Ethical Dilemma

(Foregoing Curative Medical Treatment Due to Religious Beliefs)

Select one of the following ethical issues in healthcare:
Foregoing curative medical treatment due to religious beliefs
Use the CSU Global Library and select Internet sources to conduct research on your
chosen topic. Based on your research, provide the history of the issue from a legal, ethical,
and moral perspective. In your paper address the following questions:
Do the consequences of actions always direct what is morally required?
What should happen when two principles come into conflict? For example, should
patient autonomy be considered more important than beneficence? Defend your position.
Are moral and ethically rules always binding, or are they only guidelines to be
assessed in each case? Defend your position.

Foregoing Curative Medical Treatment Due to Religious Beliefs

Introduction

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Healthcare professionals frequently find themselves in dilemmas as they undertake their
chores at the workplace, with some directly confronting the ethical issues while others turning
away. Usually, the moral courage that one possesses is what matters most as it, more often than
not, helps the practitioners in addressing the various ethical issues that may present themselves;
which could even involve doing something otherwise considered wrong. Inasmuch as there
usually are predetermined courses of action considered ethically moral or otherwise, the
consequences of the course of the action taken is what really matters (Stewart, Adams, Stewart,
& Nelson, 2013). Because of this, an action that is otherwise not acceptable may have to be
carried out in order to get to achieve a desirable consequence; for instance, according to most
religious doctrines, abortion is not acceptable, even the conscience of the individual that may be
involved may not allow it. However, if done for the sake of good will remains morally binding,
for instance, the case of complications in pregnancy.
In order for us to get to understand the implications of the ethical issues pertinent with the
health care practice, there is the need to understand the definition of nursing by the International
Council of Nurses (ICN). Under it, the profession is defined as: “Nursing encompasses
autonomous and collaborative care and communities of all ages, groups, families and
communities, sick or well and in all settings. Nursing includes the promotion of health,
prevention f illness and the care of ill, disabled, and the dying people. Advocacy, promotion of
safe environment, research, participation in shaping the health policy and in patient and health
systems management, and education are also key nursing roles.” (ICN, 2011). As outlined by
Morrison (2011), the definition incorporates the three fundamental components of bioethics. It is,
thus, conceivable to say that the health practitioners have the obligation of developing a well-

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founded ground of ethical understanding with regards to the protection of the people; which is
their sole duty.

Moral Courage

The ability of one to make the right decisions in such situations that involve moral and
ethical issues is what is called moral courage. According to Day (2007), moral courage is “a trait
displayed by individuals, who, despite adversity and personal risks, decide to act upon their
ethical values to help others during difficult ethical dilemmas. As Hall (2014) asserts, such
individuals tend to strive to see to it that the only do what is right, even in cases whereby most
are expected to choose least ethical behavior, which could even be not taking any action.

Conflict of Principles

Religious, spiritual and cultural beliefs and practices remain very crucial in the lives of
most patients, yet most health practitioners usually find themselves at the dilemma of whether to,
how and when to address such issues when dealing with patients. In the past, the physicians were
basically trained on the various ways of diagnosing and treating the various diseases, but with
very little or no training on the spiritual approach to the ordeal. Besides, the professional ethics
allows the professionals no chance of impinging their personal beliefs on their patients who are
usually very vulnerable (Brierley, Linthicum, & Petros, 2013). The matter is even complicated
further by the characteristic nature of most nations of religious pluralism, having a wide range of
systems of beliefs: agnosticism, atheism to the very many religious assortments. Because of this,
it tends to be very difficult getting to fully understand the religious beliefs of all the patients from
all walks of life.
The very first temptation that would prove worthwhile in this case is for the professionals
to fully avoid the doctor patient interactions with respect to their spiritual or religious beliefs.

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This simplest solution may never be the best as several studies have shown that the spiritual and
cultural beliefs f various patients have been proved to be very important factors for the patients
to be in a position of coping with relatively serious illnesses (McCormick et al, 2012).
McCormick et al (2012), assert that the engagement of the spiritual beliefs of the patients in their
healing process may be devised by the health practitioners through comparison of their own
beliefs against those of the patients.

