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Posted August 31, 2007

Book: Caring for those in crisis: facing ethical dilemmas with patients and families
Author: Kenneth P. Mottram
Brazon Press. Grand Rapids. MI. 2007. Pp. 160

An Excerpt from the Jacket:

In a day of advanced medical technology, many families will at some point be forced to face a complicated medical crisis with a loved one. All too often, these situations entail spiritual and ethical dilemmas for which most families are not prepared.

Kenneth Mottram writes to better equip pastors and church leaders to minister to patients and their families in times of crisis and confusion. He provides a Christian model fro ethical decision making; addresses such issues as organ donation, living wills and withdrawing life support; offers counsel on helping patients and families face mortality; and gives practical advice on hospital visitation, prayer, and serving as advocate for the family to the medical staff.

An Excerpt from the Book:

Four Common Medical Ethics Principles

1. Beneficence: the duty to “do good”

In medical care the basic principle and motivating factor for most physicians is summed up in this word, which emphasizes the benefits of receiving help. Beneficence at its core includes the highest desire of the caregiver to preserve life, to alleviate suffering, and to help the patient in a positive way. It is a principle that finds its expression in what many times is called compassion. Most physicians have practiced beneficence in the pursuit of their vocation in such a self-sacrificing way that their patients have come to think of them as a member of their own family. True love and trust have developed over many years of interaction and caring service, resulting in a strong human bond and emotional attachment between patient and physician. This desire of the physician to help and “do good” for the patient is a cornerstone of good medicine.

2. Nonmaleficence: the duty to “do no harm”

Hippocrates wrote, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so . . .Into whatsoever house I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm.” Ultimately, every physician and caregiver must come to terms with how treatment is affecting a patient and family and whether the risks and burdens outweigh the benefits of a specific treatment. Many medical interventions can cause harm in the long run. In any given situation to “do no harm” can lead to a variety of decisions.

3. Autonomy: personal freedom and responsibility

Autonomy, or individual freedom of choice, is the principle that focuses on the promotion of personal responsibility for one’s own life and actions. It has emerged as the most powerful principle in America bioethics, the basis of most regulation and the center of bioethics theory, and has become the default principle – the principle to be appealed to – when other principles conflict. Its place in medical decision making is described by one writer as follows:

Autonomy refers to personal choice, control, and self-definition. Autonomy assumes the existenc of individual values that do not need to be shared by others in order to be worthy of respect. In health care, patient autonomy is seen as the patient’s right to receive accurate information about his or her health and treatment; to be fully informed not only about the physician’s recommendations but also about alternative treatments that might preserve life, prevent disease, and relieve suffering; and to choose or to refuse any of those treatments. In addition, patient autonomy is served by permitting patients to choose others to hold and receive information and to make their decisions for them, whether physician, family member, or attorney-in-fact (as in the circumstances of granting during power of attorney).

4. Justice: fairness and equality

Justice in medical decision making concerns what is fair and equitable among people, including the allocation of scarce resources. The principles of distributive justice or comparative justice emphasize that persons of society should share similarly in the benefits and burdens as available to members of society at large. For instance, should expensive blood products be used for elective surgery when shortages occur in life-threatening circumstances? Blood is a scarce resource that provides great benefit. An example of the burden associated with a scarce resource would be the price of forgoing elective surgery.

Discovering your operational system

Besides the four principles listed above, there is an almost infinite number of what can be called “ethical principles,” or values, that guide our lives. They are different for each one of us. These can be thought about as core beliefs or personal philosophies that guide or motivate decisions in our lives. They define the things we treasure the most, and so provide a basis in our inner world for the subtle ranking of things we deeply want or desire in a way that elevates some values over others. Our values determine how we will behave in certain situations. These ethical values directly relate to beliefs concerning what is right and proper and good. Some of them for the Christian might be rom the Bible. But some of them also stem from unique living experiences that form a part of our personal histories or our family traditions. Some of them are so deeply a part of our thinking that it is difficult to name them. They are felt or intuited, rather than thought. Each one of us has a unique mix of these values that define our “operational value system.” A part of our own personal growth is to be able to verbalize what values or principles we hold significant.

Table of Contents:

1. Meeting an ethical dilemma

2. Orientation to medical ethics

3. Advocacy, trauma, and personal awareness

4. A biblical look at ethics and advocacy

5. The medical understanding of spirituality

6. Frequently encountered ethical problems

7. A decision-making model for ethical dilemmas

8. Christian distinctives in facing ethical dilemmas

9. Ethical issues in death and dying

10. Spiritual interventions by the advocate