![]() Jehovah’s Witnesses interpret these verses as indicating prohibition of the transfusion of whole blood or its primary components (including packed red blood cells, white blood cells, plasma, and platelet administration) under any circumstance. fornication and from what is strangled and from blood” (Acts 15:19-21). ![]() Members of this religion hold a fundamental belief that “consumption” of blood is forbidden, as indicated by Biblical passages such as: “Only flesh with its soul-its blood-you must not eat” (Genesis 9:3-4) “ pour its blood out and cover it with dust” (Leviticus 17:13-14) and “Abstain from. The Jehovah Witness Christian movement was founded in the United States by Charles Russell in 1872 and has grown to over 6 million members worldwide. If, following the discussion, the medical good is in direct conflict with a patient’s overarching good, rethinking is needed. When one or more levels of good conflict, a hierarchy should be determined among them to identify the overarching good. The physician should approach the case with the four components of the patient’s good in mind and ascertain the patient’s opinion on each of them. This view allows a stratification of autonomy, less conflict, and a more thorough discussion as part of clinical decision making. The levels of good are listed in the descending order of importance suggested by Pellegrino and Thomasma. We examine this clinical case through Pellegrino and Thomasma’s beneficence model, a medical adaptation of the third major ethical philosophy-the Aristotelian doctrine of “the good.” Pellegrino and Thomasma’s view features four components of the patient’s good: (1) the ultimate good, which represents the ultimate standard for a person’s life choices (2) the good of the patient as a person capable of reasoned decision making (i.e., autonomy) (3) the patient’s perception of their own good, or best interests, in their current life situation and (4) the medical good as achieved through medical intervention to treat or manage a disease. The ethical dilemma that we discuss here centres on a pediatric patient’s refusal of blood products due to the Jehovah’s Witness faith, in which at first glance the principle of autonomy seems to conflict with medical beneficence. Some common ethical dilemmas in modern medicine include the abortion of a fetus and the interplay of end-of-life decisions and religious beliefs, both situations that prompt debates on the extinguishment of life and its associated spiritual consequences. While the rightness of a decision is not difficult to determine in retrospect, evaluating the right course of action prospectively is no easy task for a clinician. The first theory concerns itself with rights, duties, and obligations the second values social good and social accountability. Two major ethical philosophies that dominate medical ethics today emphasize a respect for persons and, flowing from that, individual autonomy (Kantian) or social utility-specifically social good over the rights of the individual (utilitarian). Furthermore, each clinical case can be examined through different lenses that vary in their definition of the right course of action. The challenge with medical ethics lies in its clinical application, when multiple principles often appear to conflict, and none of the four principles can be ranked as primary in absolute terms. Current medical ethics borrows strongly from these concepts. Health care professionals practise ethical thinking when making decisions about patient management and are generally influenced by Aristotle's dictum of “first, do no harm.” The four pillars that lay the foundation for modern ethics are beneficence, nonmaleficence, autonomy, and justice. Physicians involved in decision making can apply the beneficence model to examine ethically complex cases from a different perspective, rather than approaching the complexity simply as a conflict between the medical good and the patient’s autonomy.Įthics describes a moral philosophy that guides a person’s actions. The surgeon and the patient each ranked the levels of good to determine their respective overarching goods, and then discussed their perspectives to reach a decision that minimized conflict between their overarching goods. The beneficence model outlines four levels of good: the ultimate good, the good of the patient as a person capable of reasoned decision making, the patient’s perception of the patient’s best interests, and the medical good. ![]() To explore the efficacy of Pellegrino and Thomasma’s beneficence model in surgery, we present the case of a 14-year-old Jehovah’s Witness with scoliosis requesting a bloodless surgery in which the surgeon used the model to achieve a successful outcome. ABSTRACT: Ethics-guided decision making in medicine should be approached with a sound framework.
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