Case Study: Healing and Autonomy – Parental Autonomy, Christian View of Sickness and Medicine, and Spiritual Needs Assessment
15 min read Case Study: Healing and Autonomy
Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.
The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.
Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.
James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.
Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”
Questions
- Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale.
- How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care?
- How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care?
Introduction
The Healing and Autonomy case places a sincere Christian father at the center of a conflict between faith and medicine. Mike’s decision to delay dialysis was made out of love and conviction, yet it contributed to permanent kidney damage in his son. Now he faces a second, harder choice: whether to allow James’s identical twin, Samuel, to donate a kidney, or to “wait for a miracle.” The case raises questions about who holds autonomy when the patient is a child, how Christians understand sickness and medicine, and how clinicians can respect a family’s faith while protecting a child’s life. This article works through the three questions using the four principles of biomedical ethics (Beauchamp & Childress, 2019), pediatric ethics guidance and a Christian theological perspective.
James cannot consent; parents decide as surrogates for his best interest
Dialysis and transplant offer James life and health
Delaying treatment caused harm; donation carries risk for Samuel
Both children deserve equal protection and fair consideration
1. Should the physician let Mike keep making harmful decisions, or would overriding him disrespect autonomy?
The patient is James, not Mike. Autonomy is the right of a competent person to make informed decisions about their own body and care (Beauchamp & Childress, 2019). James is 8 years old and cannot give informed consent. Mike and Joanne make decisions as surrogates, and surrogate decision-making for a child is judged by the best-interest standard: what will most likely promote the child’s welfare, not what reflects the parent’s personal values. Parental authority is broad but not unlimited. Parents may raise their children in their faith and make many choices clinicians would not, but they may not refuse effective treatment when the refusal places the child at serious risk of death or permanent harm.
The American Academy of Pediatrics (AAP) holds that respecting parents’ wishes is important, but that withholding care that could prevent death or serious disability is medical neglect, and that clinicians should seek state intervention when needed (American Academy of Pediatrics Committee on Bioethics, 2013). Adults may refuse life-saving treatment for themselves on religious grounds, but they may not make that choice for a child who has not yet formed his own beliefs.
My position: the physician should not allow Mike to continue making decisions that are clearly harmful to James, and doing so would not violate patient autonomy. Overriding a surrogate’s harmful decision actually protects the autonomy of the real patient, James, by keeping him alive long enough to make his own choices as an adult. That said, the physician should not start with coercion. A respectful, stepwise approach would be:
- Listen and understand Mike’s beliefs, fears and hopes without ridicule.
- Inform clearly about the condition, the benefits of treatment and the specific risks of delay, in plain language, and check understanding.
- Look for common ground: prayer and medical treatment are not mutually exclusive. Invite the pastor or a hospital chaplain into the conversation.
- Use support resources: an ethics consultation, social work and the hospital’s legal team.
- As a last resort, if refusal threatens death or permanent harm, involve child protective services or seek a court order, as clinicians are obligated to do (AAP Committee on Bioethics, 2013).
In the first decision, the physician could reasonably have pressed harder before letting James leave, because the delay predictably led to permanent kidney failure. Going forward, the physician should keep James on dialysis regardless of Mike’s hopes for a miracle and should guide the transplant decision carefully, because it involves a second child.
2. How should a Christian think about sickness, health and medical intervention?
Sickness and health in the Christian narrative
The Christian story moves through creation, fall, redemption and restoration. God created human beings good and embodied, and health reflects that original goodness. Sickness and death entered the world through the fall. They are part of a broken creation, not usually a direct punishment for a specific person’s sin (Hoehner, 2020). Jesus rejected the idea that illness proves personal guilt when his disciples asked whose sin caused a man’s blindness: “Neither this man nor his parents sinned” (John 9:3, New International Version). Christians hope for final restoration, when there will be “no more death or mourning or crying or pain” (Revelation 21:4), but in the meantime they care for the sick as an act of love.
This answers Mike’s tormented questions. James’s illness is not evidence that Mike lacked faith or that God is punishing him or his son. Mike needs to hear that grace and forgiveness apply to his earlier decision, which he made in love.
