2 instances Re: a patient refusing lifesaving treatment on religious grounds:

[Knicks]

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Is the following correct?:

1- If a competent patient refuses lifesaving treatment (for themselves) on religious grounds, then the physician should listen to this patient and don't treat.


2- If competent parents refuse lifesaving treatment for their child on religious grounds, you ignore the parents' refusal and treat the child anyway.

 

[lilnoelle]

Is the following correct?:

1- If a competent patient refuses lifesaving treatment (for themselves) on religious grounds, then the physician should listen to this patient and don't treat.


2- If competent parents refuse lifesaving treatment for their child on religious grounds, you ignore the parents' refusal and treat the child anyway.

yep, life and limb saving treatment will always be given, even with parental refusal... although it will require legal action... but you'd start treatment and then deal with the rest

 

[wonderboy00]

how about if a competent patient refuses life-saving treatment for his unconscious wife? There was a USMLE world questions similar to this involving a Jehova's witness who refused a life-saving blood transfusion for his wife and son....the answer said that you can't treat the wife but you can get a legal order to treat the child...i don't understand why you can treat the child but not the wife...can anyone explain please?

 

[TerpMD]

Parents don't have the legal right to refuse life saving treatment for a minor no matter what. Adults can refuse life saving treatment all they want and since he is the husband he has power to make decisions for the wife in that case, he can say not to treat. Hope that helps...

 

[45408]

how about if a competent patient refuses life-saving treatment for his unconscious wife? There was a USMLE world questions similar to this involving a Jehova's witness who refused a life-saving blood transfusion for his wife and son....the answer said that you can't treat the wife but you can get a legal order to treat the child...i don't understand why you can treat the child but not the wife...can anyone explain please?

Yeah, I didn't like that question either, but it made sense after doing more similar questions. She would have never married him (or shouldn't have) if he were going to make decisions about her life that she wouldn't agree with. You just have to assume that her husband's decisions about her life and death issues are the same decisions she would make if she were conscious/coherent, even if those decisions will result in her death. Plenty of JWs have refused transfusions for themselves.

The child is different because he had no choice in being the child of a Jehovah's Witness, and you don't assume that he is okay with being allowed to die.

 

[myrtle]

The Kaplan Ethics book lays out the rules pretty clearly, has 100 or so case questions and can be read quickly if any one has some extra money laying around.

Another note is that in that scenario, you'd treat the child immediately, not wait for a court order or consult the ethics board.

 

[osli]

In our ethics classes we dealt with a more subtle case... a minor with a congenital heart defect that required treatment, and the family did not want it for religious reasons (the surgery scarred the body eternally and it was not worth being scarred in the afterlife to improve quality or be here longer in this life).

The defect was not immediately life threatening, though it was clear that without correction it was something that was going to progress and at some point prove fatal (i.e., shorten the life span). It was never clear that the physicians had an option to force treatment on the minor.

Was this because the threat to life was not immediate? How do you handle situations in which if treatment is withheld now, death will be the result at some point down the road (say some chronic condition that will require lifelong or at least long term therapy to halt disease progression, that if not given now will bring death as a result of the disease progression later)?

 

[lilnoelle]

In our ethics classes we dealt with a more subtle case... a minor with a congenital heart defect that required treatment, and the family did not want it for religious reasons (the surgery scarred the body eternally and it was not worth being scarred in the afterlife to improve quality or be here longer in this life).

The defect was not immediately life threatening, though it was clear that without correction it was something that was going to progress and at some point prove fatal (i.e., shorten the life span). It was never clear that the physicians had an option to force treatment on the minor.

Was this because the threat to life was not immediate? How do you handle situations in which if treatment is withheld now, death will be the result at some point down the road (say some chronic condition that will require lifelong or at least long term therapy to halt disease progression, that if not given now will bring death as a result of the disease progression later)?

In a less emergent case, you'd have time to have a court decide if the child should be treated or not. In an emergency situation, time is a large factor and therefore, its important that we understand to go ahead and take care of the child right then rather than wait for a judge's permission.

 

[myrtle]

In our ethics classes we dealt with a more subtle case... a minor with a congenital heart defect that required treatment, and the family did not want it for religious reasons (the surgery scarred the body eternally and it was not worth being scarred in the afterlife to improve quality or be here longer in this life).

The defect was not immediately life threatening, though it was clear that without correction it was something that was going to progress and at some point prove fatal (i.e., shorten the life span). It was never clear that the physicians had an option to force treatment on the minor.

Was this because the threat to life was not immediate? How do you handle situations in which if treatment is withheld now, death will be the result at some point down the road (say some chronic condition that will require lifelong or at least long term therapy to halt disease progression, that if not given now will bring death as a result of the disease progression later)?

The book I have doesn't deal directly with that issue but it does emphasize that you treat the child immediately for something that is an emergency. I'm guessing but I think the thing to do in the case of something like this where it could be life-threatening down the line would be to get a court order or go to the ethics board.

 

[myrtle]

In a less emergent case, you'd have time to have a court decide if the child should be treated or not. In an emergency situation, time is a large factor and therefore, its important that we understand to go ahead and take care of the child right then rather than wait for a judge's permission.

She said it better!

 

[Knicks]

yep, life and limb saving treatment will always be given, even with parental refusal... although it will require legal action... but you'd start treatment and then deal with the rest

Cool, thanx. 🙂

 

[PeepshowJohnny]

A good example for a nonemergent case was that hippy-dippy kid with Hodgkin's disease who was a minor and wanted to refuse his chemo (with his parent's support). http://en.wikipedia.org/wiki/Virginia_v._Cherrix