Amish Case Study: Ethical And Legal Considerations In Pediat
Amish Case Study: Ethical and Legal Considerations in Pediatric Cancer Treatment
This paper explores the ethical and legal complexities involved in the case of Sarah Hershberger, an Amish girl diagnosed with lymphoblastic lymphoma, whose parents have refused chemotherapy treatment, favoring natural remedies and religious beliefs over modern medicine. The case raises critical questions regarding patient autonomy, beneficence, nonmaleficence, justice, and fidelity, particularly as they relate to minors and culturally religious families. It discusses the facts of the case, the involved parties, ethical principles, potential alternative actions, and the implications of age and cultural beliefs in medical decision-making. Finally, it offers a reasoned recommendation from an ethics committee perspective based on core ethical standards and legal precedents.
Introduction
The case of Sarah Hershberger vividly illustrates the tension between parental rights, cultural and religious values, and medical obligations in pediatric healthcare. As an Amish family, the Hershbergers prioritize faith and natural healing approaches, challenging the medical consensus that chemotherapy offers a significant chance of cure. This situation involves complex ethical principles, legal considerations, and cultural sensitivities, making it a compelling subject for analysis within healthcare ethics.
Facts of the Case
The case involves Sarah Hershberger, a 10-year-old girl diagnosed with lymphoblastic lymphoma, a type of non-Hodgkin lymphoma with an 85% five-year survival rate when treated with chemotherapy (Bushak, 2013). The diagnosis was made at Akron Children’s Hospital, where she initially received chemotherapy. Her Amish parents, Andy and Anna Hershberger, later decided to terminate her treatment, citing religious beliefs and a preference for natural remedies such as herbs and vitamins. They believe they can "use modern medicine, but at some times we have to stop it and do something else" (Bushak, 2013). An Ohio Medina County judge initially ruled that the parents have the right to decide her medical care. However, an appellate court reversed this decision, favoring the hospital’s position that life-saving treatment should continue, viewing the case as a matter of life and death (Bushak, 2013). The involved parties include Sarah, her parents, healthcare providers at Akron Children’s Hospital, legal authorities, and the court system. The ethical situation primarily occurs in Ohio, where the legal and medical processes are underway, and the conflict aligns with urgent health, legal, and ethical concerns.
Ethical Principles and Issues
Autonomy
Autonomy, the right of individuals to make decisions about their own bodies, is challenged here. As a minor, Sarah’s capacity for autonomous decision-making is limited; parental authority typically guides her care. However, her expressed desire to refuse treatment and her testimony against resuming chemotherapy complicate this principle, raising the question of whether her autonomy should be respected or overridden by her parents and medical professionals.
Beneficence
The principle of beneficence obligates healthcare providers to act in the best interest of the patient, promoting well-being and preventing harm. In this case, chemotherapy's high success rate suggests that continuing treatment aligns with beneficence, aiming to save Sarah’s life (Bushak, 2013). The hospital advocates for this, asserting that stopping treatment would likely result in death.
Nonmaleficence
Nonmaleficence, the obligation to do no harm, supports continuing chemotherapy to prevent harm through disease progression. Conversely, the parents argue that chemotherapy causes pain and suffering and that respecting their religious beliefs is essential, which introduces a conflict between preventing harm and respecting cultural values.
Justice
Justice relates to fair treatment and resource allocation. This case questions whether the child’s right to life supersedes cultural and religious freedoms. The legal system aims to ensure that Sarah receives appropriate medical care, balancing individual rights with societal obligations to protect vulnerable minors.
Fidelity
Fidelity involves faithfulness and loyalty to the patient’s best interests and to ethical commitments. Healthcare providers are tasked with maintaining trust and advocating for Sarah’s well-being, which in this context supports continuing treatment despite parental objections.
Major Principles, Rules, and Values
The key values include respect for cultural and religious beliefs, the sanctity of life, and the rights of children. Ethical principles such as beneficence and nonmaleficence prioritize saving Sarah’s life, while respect for autonomy and cultural values emphasizes honoring parental authority and religious convictions. The rules governing pediatric care generally favor parental rights but also include legal mandates to prevent harm to minors, especially in life-threatening situations.
Alternative Actions by Parents and Healthcare Facility
Potential alternatives include continued negotiation and counseling to find a mutually acceptable treatment plan that respects religious beliefs while emphasizing the importance of medical treatment. The hospital might offer integrative approaches, combining natural remedies with supportive therapies, or seek religious-compatible compromises. Legally, courts may mandate treatment, as seen in prior cases involving minors and life-saving procedures, to prevent imminent death (Seewer, 2013).
Respecting Cultural and Religious Beliefs
While hospitals are ethically obliged to respect cultural and religious beliefs, this respect does not extend to actions that would cause significant harm or death. The case raises the question of whether religious beliefs justify withholding standard medical treatment in minors. Courts have previously intervened in similar cases to uphold the child's right to life, such as Jehovah’s Witnesses’ refusal of blood transfusions (Seewer, 2013). It remains that healthcare systems have an ethical obligation to protect minors from harm, even when it conflicts with religious convictions.
Impact of Patient’s Age
The age of the patient significantly affects ethical considerations. As a minor, Sarah cannot fully exercise autonomy; parental authority typically guides decisions. However, her capacity to express informed dissent complicates matters, especially given her age's influence on courts and decision-makers. While adults may refuse treatment based solely on personal beliefs, minors’ rights are often subordinated to protect their well-being, prompting legal interventions to ensure necessary care (Seewer, 2013).
Recommendations as an Ethics Committee Member
From an ethical standpoint, prioritizing Sarah’s best interests aligns with the principles of beneficence and nonmaleficence. I would recommend that the healthcare facility pursue legal avenues to ensure continuation of chemotherapy, as this treatment offers the best chance for survival. Efforts should also be made to involve culturally sensitive counseling to address the family’s beliefs, emphasizing that preserving life does not necessarily conflict with religious values. It is crucial to uphold Sarah’s right to receive life-saving treatment while respecting her and her family’s cultural context. If negotiations fail, judicial intervention should be supported, ensuring that the child's welfare takes precedence over parental religious objections, consistent with established legal precedents (Bushak, 2013).
Conclusion
The case of Sarah Hershberger underscores the complex interplay between ethical principles, legal statutes, cultural values, and medical responsibilities. While respecting religious beliefs is fundamental, the paramount obligation to protect vulnerable minors from imminent harm justifies overriding parental refusal of essential treatment. Ethically and legally, the best interests of the child must prevail, with compassionate efforts to respect the family’s cultural background within the bounds of medical necessity. Ultimately, judicial intervention appears justified to save Sarah’s life, exemplifying how ethical principles guide real-world medical decisions where conflicts arise.
References
- Bushak, L. (2013, August 9). Court rules that Sarah Hershberger, Amish girl battling cancer, should be appointed legal guardian after parents stop her chemotherapy. Medical Daily. https://www.medicaldaily.com
- Seewer, J. (2013, November 28). Amish family flees from chemo doctors say girl will die; Parents say she's better. Journal-Gazette. https://www.journalgazette.net
- Legal and Ethical Issues for Health Professionals: Chapters 7-8. (2023). Aspen Library.
- Bismarck Tribune. (2013, August 29). Court sides with Ohio hospital on Amish girl care.
- Church & State. (2013, October). Court intervenes in cancer treatment of Ohio Amish child.
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