First year Caroline Cristofaro, bravely explores the controversial issue of the impact that the religious views of Jehovah’s Witnesses has on their healthcare.
In the field of medicine, there has been a constant battle of wills between doctors and patients: a doctor insisting on a patient’s consent for treatment that would be in a patient’s best interest, and the patient refusing to do so for various reasons. This has become an increasing source of frustration for doctors as they are being barred from giving the best care to patients, by the patients themselves. A classic example of this would be a Jehovah’s Witness patient refusing to consent for a blood transfusion when undergoing surgery with a high risk of blood loss.
The primary ethical question, which arises from this scenario, is whether a surgeon is correct in administering an allogeneic blood transfusion, even if the patient has specifically withheld their consent on the grounds of their religious beliefs ? The reason why this question is so difficult to answer is that both the autonomy of a patient and the role of a health professional are being called into question; which holds more weight?
In June of 2012, a 22-year-old man diagnosed with sickle cell disease was allowed to pass away after refusing to have a blood transfusion (Dyer, 2012). Being a Jehovah’s Witness himself, he refused the transfusion based on his religious beliefs. His mother, also a Jehovah’s Witness, spent much time at his bedside and doctors suspected that perhaps she coerced him into withholding his consent. After being assessed by a doctor from a neighbouring trust, it was confirmed that he did indeed have full capacity . These circumstances were very difficult for the doctors treating him as such a simple procedure would have saved his life . However, if they had interfered and overruled his decision, legal action would have been taken and the doctors would have been charged with assault (Jehovah’s Witness Ethics, 2009). Such examples hold a great deal of frustration for doctors in the medical practice, as they are unable to act in the patient’s best interests (which is the primary goal of health care professionals) because of the patients themselves.
However, the situation changes when the patient in question is younger than 16 years of age, as their parents, the proxy-decision makers, now give consent (Knott, 2011). If this refusal to give consent interferes with the health of the child, which it often does, then there are two legal actions that may be taken; either the child will become a ward of court or the court will release a specific issue order that legally eliminates the need for parental consent for a specific treatment (Knott, 2011). Therefore, a parental refusal for consent regarding their child can be overruled, but they can still remain as the proxy-decision makers for all other medical procedures concerning their child (Knott, 2011). This acknowledges that it is possible for parents to make decisions that are detrimental to a child’s health because of the weight certain views or beliefs hold for them. If a parent feels very strongly about their Jehovah’s Witness faith, they may regard their child having allogeneic substances transfused in their body worse than their child losing their life (Jehovah’s Witness Ethics, 2009). It should be noted that the court almost always supports medical professionals in these sorts of cases, but there have been instances when the court has decided to allow parents to refuse to give consent for their child’s treatment (Dyer, 1996).
In 1996, the Court of Appeal supported a mother’s refusal to give consent regarding her son receiving a life-saving liver transplant (Dyer, 1996). The boy was born with biliary atresia (bile ducts within or outside of the liver are blocked or have abnormal openings, which results in obstructed bile flow) (Biliary Atresia, 2012) and doctors predicted that the boy would only live for another year without the transplant (Dyer, 1996). The parents were both experienced health care professionals and based their decision on a previous operation their son had had which caused him much pain and had virtually no benefits on his health (Dyer, 1996). Due to the fact that both parents were experienced medical professionals and they had a strong base for why they refused to give consent, the court decided to rule in their favour and respected their decision (Dyer, 1996). Albeit these particular cases, where medical judgment is opposed, the legal proceedings in the 1989 Children’s Act have greatly aided doctors in delivering care to children without being hindered by parents unwilling to comply due to their own religious reasons (Knott, 2011).
Lastly, another ethical question begs to be asked: is it morally right for a surgeon to refuse to treat a Jehovah’s Witness patient because their religious views prohibit them from accepting a blood transfusion? There are surgeons who refuse to operate on practicing Jehovah’s Witness patients (Jehovah’s Witness Ethics, 2009) as they are not prepared to watch a patient die a preventable death or because they are considered high risk and will skew the surgeon’s results, making the surgeon seem less proficient. Some would argue that doctors should always operate if it is in the best interests of the patient, others would say they are right in refusing or that it would depend on the surgeon’s reasoning behind the refusal. Although many oaths and medical teachings state that doctors should not discriminate against patients, including their religions, surgeons are legally allowedto refuse to operate on a patient (Jehovah’s Witness Ethics, 2009).
Among all of the “gray” areas of the ethical dilemmas of medicine, the law has solved some, but many still remain a great source of exasperation for medical professionals. Although most verdicts favor the side of health care professionals, sometimes the patient’s own religious beliefs are given more weight (Dyer, 2012). The crux of frustration for doctors is that just one of these four ethical principles of medicine can trump the remaining three. Patient autonomy is held as the most legally important ethical principle of medicine, whilst the other principles have the most benefit to a patient’s health which doctors support the most (Jehovah’s Witness Ethics, 2009).
Drake, D P., Morecroft, J A., Wheeler, R A., Wright, V M 1996, ‘Management of blood loss in children ofJehovah’s Witnesses’. BMJ 10 February. Available from <www.bmj.com>. [2 November 2013]. !
Dyer, C 2012, ‘Young Jehovah’s Witness who refused a blood transfusion is allowed to die’. BMJ 12 June.Available from <www.bmj.com>. [2 November 2013]. !
Dyer, C 1996, ‘Mother wins right to refuse treatment for her child’. BMJ 2 November. Available from<www.bmj.com>. [2 November 2013]. !
Knott, L 2011, ‘Consent to Treatment in Children (Mental Capacity and Mental Health Legislation)’.PatientPlus 19 October. Available from <http://www.patient.co.uk/patientplus.asp>. [2 November 2013]. !
Biliary Atresia 2012. Available from:<www.digestive.niddk.nih.gov/DDISEASES/pubs/atresia/>. [2 November 2013]. !
Jehovah’s Witness Ethics 2009. Available from:<www.bbc.co.uk/religion/religions/witnesses/witnessethics/ethics_1.shtml>. [2 November 2013].