Applying the Four Principles: Case Study

Medical Indications

Beneficence and Nonmaleficence

The patient is a boy, eight years old James, for whom A streptococcus infection caused acute glomerulonephritis, kidney failure. It is a rare disease, as well as an uncommon complication (Center for Disease Control and Prevention, 2018). Elevated blood pressure and enough fluid buildup were indications for the use of temporary dialysis, which, however, was not applied. Two days after the refusal, the patient’s condition worsened – he needs constant dialysis and a kidney transplant within the year. The only suitable donor is James’s twin brother – Samuel.

Patient Preferences


Due to the age of the patient, his parents, Mike and Joanne, make decisions about his health. Their preference is healing through faith and prayer. However, they are depressed, as their first decision, orientated on this preference, has led to complications and the need for a kidney transplant. Parents are more open to deciding on procedures than before since each intended to give their son their kidney but turned out to be incompatible. Several other donors also proved unsuitable, leading to the option of using the patient’s twin-brother’s kidney. Mike and Joanne have doubts whether it is worth asking Samuel to donate a kidney, or they should hope for the will of God.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

James, in regular dialysis procedures, has an average quality of life – he is stable. A patient with this diagnosis is most likely to experience a decline in strength, dizziness, or headache due to pressure, loss of appetite, pain, and swelling in the joints. However, kidney transplantation is necessary within a year, and then this will increase his life expectancy and will not require dialysis.

Contextual Features

Justice and Fairness

The patient’s parents are Christians and believe in God’s will, and the pastor of their church is an authoritative figure for them. The rarity of the disease could affect the perception of its complexity. Moreover, parents would like their child to have a new kidney. A crucial aspect of the case is that the patient has a brother twin, Samuel, who can become an ideal donor. Considering close relationships that are usually established between twins, the loss of a brother can negatively affect Samuel’s future and health.

According to the Christian worldview, how would each of the principles be specified and weighted in this case?

Medical ethics principles and religious views are often encountered in practice. They can both complement and contradict each other, and it is vital to know how ethical principles can be interpreted in a religious view:

  • Beneficence and Nonmaleficence. The practical attitude of a doctor towards a sick person initially focused on care, assistance, and support, is undoubtedly the main feature of professional medical ethics. In Christian morality, there are the norms for interpersonal relationships – “love your neighbor as yourself” (“Mark 12:30-31,” n.d.) “love your enemies” (“Matthew 5:43-48,” n.d.). In professional medical ethics, they are a real criterion for both choosing a profession and determining the measure of medical art. This fact means that the doctor primarily takes care of James’ well-being and makes recommendations for his recovery. Moreover, for a Christian, the sanctity of life is essential principally. If parents and medical personnel correctly explain to Samuel what donation will mean, it will be an act of love and life-saving.
  • Autonomy. In the studied case, the decision is taken by the patient’s parents. According to the Christian worldview, parents must take care of their children’s physical and spiritual well-being. For this reason, they must make a decision that is as appropriate as possible to the interests of James and Samuel.
  • Justice and Fairness. From a Christian point of view, justice is that a doctor treats everyone equally, regardless of the circumstances (Torry, 2017). In any such case, if the family had a different religion or race, the patient would be offered the same treatment.

According to the Christian worldview, how might a Christian balance each of the four principles in this case?

For the most effective application of ethical principles, a Christian must evaluate their use according to the situation. In the studied case, beneficence plays the most critical role since James may die in the absence of any actions. The sanctity of life requires medical personnel and the boy’s family to use all possible measures to save him. A Christian must also show love for his neighbor. Donation and caring can be one way to manifest it and follow Jesus “example of sacrifice (“A Christian perspective on organ donation,” n.d.). Moreover, the nonmaleficence principle also applies here, since lack of action can cause even more harm to James.

Justice and autonomy are not so important in this case. A Christian must always act honestly – a doctor when allocating resources for treatment, and parents when making decisions about their sons. It may seem dishonest to take away a healthy son’s kidney to treat James. However, it will also be unfair to deny him the chance to save his brother and show his love. Autonomy can manifest itself in respect for the positions of each of the parties concerned and in non-conflict communication. For example, considering the pastor’s authority, the doctor may suggest that James” parents consult with him. Summing up, the balance of ethical principles from a Christian’s point of view, in this case, shifts in favor of beneficence. The boy’s life is sacred, and if there is an opportunity to save him, everyone needs to take advantage of it.


A Christian perspective on organ donation. (n.d.). Web.

Center for Disease Control and Prevention. (2018). Post-streptococcal glomerulonephritis: All you need to know. Web.

Mark 12:30-31. (n.d.). Web.

Matthew 5:43-48. (n.d.). Web.

Torry M. (2017). Ethical religion in primary care. London journal of primary care, 9(4), 49–53. Web.

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