Case Scenario: Foregoing Curative Drugs due to Religious Beliefs
In some communities, there is too much belief in the traditional practices that accepting
the modern medicines becomes very difficult. Such communities have a belief system in which
they believe and may recognize the move towards accepting the western medicine as evil. In
such a case, the patient may never be taken to the hospital, or worse still, after getting to the
hospital refuse to take the prescribed medicine on the belief that it is against the doctrines of their
religion. The most common cases, include, but not limited to; blood transfusion, abortion, taking
of family planning pills and even the normal tablets.

Conflict in Principles

In case of the principles coming into conflict, there usually is the need to be very flexible
as there are so many ways in which the situations may present themselves. For effective
resolution of such conflicts, the ethical and professional principles, rather than the personal
preconceived ideas, should always form the pillar for the effective decision making when it
comes to ethics (ANA, 2011). The ethical behavior of nurses is usually guided by a set of
principles contained in the American Nurses Association (ANA) Code of Ethics of Nurses
(2001). It is expected of all the nurses that they uphold all the principles in the course of their
practice of professional nursing, while, at the same time, the Cord of Ethics for Nurses

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encourages them to ensure consistency with their personal values. There is also emphasis on the
need to hold open discussion with regards to conflicting ethical principles in such a manner that
all the principles are placed at the same level and treated equally.
Autonomy versus Beneficence

Autonomy
Autonomy refers to the personal self-rule that is both free from controlling such
interferences that may result from others and the personal imitations that my put meaningful
choices at jeopardy. In the health care, autonomy forms one of the key guidelines for the clinical
ethics. A point that must be noted is that when speaking of autonomy, it does not merely imply
leaving the patients the freedom of making their own choices. Rather, the health practitioners are
under an obligation to see to it that they create the conditions that provide room for the
independent choices, thought under some guidance. The respects for autonomy scenarios include
giving room for autonomous choices as well as respecting the right to self-determination of an
individual.
It must be noted that the doctors are usually visited by the people because they may not
be equipped with the necessary information or background necessary for the making of informed
choices. Hence, it is the physicians that educate the patients in order for them to adequately
understand the situations, including; addressing the fears and emotions that may interfere with
the decision making ability of the patients. Confidentiality is another form of autonomy very
crucial in administering the treatment to the patients.
Beneficence
Usually, this is an action done purely for the benefit of others through either removing
harm or simply by improving their situations. Apart from being refrained from causing harm, the

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health practitioners are expected to see to it that they help the patients. Due to the nature of the
relationship inherent between the patients and the physicians, the doctors have the obligation
removing or preventing harm and balancing and weighing the possible risks against the possible
benefits of any action.
Balancing of autonomy and beneficence
Amongst the most difficult and common ethical issues to tackle comes in when the
patient’s autonomous decision comes into conflict with the beneficent duty of the physician,
which is mainly looking after the best interest of the patient. For instance, a patient who has very
strict religious background may refuse to take medicine, simply because they believe in spiritual
healing. This may be so challenging, especially when the physician has successfully diagnosed
the ailment and knows its cause well, hence, its prescription (ANA, 2011). At such a point, the
physician may be under the challenge of whether to maintain the autonomy of the patient or take
a beneficence action, which will violate the autonomous requirement of the patient. More often
than not, the two are equally important, however, beneficence comes first as it is a matter of life
and death.
Basically, the modern biomedical ethics are grounded on four principles, which balance
categorical Imperative of Emmanuel Kant: you must always do the right thing no matter what it
takes, and Utilitarianism of John Stuart Mill and Jeremy: make the best decision for everyone all
around. When in combination, the principles are usually called Principalism.
Respect for autonomy: giving priority to the informed choices of the patient. This theory
asserts that the practitioners need to see to it that the wishes of the patients are taken into
consideration. As such, the wish by a patient to have a kind of special attention with regards to
choice of the health care services administered should solely depend on the patient’s wish.