Medicine as a gift, not a rival to faith
Mainstream Christian tradition sees medicine as one of the ways God heals. Physicians use knowledge of God’s created order, and their skill can be understood as a gift of common grace. Scripture supports using means: James 5:14 calls for prayer and anointing with oil, a common medicine of the time; the Good Samaritan bandaged wounds with oil and wine (Luke 10:34); Paul advised Timothy to take some wine for his stomach (1 Timothy 5:23); and Luke was “the doctor” (Colossians 4:14). Jesus said, “It is not the healthy who need a doctor, but the sick” (Mark 2:17). Faith and medicine therefore work together: Christians pray for healing and accept treatment, trusting God through both (Hoehner, 2020).
Mike’s reasoning that refusing treatment shows “greater faith” also deserves gentle challenge. When Satan urged Jesus to throw himself from the temple so God would rescue him, Jesus answered, “Do not put the Lord your God to the test” (Matthew 4:7). Deliberately refusing available help to force a miracle can become testing God rather than trusting Him. Real faith can say, “God may heal through dialysis, a transplant or a miracle, and I will trust Him whatever the outcome.”
What should Mike do?
- Continue dialysis without hesitation. It is keeping James alive and is fully compatible with prayer.
- Pursue a transplant, including placing James on the deceased-donor waiting list and exploring all living donors.
- Consider Samuel’s donation carefully, not hastily. As an identical twin, Samuel is an ideal genetic match, which greatly reduces rejection risk. However, Samuel is also an 8-year-old who cannot give informed consent, and removing a healthy kidney carries surgical risk and lifelong implications for him. Beneficence and nonmaleficence apply to both sons. Living donation by minors is ethically permissible only in exceptional circumstances, with strong safeguards: a close emotional relationship and benefit to the donor, low risk, no suitable adult donor, the child’s assent and an independent donor advocate who represents Samuel’s interests alone (Ross & Thistlethwaite, 2008). An identical twin donating to a twin is one of the situations in which these criteria are most likely to be met, but the decision must be made by a transplant team and ethics committee, not by guilt or pressure.
- Pray, seek counsel and include Joanne and his church community. Faith should support wise action, not replace it.
Reasoning about trust, beneficence and nonmaleficence
For Mike, honoring beneficence means actively doing good for James: accepting treatments that are likely to help. Honoring nonmaleficence means avoiding harm: delaying effective treatment caused harm once, and doing so again would be a moral failure, not a test of faith. At the same time, nonmaleficence protects Samuel. Mike should not treat Samuel’s kidney as a way to “make up” for his earlier choice. A Christian ethic of love (agape) values sacrifice, but genuine sacrifice is freely given. Mike’s role is to protect both children and let the medical team and ethics process evaluate whether Samuel’s donation is appropriate.
| Option | Beneficence (for James) | Nonmaleficence | Christian reasoning |
|---|---|---|---|
| Refuse treatment and wait for a miracle | None; risks death | Serious harm to James | Risks testing God; not required by faith |
| Continue dialysis and wait for a deceased donor | Keeps James alive; transplant may come later | Dialysis burdens but no new harm to Samuel | Prayer and medicine together |
| Living donation from Samuel | Best match and outcome for James | Surgical risk and loss of a kidney for a child who cannot consent | Acceptable only if freely assented to, low risk and approved with independent safeguards |
3. How would a spiritual needs assessment help?
A spiritual needs assessment is a structured conversation that identifies a patient’s or family’s beliefs, values, sources of meaning and support, and how these affect health decisions. It is not an attempt to change someone’s faith. It helps clinicians understand why a family is choosing as it is and how to work with their beliefs rather than against them. Widely used tools include FICA and HOPE.
The FICA spiritual history tool asks about (Puchalski & Romer, 2000):
- F – Faith, belief and meaning: “Do you consider yourself spiritual or religious? What gives your life meaning?”
- I – Importance and influence: “How do your beliefs influence the decisions you make about James’s health care?”
- C – Community: “Are you part of a faith community? How does it support you?”
- A – Address in care: “How would you like us to address these issues in James’s care?”
For Mike’s family, an assessment would help the physician in several ways:
- Reveal Mike’s specific beliefs about healing, faith and medicine, including whether he believes accepting treatment shows a lack of faith. Many Christian traditions, including probably his own church, do not teach this, and this opens room for dialogue.
