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Wyeth De Leon, RN

A Clinical Case Analysis in Bioethics




In any kind of clinical case, a lot of ethical issues often arise. Every actual ethical
problem is a complex collection of many circumstances. The conflict between the
doctors, nurses, patients, and relatives regarding what needs to be done usually
happens. The question here is who needs to make the decision? Knowing the moral
principles while making a decision is definitely important to maintain and protect the
ethics that stays at the heart of quality care.

A lot of us know how important respect for autonomy is. Respect for autonomy
includes respecting someones right to self-determination and mainly respecting his
wishes, but autonomy in medicine is not merely allowing patients to build their own
decisions easily. People come to doctors for assistance in making choices because
they do not have the essential background or information for making informed choices.
Physicians educate patients so that they understand the situation adequately. While
beneficence on the other hand is providing benefits to persons to contribute to their
welfare, meaning to do no harm. Beneficence can also involve protecting and defending
the rights of others, helping individuals who are in the state of danger, and helping
persons with ill health. Due to the nature of the relationship between physicians and
patients, doctors do have an obligation to 1) prevent and remove harms, and 2) weigh
and balance possible benefits against possible risks of an action. Beneficence can also



include protecting and defending the rights of others, rescuing persons who are in
danger, and helping individuals with disabilities.

In this situation, the autonomous choice of the patient conflicts with the
physicians duty of beneficence and following each ethical principle would lead to
different actions. As long as the patient meets the criteria for making an autonomous
choice, then the physician should respect the patients decisions even while trying to
convince the patient otherwise. The patient should understand the decision and medical
indication at hand and is not basing the decision on delusional ideas knowing that this
clinical situation occurs just after an accident. Had the physical and emotional shock of
the accident weaken his capability to make a decision for himself? If the patient is
mentally incapacitated at the time a decision must be made, we must ask "Who has the
authority to make a decision on behalf of this patient?. What are the ethical and legal
parameters of that authority? Also the relevance of the quality of life of the patient
should also be given justice, knowing Mr. HS quality of life before the motor-car
accident would give us a better understanding about the patients decision. How can be
Dr. M and the other doctors are of benefit and do no harm while respecting the patients
deliberate preferences and honoring their values.

To sum it all up, I believe that understanding the moral principles and value in this
clinical situation would lead to a decision that would benefit both parties. Understanding
the explanation of medical indications, the degree risks permissible, the use of
technological advances provides benefits that outweigh risks, the mental capacity of the
patient to decide for himself, the quality of life of the patient, and the principle of
autonomy should be the focus in this situation. As long as these moral principles,
values, and factors are met and the procedure (including the risks, benefits and
probable outcomes of each treatment modality) was clearly stated to the patient, then
whatever the decision of Mr. HS will still be the final decision.