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Non-malfeasance: do no harm
Beneficence: do what is best for the patient, regardless of their consent. This principle
asserts that the consent of the patient may be overlooked in order to see to it that the course of
action is for their own good. With this, the health care practitioners are expected to ensure the
good of the patients even if it means doing what they don’t wish for. The ultimate consideration
of the morality will lie in the consequences, and at times, even if a patient requested for the end
not to have blood transfusion due to religious beliefs, they may eventually end up thanking the
physician, rather than suing them (Morrison, 2011).
Justice: always balancing the social and individual costs, risks and benefits. The
physician has the obligation of seeing to it that they properly advise the patients with respect to
the possible risks involved to ensure they are well informed before getting to a medical ordeal.

Morals and Ethics

Most of the moral dilemmas that tend to arise in medicine are usually analyzed using the
four aforementioned principles but with some consideration given to the resultant consequences,
though the frameworks may have limitations. The judgment of the best consequences is not
always clear, and din case the principles conflict, the ease of deciding on the best dominant is
always very hard. Virtue ethics usually focuses on the nature of the moral agent rather than how
right the course of action taken is. Usually, as a practitioner, the ethical principles, which guide
what action to be taken do not usually take into account the moral agent’s nature (Cordella,
2012). To look into how binding the morals usually are, the “standard” Jehovah’s Witness case
may be used.
A very competent adult believer loses too much blood due to bleeding in a vessel in an
acute duodenal ulcer, and the only best chances of saving his life is by having a blood transfusion

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together with some operation done on him. In exercising his autonomous decision, the patient
requests for surgery and treatment with the best non-blood products available, and refuses blood
transfusion. He even accepts the risks that are pertinent with surgery without blood transfusion.
It is very important for the health practitioners to get to distinguish between morality and
legally binding courses of actions as an action may be legal but not moral and vice versa. For
instance, the resuscitation of a dying patient may be considered legal, but not moral. On the other
hand, when a patient falls too sick at home, it may be moral to over speed to the hospital but
illegal. Also, the physicians have the obligation of distinguishing between religion and morality.
From instance, some of the religions believe in circumcising women while others recognize it as
a sin.

Moral Frameworks

However, the moral theories tend to provide different frameworks upon which the nurses
may be able to get clarification as well as view the patients’ disturbing situations. Widely used
and applicable are three frameworks that may guide the physicians. The three basic broad
categories of the moral frameworks are: virtue theory, deontological and utilitarianism theory.
Virtue theory
This theory exclusively probes the human morality. It gives very little attention to the
regulations that people need to adhere to; rather, it puts more emphasis on what is deemed
necessary in development of human characteristics considered as good, just like living a
generous and kind life.
Deontological ethics
These are usually associated with the ethical and moral standards in the execution of the
professional duties by the health professionals.

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Utilitarianism theory
This is the belief that any form of action is considered as being right as long as it leads to
the greatest good for larger number of people. As such, there usually is a calculation on the
outcome of any particular action. As such, if a health practitioner considers an action as having
high propensity of bringing good and happiness to larger number of people; it definitely is the
right thing to do (Morrison, 2011). In other words, the utilitarianism tends to base its reasoning
on the usefulness of the action that may make it be considered as moral or immoral; for the
course of action to be considered as moral, the good outcomes have t outweigh the bad ones.
Moral principles
They are the broad and general statements of philosophical concepts that provide the
foundations upon which the moral rules are founded.
The health practices usually come with too many challenges which leave the practitioners
at a dilemma in more often situations than not. For instance; the debate n abortion, organ
transplant, end-of-life issues, management of personal health information and the allocation of
the scarce health resources. Looking into each of the aforementioned issues, it usually leaves the
platform very open for the practitioner to decide what they deem right course of action to take.
As put across by Elliot (2011), “Culture provides the rules or framework that guides us as we
negotiate our way through our daily activities of life.” Through the assessment of the heritage of
any particular patient helps the nurses to understand well how such a person relates to their
surroundings, how they view health and wellness, their various ways of gaining and applying
knowledge as well as any other area that may be of interest in health care provision.
Most of the nations of the world, for instance, in America, the populations are
characterized by people of vast diversification in the religious, ethnic, sexual orientation and

