State statutes mandate that healthcare professionals abide by the practice acts established by their respective state's professional licensing boards in carrying out their professional duties.
As Harris (2008) notes, healthcare professionals must integrate ethical considerations into their skilled practice to deliver quality care to the public. Nevertheless, patients' religious beliefs can give rise to ethical quandaries for healthcare providers - a common example being Jehovah's Witnesses who often decline blood transfusions in medical settings.
In 1872, the Jehovah's Witness Society was established in Pittsburgh. In 1961, their belief that shunning blood transfusions would preserve their spirituality began, resulting in the expulsion and ostracization of those who chose this medical treatment by members within the religious community. However, in June 2000, the Watchtower Society reversed this policy and required individuals who opted for blood transfusions to publicly denounce themselves fro
...m the group and renounce their congregation at their own discretion - a decision made by the governing body of Jehovah's Witnesses. Conflicting ethical principles arise within the community when competent adult patients deny life-saving treatments recommended by healthcare professionals (Berend & Levi, 2009).
The principles of patient autonomy, beneficence, nonmaleficence, and justice are essential in healthcare. These principles take precedence over the provider's own beneficence and nonmaleficence. Autonomy is recognized as a fundamental right under common law. Informed consent is a legal tool that grants individuals the ability to express their medical care preferences, including their choice to undergo procedures such as blood transfusions. For informed consent to be valid, it must consider three critical factors.
Mclnroy (2005) outlines three prerequisites for patients to provide informed consent regarding treatment plans: comprehending the treatment, making a voluntary decision devoid of undu
influence, and receiving complete disclosure on benefits and risks from the physician. Jehovah's Witness members hold that declining blood transfusions aligns with beneficence and nonmaleficence ethical principles as it results in less harm than accepting such treatments. This belief is anchored in their conviction that eternal salvation holds greater significance than temporary life on earth, rendering their refusal a logical choice (Macklin, 2003).
It is crucial to uphold the ethical principle of Justice in patient care by showing fair and equal respect regardless of cultural or religious beliefs, even if conflicts arise with the personal values of physicians or healthcare teams. Upholding justice is an obligation and expectation (Morrison, 2011). Additionally, adhering to the ethical principles of beneficence and nonmaleficence involves prioritizing doing good and avoiding harm in care. This includes providing sufficient information, guidance, and advice for treatment options that align with patients' cultural health beliefs and social situation.
In situations where a patient disagrees with their physician's advice, such as refusing a blood transfusion that may have negative consequences for their health, ethical principles of healthcare professionals must prioritize respect for the patient's autonomy over beneficence and nonmaleficence. The healthcare team should consider the patient's evaluation of the potential positive and negative outcomes when declining treatment. Examining moral dilemmas that arise from conflicting ethical principles can be challenging, particularly in critical situations where emotions must also be taken into account (Macklin, 2003).According to ancient Greek philosophers like Socrates, Plato, and Aristotle, the moral character of individuals is more important than their actions. This belief forms the central focus of virtue ethics and applies to healthcare team members and physicians. To be considered good, one must
cultivate their virtues continually until they become a part of them. In an ethical dilemma such as a Jehovah's Witness patient refusing treatment on religious grounds, a virtuous doctor would consider the emotional impact and potential frustration that may arise from dealing with such conflicts.
The frustration might stem from an inability to perform job duties effectively resulting in a preventable medical crisis and the premature death of the patient, leading to emotional burden for their family and friends. To address these ethical issues, virtue ethics such as compassion, trustworthiness, discernment, and regret can be helpful. Compassion involves empathizing with the patient's suffering and recognizing their courage in facing the risk of death. This can inspire feelings of respect and worth towards the patient.
Trustworthiness is essential to maintain a strong relationship between a patient and their physician. Patients depend on their physician's moral character and competence to respect their personal and health concerns. A trustworthy physician should not attempt to persuade their patient to change their beliefs but respond appropriately to their requests. In addition, discernment provides sensitive awareness that leads to a reasonable judgment of the situation. Regret is also an important virtue that distinguishes its place in tragedies resulting from conflicting ethical principles.
According to Gardiner (2003), a physician who chooses a course of action after a thorough and extensive discussion should not experience any distress because the decision made was the right one. Health care professionals are often confronted with complex medical, ethical, and legal issues when treating Jehovah's Witness patients who firmly refuse blood transfusions. With the growing membership of this religious group worldwide, it's important for health care professionals to be
prepared in managing these conflicting ethical principles. Therefore, prioritizing sufficient knowledge and understanding of core ethics and basic human rights laws is crucial for health care professionals.
Having a greater understanding of ethical issues can help healthcare providers prioritize the patient's involvement as the focal point in all decision-making processes (Bingham, 2012).
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