Ethical Dilemma in Treating a Six Year Old Boy with Meningitis

Updated on July 18, 2018
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Vince is a technical writer working in the medical research field. He also enjoys exploring literature in his free time.

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Ethical Dilemma in Treating a Six Year Old Boy with Meningitis

Morality is the underlying code of conduct which each individual and society as a whole use to guide their behaviors. In simple terms, morality defines the difference between what is seen to be right and what is viewed as wrong. There are various forms of morality such as personal, societal, and professional moralities. Each form of morality is based on a set of values and possesses the goal of achieving some action that benefits these values. At times, different forms of morality can come into conflict with each other as the path to right action becomes ambiguous or has multiple routes. In these instances, ethics comes into play as the logical method by which a person can examine the competing concepts of good and decide upon a course of action which best serves the underlying values. Thus, though one form of morality may prevail over the others in a particular situation, the overall goals can be preserved. In medicine, the teleology of such ethical discussions is patient centered care. (Purtilo & Dohurty, 2011).

Ethical Dilemma

At times, in the application of ethics, one may find situations in which two moral avenues of action may be appropriate, and yet cannot both be followed as they are mutually exclusive. These instances are identified as ethical dilemmas. In the realm of ethics, the term dilemma carries a more specific meaning than in common speech, and that meaning is a situation in which two moralities cannot both be followed, necessitating a violation of at least one (Purtilo & Dohurty, 2011).

An example provided for the purpose of this paper is one of an ill six year old boy admitted to a unit with fever, vomiting, and convulsions. Recognizing the symptoms of meningitis, the physician recommends treatment begin, but cannot get the mother to give consent as she is a Christian Scientist, and such medical procedures violate her religious beliefs. She has primary custody, though she is not the biological mother. The biological father insists treatment be started.

Here, the medical staff are placed in an ethical dilemma. A cultural difference in morality has caused the medical team to perceive good in a different manner than the mother (Annas & Annas, 2001). The medical team have no such moral convictions regarding religion, however, respecting a guardian's decision falls within their professional morality. Their two forms of morality are divergent: obligation to legal standards dictates that they respect the wishes of the child’s guardian, however, their professional morality calls for them to protect life and treat the ill to the best of their capabilities. Both of these routes can be viewed as correct. The obligation to respect primary custody can be upheld by not treating the child. The goal of saving lives will be served by treating him. No matter what course of action the medical team choose, they will violate the other, and therefore both routes are simultaneously right and wrong.

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Decision-Making Model

Utilitarianism is a form of ethical reasoning used to weigh moral outcomes against each other. In this model, while two separate moralities can be mutually exclusive, the outcome of either is not treated as equal. Utilitarianism acknowledges that a “wrong” action is necessary in selecting one action over the other, but it does not acknowledge both possible outcomes as having the same weight. In utilitarianism, one moral violation will be viewed as less severe than another, and therefore, the opposing moral action will be followed.

Resolution

Applying utilitarianism to this issue involves reflection on personal values. The ability to understand one’s own values in a clear manner that is applicable to real life situations is an important trait for medical professionals to possess (McAndrew & Warne, 2008). The idea of going against the wishes of a family member is more tolerable to me than potentially having a child die due to non-action. If given the clear choice between violating a parent’s wishes and not treating a child with a deadly illness, I would choose to treat the child and accept the negative consequences of violating the alternate moral path.

Additionally, the issue at hand is more ambiguous than it appears at first. While it would be my choice to treat the child even if violating the parent’s rights was certain, in this situation, other variables make the morality that guides the need to respect the parent’s decision less clear. For example, primary custody is not the same as sole custody, and depending on the state, the child’s father may have a say in the treatment. So, no violation may in fact occur should I advocate for treatment against the mother’s consent. Furthermore, there is legal precedence of parents being charged with neglect for refusing to seek medical care for their sick child. Depending on the whim of a judge, the mother in this scenario, may not in fact have the right to deny her child treatment, and to follow her wishes would be to defy my professional morals of beneficence and preventing harm.

