You are on the ethics committee at May Morley Hospital in Lincoln Nebraska called in to give an opinion on the following case.
There is a patient with a terminal form of leukemia. She has come to May Morley for a bone marrow transplant to save her life. She had had other forms of treatment that helped for a time and then failed. The only donor for her is her 8-year-old daughter. When the procedure is explained to the child, she refuses to go through with the bone marrow transplant.
An ethics consult was called by the physicians on the case. Their question to the ethics committee was, "The only way to save this patient's life is donation by the child. Can we override the child's refusal and harvest her bone marrow?"
Background: The patient was a recent Korean immigrant to the United States. She had given up her daughter at birth to a family in another state. The daughter knew the couple who had raised her as her "true" parents, although she knew she was not their biological child. When the mother was diagnosed with leukemia and it was found that she needed bone marrow transplantation, the adoptive parents gave permission to test the biological daughter as a potential donor.
As a member of the ethics committee, give your decision in the case. Explain the steps of ethical decision-making using the framework described in the lecture this week.
Ethical decision-making involves the following steps.
1. Recognizing and defining the moral/ethical issues. This may be the most difficult step and is based upon your own value system and ethical beliefs. It is a determination that something is wrong even if it is legal or has always been acceptable to your organization. Though identifying moral and ethical issues is primarily based on your own values, if it directly involves a patient, the patientâ??s ethical position must take center stage, provided itâ??s legal.
2. Defining and obtaining relevant facts. While a large amount of data is usually available, you must define which facts are relevant and focus on those. Select facts taking into account the perspectives of patients and their families as well as healthcare providers and administrators. While studying these facts, remember that alternative interpretations of the same information are possible. As you study the facts available, you will ask more questions and want even more information. You will need the ability to draw a line somewhere, judging that you have the important facts necessary to inform your decision-making.
3. Identifying the primary stakeholders. Patients, families, hospital administrators, healthcare providers, other employees, etc. may be impacted by the ethical decision you make. Further, they may be affected in different ways. Be aware that conflicts of interest may exist among them.
4. Identifying and evaluating the possible solutions for the issue. What are the consequences of each option? Which option will result in the most good or the least harm? How will each of the stakeholders identified in Step 3 be impacted? Which solution must be eliminated because of constraints in executing it? Is the solution consistent with your ethical beliefs and is it in the best interest of your institution?
5. Defending your decision. Once a decision has been made, can you justify it to others? Can you explain why this course of action is preferable to other alternatives? Try to put yourself in the shoes of other people and think about how they will view your decision. This exercise will often show up flaws that you had earlier missed or suggest better ideas
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Hope this helps you with the ethical decision-making case.
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Ethical issues in this case revolve around two main issues- the patient's right to received appropriate treatment and a child's competency to give an informed consent as a donor. At hand is a patient who after failing all treatments has as only hope for cure a bone marrow transplant. The only match is an 8 year old child that the patient gave for adoption at birth and that dissent to be a donor.
Whether a child should or should not be donor has been discussed at many governmental levels around the world. The World Health Organization Guiding Principles on Human Cell, Tissue and Organ Transplantation (principle 4) state that "no cells, tissue, or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law"(Entrepreneur, 2008, July,¶13). A major exception is considered familial donation of regenerative cells when an adult donor is not available. It also states that whenever possible the minor's assent should be obtained before donation. That takes us to when should we consider that a child can give an informed consent for a medical procedure.
Children under 16 are presumed not to be legally competent to make decisions regarding their healthcare. Many physicians apply the Gillick-competence test to decide if the child is competent to give consent. This test is based on the principle that says "A minor is capable of giving informed consent when he or she achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed" (Law reform Commission, 2004, §2.7). But this mostly applies when the child is the recipient of the medical ...
The solution involves a deep discussion on how to reach an opinion on a case involving an adopted minor refusal to donate bone marrow to her biological mother using ethical decision-making steps.