Analysis of Case Study on Biomedical Ethics: Divided Loyalties

Ava Jones is a four-year old girl who is in severe renal failure. Severe renal failure results in the gradual decrease of the kidney’s functioning, and leads to the inability to filter waste from the blood (Johns, 2018). Ava’s physician has noticed that her ability to thrive is decreasing. Her physician states that without a kidney transplant in the near future, she will not be able to survive without a properly functioning kidney. The only way for a chance at a successful transplant is around ninety percent, but only if the kidney is transplanted from a close relative who has a similar tissue type as Ava. If they do not find a similar tissue type the transplant will most likely not result in a successful surgery, even if the kidney is from a close relative.

The implantation of a close relative without a similar tissue type would result in an equally poor outcome as a cadaver with a non-similar matched tissue. Furthermore, if a cadaver has a similar tissue type it would have a lower probability rate of a good tissue match than a close relative from within the family. The physician informed Ava’s family, which consists of her parents and two older siblings, of the tissue type matching that they needed tests from her close relatives. Her family agrees to undergo a testing to find the results for the best tissue type for Ava’s kidney transplant. The test came back and showed that the excellent candidate for the donation is Ava’s father, all the other family members test came back to be poor matches. The physician is ready to call the family and tell them the good news of the test results, but is interrupted by the father who wants to speak in private to Ava’s physician. She tells him the test results, but to her surprise he burst out in sudden tears saying he is scared to donate his kidney. He continues to urge the physician to tell his family that none of them are a perfect match to be a donor, and asks to begin a search for a cadaver with a good match.

Ava’s best chance of survival for this kidney transplant is to receive a kidney from her father. The physician feels that if she tells the man’s wife that he will be talked and shamed into the donating his kidney. She did not want Ava’s father feeling pressured into being a kidney donor for his daughter’s implantation operation.

In the case above, I, as a physician would notice the problem of divided loyalty between the patient’s father and Ava. I owe the whole family to be informed of the test results, not just to the father. The result of telling the man’s wife that none of the close relatives are not perfect tissue matches for her daughter is considered dishonesty. One must remain truthful at all times especially as a healthcare physician. One could say that by telling the man’s wife and Ava’s family that the test results came back showing that no close relatives are perfect matches for Ava’s kidney implant would result in the father’s not being forced by his will or shamed into being the kidney donor for his daughter. Therefore, the solution is to work on finding another matching tissue type and a willing donor for Ava. According to the prima facie moral principle of autonomy, lying to the man’s wife is justifiable because this principle protects Ava’s father’s body from forcing him to be a donor. This would also benefit a close relative by not risking their own life to live without a kidney by donating it to Ava.

On the other hand, one could argue that it is morally wrong for the physician to be dishonest with the man’s wife and Ava’s family by not telling them the test results showing of the father’s perfect tissue match, according to the test results. By informing the family of the situation of Ava’s father’s being frightened to have the kidney surgery, they could be understanding of his feelings and possibly talk him through it. Another thing to consider in this situation is that, in donating his kidney, his daughter’s life would be saved by receiving an implant of a new kidney; thus preserving a life for the next generation. Being professional is very important in healthcare, and to me as the physician in this situation. One untruthful result told to a patient could jeopardize his or her career.

A second principle of autonomy is the principle of promise-keeping. The principle of promise-keeping is “Generally, moral agents have the obligation to keep their promises”. As a doctor, you have a moral obligation to keep my patient’s medical records confidential. No matter who I show their records to, I have to have permission from the patient to inform them. Otherwise, they are to be kept confidential. As a physician, I have this obligation towards Ava and her father. Normative models are also meant to decide the issues of personal involvement and relationships between the patient and the physician. Duty normative ethical theory is one example; deontology is “rights and duties are justified regardless of consequential values”.

There are two deontological theories; Kantianism and Contractarianism. Kantianism is “An action is morally good only if it is motivated by a recognition that the action is a moral duty, not by inclination desire”. Contractarianism is “any of various theories that justify moral principles and political choices because they depend on a social contract involving certain ideal conditions, as lack of ignorance or uncertainty”. In this situation Kantianism is more relatable, because the action of the physician is morally good if she does not force Ava’s father out of obligation to donate his kidney for his daughter’s transplant. But this is also dangerous for Ava’s health and benefit.

Kantianism is considered to be only right or wrong without thinking of the consequences, while Utilitarianism is considering the consequences. In the situation it is morally right to tell the family the true test results, rather than to respect the father’s wishes to withhold the results because of his fears. Otherwise, it could endanger Ava’s life by waiting for another perfect tissue match, but not respecting the father’s wishes of his worries about the surgery. Nevertheless, we still have to morally consider our two options; to tell Ava’s family the true test results or not.

The first step into finding out which situation is the correct approach is through beneficence, a term which provides guidance for the physician to decide who is benefitted more. As a physician, you have an obligation to do for patients what is of the most benefit to them. Included in this approach is the opposite obligation that of non-maleficence or not causing harm to others. The physician is expected to do anything that helps improve and preserve Ava’s life but also her father’s life. By not telling Ava’s family about the test results, the father’s life would be preserved and the search for a match for Ava’s transplant would continue. In this scenario, the physician felt that it was wrong to tell Ava’s family the true test results, so her father was not shamed into being the kidney donor. However, my main priority in this case is to Ava, the real patient, I have a moral obligation towards. This also leads to the principle of honesty. A physician’s main obligation is to be honest and truthful about results about the patient. By not telling Ava’s family the true test results, it would also break the principle of honesty. But this would also be non-beneficial to Ava, which the physician has a main priority and moral obligation towards.

The second step is the approaches to theoretical normative ethics which shows that “values is any trait or characteristic of something that is either good or bad”. According to utilitarianism, it produces a balance between good over evil, or the least possible way of evil over good. Another consideration would be to ask who would be most affected by the physician’s actions. The physician’s actions to this matter, also depends on determining the moral status. Act utilitarianism is one option. Teleological ethics (consequentialism) can be explained as followed: “the moral values of voluntary actions are wholly determined by the non-moral values of their consequences”.

The actions will have significant effects on the patient or her father. Moral agents prove the consequences of a physician and the patients. Using principle of utility would help apply the results of each case between Ava and her father. It would give an idea of comparing the consequences of the moral subject actions. Next, they would consider the outcome and welfare of the patient. Determining the best assessment and interests of the health of Ava. If she would continue without a kidney transplant, her health would be jeopardized and she would most likely not be able to survive long. According to Utilitarianism, considering the consequences of either decision will result in the moral answer of the physician.

My personal opinion, as the physician should tell the family the true test results, because it is their right to know. Since Ava is my main priority and patient, it is morally right to do what is more beneficial to Ava. Also, the father’s worries of surgery could still be a choice to do it or not, with speaking to his family before. The family has a right to know the results, and it is the physician’s obligation to inform them the truth. To put into consideration, Ava needs this transplant in order to survive and thrive. If the family’s decision is to not have the father as the donor for Ava’s surgery, then the search will continue for a matching tissue type. The physician has a moral obligation to the family and Ava to tell the truth. Honesty is a priority in healthcare. The test results should be told to the family because of the principle of honesty, which states that honesty is the right and moral thing to do. Also, to remember the main priority, the physician’s main obligation is to the patient, Ava.