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nationality. As such, the patients that visit the health centers present with themselves varied
symptoms requiring medical attention, some based on illness while others grounded on the
cultural and religious backgrounds of the patients.
As the patients are guided through any healthcare facilities of the dialysis unit, it is very
recommended that the practitioners not only concentrate on the clinical needs, but also see to it
that they identify the patient’s demographics and religious orientations amongst others. The
problem very common is the avoidance of the common mistakes that greatly impact safety and
quality and instead, pay too much attention on the nature of the illness and how the patient may
be treated. In doing this, they are not really identifying with the patient in order to attend to them
as an individual. A point that must be noted is that all patients have diversified characteristics
and needs, both the clinical and non-clinical, which affects the manner in which they participate,
receive and view their treatment (Morrison, 2011).
Unlike in the past when health provision was mainly limited to a particular community,
mostly, where one came from, there have increasingly arisen changes due to the cultural and
religious diversity. There is need for the healthcare providers to see to it that they are well
conversed with all the possible cultural and religious traditions inherent in the societies within
which they work. It is based on this challenge that the terminology ‘cultural competence’ came
to be, whereby all the practitioners are expected to be able to work in the various cultural and
geographical regions without much trouble (Cordella, 2012). This may only be so through
getting to first and foremost understand the various cultures to help learn their beliefs.
A fact that all health care practitioners must come to terms with is the diversity in the
religious beliefs inherent in the various cultures and people from different walks of life. The
beliefs of the various patients tend to be aligned to their religious backgrounds, which may never

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be easy to change. Due to this, it is in order that all the professionals fully understand the
possible challenges that they may expect, however, they should never let the various beliefs by
such patients waver their conscious mind of making the right decisions to do good. Once a
person believes in the consequence o the course f action they are about to take, they should do so
without any fear.

Conclusion

In conclusion, we as health practitioners are faced everyday with caring for patients of
different faiths, cultures and religions. It is important to always keep an open mind and allow
yourself to try to understand the faith that our patients believe. Understanding other cultures and
beliefs are critical in the healing process. In healthcare today as physicians, we need to keep an
open and unbiased mind, treating everyone as equal. Through the development of proper cultural
competence, we may help our patients by accepting their beliefs without abandoning our own
personal customs. As health practitioners, we may not be able to change the beliefs of the various
patients from the different walks of life as the populations continually get diversified, rather,
there is need to remain open minded in order to accommodate the diverse beliefs. In addition, as
long as we believe that the course of action that we are taking will lead to more good than bad,
then the autonomous stake of the patients should always be put at stake. After all, they will
eventually appreciate the results.

References

American nurses association ANA, (2011). Code of Ethics for Nurses with Interpretive
Statements. Washington, D.C.: American Nurses Association.

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Brierley, J., Linthicum, J., &Petros, A. (2013). Should religious beliefs be allowed to stonewall a
secular approach to withdrawing and withholding treatment in children?. Journal of
Medical Ethics, (9). 573. doi:10.1136/medethics-2011-100104.
Conflicts between religious or spiritual beliefs and pediatric care: informed refusal, exemptions,
and public funding.(2013). Pediatrics, (5), 962.
Cordella, M. (2012).Negotiating Religious Beliefs in a Medical Setting. Journal Of Religion &
Health, 51(3), 837-853. 
Elliot G. (2011). Cracking the cultural competency code. Canadian Nursing Home, 22(1), 27-30.
Hall, H. (2014). Faith healing: religious freedom vs. child protection: the medical ethics principle
of autonomy justifies letting competent adults reject lifesaving medical care for
themselves because of their religious beliefs, but it does not extend to rejecting medical
care for children. Skeptical Inquirer, (4). 42.
International council of nurses, (ICN). (2011). Nursing and health professions. 2011.
Krohn E. (2013). Recovering health through Cultural Traditions. Forth World Journal, 12.
Lamparello, A. (2001). Taking God Out of the Hospital: Requiring Parents to Seek Medical Care
For Their Children Regardless of Religious Belief. Texas Forum On Civil Liberties &
Civil Rights, 647.
Morrison, E. E. (2011). Ethics in health administration : a practical approach for decision
makers / Eileen E. Morrison. Sudbury, Mass. : Jones and Bartlett Publishers, c2011.
Stewart, W., Adams, M., Stewart, J., & Nelson, L. (2013).Review of Clinical Medicine and
Religious Practice. Journal Of Religion & Health, 52(1), 91-106.

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