- Uncover guilt and spiritual distress. Mike’s questions about punishment and insufficient faith are signs of spiritual distress that affect his decision-making and well-being. A chaplain can address them directly.
- Identify supports, such as the pastor and church members who have already offered kidneys. With the family’s permission, the pastor can be invited to a care conference, where he may affirm that seeking medical treatment is compatible with faith.
- Guide interventions: referral to the chaplain, prayer with the family if they wish, culturally and spiritually sensitive education, family meetings and counseling.
- Include everyone affected: Joanne, who agreed to the first decision; Samuel, who needs age-appropriate information and his own advocate; and James, who needs comfort and hope during dialysis.
- Build trust, which makes the family more likely to accept treatment recommendations and less likely to leave the hospital against medical advice.
By taking Mike’s faith seriously, the physician can reframe the decision: trusting God and accepting dialysis and transplant are not opposites. That reframing gives the best chance of a decision that protects both boys and that Mike can live with spiritually.
Sample discussion post
Original example for study purposes. Use it as a model, not as your submission.
The physician should not allow Mike to continue making decisions that harm James, and intervening would not disrespect autonomy, because James, the patient, is an 8-year-old who cannot consent. Parents act as surrogates under the best-interest standard, and refusing treatment that prevents death or permanent harm crosses into medical neglect (AAP Committee on Bioethics, 2013). The physician should first listen, educate and involve a chaplain or pastor, and seek legal intervention only if needed.
From a Christian perspective, sickness results from a fallen world, not personal punishment (John 9:3), and medicine is one of the means God uses to heal (Hoehner, 2020). Mike can pray for a miracle while accepting dialysis and pursuing a transplant. Refusing help to force a miracle risks testing God (Matthew 4:7). Beneficence and nonmaleficence apply to both sons, so Samuel’s donation should only proceed with his assent, an independent donor advocate and ethics review (Ross & Thistlethwaite, 2008).
A spiritual needs assessment, such as FICA (Puchalski & Romer, 2000), would reveal Mike’s beliefs, guilt and support system, guide chaplain and pastoral involvement and help the team build trust, so treatment decisions honor both the family’s faith and James’s welfare.
Frequently asked questions
Can parents refuse treatment for a child on religious grounds?
Parents have wide latitude, but when refusing treatment puts a child at serious risk of death or permanent harm, clinicians are expected to intervene, which may include involving child protective services or the courts (AAP Committee on Bioethics, 2013). State laws vary.
Can a minor be a living kidney donor?
Only in exceptional circumstances, with safeguards such as the child’s assent, low risk, no suitable adult donor, a close relationship that benefits the donor and an independent donor advocate (Ross & Thistlethwaite, 2008).
Why is an identical twin an ideal donor?
Identical twins share the same genetic tissue type, so the risk of rejection is very low and less immunosuppression may be needed.
Related reading: Healing and Autonomy: Christian narrative analysis, what makes a true ethical dilemma, cultural humility in health care, the ANA Code of Ethics and continuing education and professional nursing values.
Conclusion
The Healing and Autonomy case shows that respecting a family’s faith does not mean accepting every decision made in its name. Because James is a child, his parents’ authority is limited by his best interests, and the physician has a duty to protect him. A Christian understanding of sickness, healing and medicine supports prayer and treatment together and frees Mike from the false belief that accepting medical care is a failure of faith. A spiritual needs assessment gives the care team a respectful way to understand the family, address Mike’s guilt, involve trusted spiritual leaders and reach decisions that honor beneficence and nonmaleficence for both James and Samuel.
References
American Academy of Pediatrics Committee on Bioethics. (2013). Conflicts between religious or spiritual beliefs and pediatric care: Informed refusal, exemptions, and public funding. Pediatrics, 132(5), 962–965. https://doi.org/10.1542/peds.2013-2716
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Hoehner, P. J. (2020). Practicing dignity: An introduction to Christian values and decision making in health care (2nd ed.). Grand Canyon University.
New International Version Bible. (2011). Biblica. (Original work published 1978)
Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129–137. https://doi.org/10.1089/jpm.2000.3.129
Ross, L. F., Thistlethwaite, J. R., Jr., & Committee on Bioethics. (2008). Minors as living solid-organ donors. Pediatrics, 122(2), 454–461. https://doi.org/10.1542/peds.2008-1525
