemma is Shirley’s parents’
refusal of medical assistance for their daughter owing to their Christian Science beliefs. When
Betsy notices Shirley’s seizures, she thinks it is her duty to make sure Shirley receives medical
attention. As she respects the religious faith and belief of Shirley’s parents, she decides to
explain the risks that seizures could involve. She also includes Dr. Campbell in the conversation
so that he could provide an objective opinion to make them understand the need for medical
intervention. However, Shirley’s parents are certain that prayer will cure her seizures.
Considering that their attitude could result in serious health implication for Shirley, Betsy is
concerned about the little girl receiving appropriate medical attention (Baumrucker, et al., 2017).
Using the Ethical Decision-Making Model to Analyze the Case Study
The three components of the ethical decision-making model—moral awareness, moral
judgment, and ethical behavior—can help analyze the ethical issue outlined in the case study.
Whereas moral awareness is knowledge of the existence of an ethical dilemma, moral judgment
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involves choosing between the right and wrong actions when posed with such a dilemma. Both
moral awareness and moral judgment lead to ethical behavior. Ethical behavior is taking the right
action to resolve a dilemma. Betsy’s moral awareness is reflected by the fact that she recognizes
the circumstances surrounding Shirley’s condition. Her moral judgment is reflected by her
decision to try to convince Shirley’s parents to get Shirley medical help because she believed
that it was the right thing to do. Betsy’s ethical behavior constitutes the action she takes to
resolve the dilemma. This, in turn, depends on her personal judgment and the four principles of
health care ethics (autonomy, beneficence, nonmaleficence, and justice) she should abide by as a
health care professional.
Effectiveness of Communication Approaches in the Case Study
Listening plays an important role in patient–physician communication. By listening to
Alice, Betsy learns of the frequency of Shirley’s seizures and the reduction in their occurrence.
She also learns that Alice and her husband believe that this reduction is due to their prayers and
faith in Christian Science. Therefore, active listening helps Betsy understand the situation better.
Betsy is aware that if she decides to get medical help for Shirley without the consent of
Shirley’s parents, she would be violating their right to informed consent and overstepping her
boundaries as a health care professional. So, she decides to present them with the information
they need to make an informed decision. She maintains an open communication with Shirley’s
parents while explaining the impact of seizures on their daughter’s health. She stresses the
importance of immediate diagnosis of Shirley’s seizures. Thus, by being respectful of Shirley’s
parents’ emotions and providing them with complete information about the problem, Betsy
communicates the situation to them in an effective manner.
During the discussion with Shirley’s parents, both Betsy and Dr. Campbell are
empathetic toward Alice and her husband’s reluctance to get the necessary medical help for their
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daughter on account of their religious faith. Betsy seems to have involved Dr. Campbell so that
he could share his objective expert opinion based on his experience in dealing with patients who
have similar symptoms. She probably thought that Shirley’s parents would change their decision
if Dr. Campbell reiterated that Shirley could develop severe cognitive problems (such as learning
difficulties and memory deficits) or behavioral problems (such as irritability, anxiety,
hyperactivity, and mood swings) if her seizures are neglected. However, they were unable to
convince Shirley’s parents to get Shirley medically diagnosed.
Although Betsy followed a systematic approach while dealing with the issue at hand, it
seems to have been ineffective as Shirley’s parents continued to stand by their faith in prayer.
However, listening patiently to patients’ problems and showing empathy and genuine care while
communicating with them are some lessons that health care professionals can take back from this
case study.
Resolving the Ethical Dilemma by Applying Ethical Principles
The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are
often employed to resolve ethical dilemmas related to health care. Autonomy refers to accepting
and understanding patients’ values, beneficence refers to acting for the welfare of patients,
nonmaleficence refers to not doing harm to the patient, and justice refers to treating patients
fairly without bias.
The ethical dilemma that Betsy faces in this case involves three of the four basic
principles of medical ethics. In the case study, the ethical dilemma is caused by the conflict
between the principles of autonomy on the one hand and beneficence and nonmaleficence on the
other. Betsy preserves the autonomy of Shirley’s parents by respecting their religious beliefs and
not coercing them to get the girl correctly diagnosed. She further ropes in Dr. Campbell to try to
explain to them the importance of getting an accurate diagnosis.
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Approaching Child Protective Services—a social service agency run by the government
to counsel and support children and their families and promote child welfare—could be
considered by Betsy as an ethical means to resolve the dilemma. As Betsy is obligated to help
Shirley get medical care (beneficence) and prevent any harm that might be caused from ignoring
her seizures (nonmaleficence), she could seek intervention from Child Protective Services.
Although involving Child Protective Services could result in overriding the ethical principle of
autonomy, Betsy might have to take this decision keeping Shirley’s best interests in mind
(Baumrucker et al., 2017).
Conclusion
The four principles of health care ethics can be applied by health care professionals to
analyze and resolve ethical dilemmas. In the case study, Betsy has to decide between respecting
Shirley’s parents’ religious beliefs and performing her moral obligation as a health care
professional by helping Shirley seek medical care. The proposed solution involves upholding the
principles of autonomy, beneficence, and nonmaleficence to resolve Betsy’s ethical dilemma.
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References
Baumrucker, S. J., Easterday, J., Stolick, M., McCall-Burton, M., Adkins, R. W., Winiger, D., &
Cook, C. (2017). Ethics roundtable: Parental autonomy and the minor patient. American
Journal of Hospice & Palliative Medicine, 34(3), 287–292.
http://journals.sagepub.com.library.capella.edu/doi/pdf/10.1177/1049909115608812
Capella University (2018). NHS-FP4000 Exemplar Sample Ethical Case Study. Capella Website:
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