HLTH 3100 Week 11 Ethics Course Reflection Example

From Autonomy to Justice: Which Principle Now Carries the Most Weight for Me, Anchored to Two Assignments, and What I Gave Up to Get There

Student Name

Walden University

HLTH 3100: Ethical and Legal Issues in Healthcare

Instructor Name

Month Day, Year

From Autonomy to Justice: Which Principle Now Carries the Most Weight for Me, Anchored to Two Assignments, and What I Gave Up to Get There

Where I Started

In the first week I would have answered without pausing that respect for autonomy is the most important principle in health care ethics. I work at the front desk of a pediatric clinic, and my Week 1 post was about a mother who needed her son's immunization record before a deadline. I argued that the rule requiring written requests had to bend to let a family manage its own affairs. Autonomy, as I understood it then, meant letting people decide for themselves and getting out of their way. I still believe autonomy matters a great deal. But by the end of the course, the principle that carries the most weight for me is justice, the fair distribution of benefits and burdens (Beauchamp & Childress, 2019). This reflection explains how that happened, anchored to two specific assignments, and admits what I gave up.

Anchor 1: The Consent Scenario

In Week 4, I analyzed Mrs. Alvarez's refusal of cardiac catheterization by testing capacity, disclosure and voluntariness one at a time. I expected the case to confirm my view of autonomy: she had capacity, her choice was voluntary, so her refusal should stand. It did confirm that, since she met the usual tests of decision-making capacity (Appelbaum, 2007). But the disclosure test showed something I had not expected. Her refusal rested partly on a gap in information, a belief about the procedure shaped by her husband's death, and nobody had explained the risks in terms she could follow. Respecting her autonomy required more than accepting her answer. It required effort and time from the team, and that effort is not evenly distributed. A patient with an educated, insistent family member gets more of it than a patient who arrives alone.

That was the first time I saw that autonomy depends on resources. A choice is only as free as the information and support behind it, and those are things an organization gives some patients more readily than others.

Anchor 2: The Allocation Argument and the Rebuttal

In Week 9, I argued that 20 places in a free diabetes program should go first to the patients with the highest A1c, then by lottery. In Week 10, a classmate argued for first come, first served, and I rebutted one step in his argument: a rule blind to who people are still sorts them unfairly when their circumstances decide their place in line. Writing that rebuttal changed my view more than anything else in the course. I realized that my Week 1 post had a hidden assumption. The mother at the desk got her record because she could come to the clinic at 4:40 p.m. and speak English with me. A family without those advantages would have met the rule and gone home. My act of bending the rule was kind, but it was not fair, because it depended on who happened to reach the desk. Apparently neutral rules like first come, first served can favor the well-positioned (Persad et al., 2009), and I had been applying exactly that kind of rule in my own work without seeing it.

Smaller Moments That Pointed the Same Way

Two other assignments added to the shift, though less directly. The case of the nursing home photo showed me that the people least able to protect their own dignity, residents with dementia, depend entirely on rules applied consistently by others. And the statute analysis showed me how much of what we call patients' rights depends on whether an organization writes clear procedures. In both, fairness turned out to be a matter of design rather than of good intentions. I also noticed that my discussion posts changed tone over the term. Early posts defended individual choices; later ones asked who was left out of a rule. Rereading them for this reflection was the clearest evidence I have that the shift is real and not just something I am claiming at the end of the course.

Where I Stand Now

Justice now carries the most weight for me, not because it overrides autonomy, but because I now see autonomy as something the system distributes unequally. When I think about a decision at the clinic, I ask first who can use this choice and who cannot, and only then whether the choice is respected. In practice, that has changed small things. I now offer every parent at the desk the same options for getting records, by portal, mail or pickup, in their preferred language, instead of helping whoever asks most persuasively. I have suggested to my manager that our records policy include a same-day option for school forms, written into the policy, so that families get it whoever is on shift.

Both changes are small, and both would have seemed unnecessary to me in the first week of this course.

What I Gave Up

The shift has a cost, and I want to name it honestly. Thinking first about fairness has made me less willing to make the generous exception for the person in front of me. In Week 1, I was proud of bending the rule for one mother. Now I see that the same generosity, applied unevenly, can widen gaps. I have given up some of the satisfaction of individual kindness in favor of consistency, and I am not entirely comfortable with that. There will be cases where a rigid, fair rule fails a particular person whom a flexible clerk could have helped. My answer, for now, is to build the flexibility into the rule, as with the same-day option, so that it is available to everyone and not only to those who know to ask. But I recognize that no written rule anticipates every case, and that the autonomy-first instinct I started with was protecting something real.

I expect my view to keep moving as I gain experience, and I would rather hold it honestly than defend it as settled.

References

Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431. https://doi.org/10.1016/S0140-6736(09)60137-9