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Example Dialogue

Mrs. (Parent Name), I am sorry but due to the severity of your son’s condition we are going to have to move forward with treatment. I understand that this is against your wishes, but due to his convulsions, there is a risk that he is experiencing brain damage that could kill him. We have an ethical obligation and a liability to stabilize all patients. We have very good reason to believe that your son’s condition may be immediately fatal without intervention.

I recognize this may be upsetting for you, but please understand that we may be found legally responsible if we do not do everything in our power to help your son. This is especially true since we have the father’s permission to treat him. While I am not a lawyer, it is my understanding that primary custody refers only to the child’s living arrangements, whereas legal custody can be retained by both parents. Given the severity of your child’s condition, if we receive one parent’s permission and do not act, and your child dies, we may be held legally responsible. As such, we are moving forward with your son’s treatment. It is not our intention to offend you; only to ensure your child is receiving the best care possible.

References

Annas, J. and Annas, J. (2001). "Ethics and morality." L. Becker & C. Becker (Eds.), Encyclopedia of Ethics. London, United Kingdom: Routledge.

McAndrew, S. and Warne, T. (2008). "Value." A. Bryan, E. Mason-Whitehead & A. McIntosh (Eds.), Key Concepts in Nursing. London, United Kingdom: Sage UK. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.credoreference.com/content/entry/sageuknurs/value/0.

Purtilo, R. and Dohurty, R. (2011). Ethical Dimensions in the Health Professions. 5th ed. St. Louis, MO: Elsevier Saunders.

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      Eric Nelson 

      3 months ago from Petaluma, CA

      I commend you, Vince, for laying the groundwork for a thoughtful and reasoned discussion on a difficult but important topic. This makes it all the easier for me to share my own perspective on the subject of the ethics of healing in Christian Science.

      Christian Scientists like myself are often mischaracterized as being dogmatic, willing to sacrifice anything – even the health of their child – in the name of their religion. Such a posture is not what Christian Science teaches at all.

      At the heart of our teachings and practice is the Golden Rule, “All things whatsoever ye would that men should do to you, do ye even so to them.” It’s this ethic – this commitment to love, really, which Christian Scientists share with conscientious medical professionals – that finds expression, for instance, in regard for the concerns of others, including other family members as well as the larger society, and obedience to the laws of the land.

      As a Christian church, we have long recognized and continue to urge that parental differences on the care of children in families be worked out on a basis of mutual respect. Reliance on prayer for healing wouldn’t normally be pressed by one parent, even in a divorce, if it is not supported by another. In the same spirit, Christian Scientists recognize their duty of care under the law and are committed to the basic human values that ensure children are well cared for and thrive. The ethics of our practice is always to follow the course that seems most reasonable, wise, and loving in each situation — what will actually bring healing. We love our children as decent parents everywhere do. They are of primary concern, and we wouldn’t feel it was in any child’s interest to become a battleground of contending points of view.

      I found this to be true some years ago when, as a young teenager, I was involved in a serious accident. My pelvis was shattered; my leg was broken; my face was pretty banged up; and as I discovered after being airlifted to a hospital, there was internal bleeding.

      While my parents and I respected the concerns and recommendations of my doctors, they, in turn, respected our preference to rely on spiritual instead of medical means for healing to the extent their professional responsibilities permitted. In the end, no medical treatment was required for my internal bleeding or facial scarring, nor was there any requirement, as was originally expected, to have a metal plate inserted in my hip. Since then I’ve been able to walk across the Grand Canyon in a single day and ride my bike for as many as 200 miles in a single stretch.

      Contrary to what was suggested in your article, such an approach to healing cannot be dismissed as “non-action.” While the track record of Christian Scientists is not perfect, it is remarkable, involving a number of medically diagnosed and confirmed cases (see “A study of Christian Science testimonies of healing / https://www.christianscience.com/press-room).

      Again, I’m grateful for the manner in which you presented this topic and for the opportunity to respond.

      Eric Nelson

      Christian Science Committee on Publication for Northern California

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