Step I Ethics Question

Started by Lonely Sol
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Lonely Sol

Lonely Sol

cowgoesmoo fan!
15+ Year Member
Mother refuses to consent to emergency life-saving treatment for her daughter on religious grounds, do you treat or no treat? (Assume daughter is younger than 18)?

Kaplan says to Treat..but I thought Parents have the right.

Can someone explaing..maybe I am just fried from studying all day or something but im not getting it. I know we are suppose to save lives, but what about in this case?
 
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Minors can only make medical decisions in a few circumstances. This includes STDs and Pregnancy. All other medical decisions are made by the parent, unless the child is emancipated. Your first duty is to act in the best interest of the child. In an urgent situation, like transfusion, you always give the life saving treatment, even if it goes against the parents wishes. This is because of the duty to act in the interest of the child. If the situation were not urgent, say chemotherapy was needed, then a court order would be appropriate, because time is of less importance. Acting in the patient's best interest is croosh. I have had a couple questions on Exammaster dealing with this one.

I would highly recommend this book for boning up on BE: http://www.amazon.com/Cambridge-Textbook-Bioethics-Peter-Singer/dp/0521694434
My school's library has it and I use it for USMLE Step 1 BE when its not checked out (which it always is because everyone uses it! Uggh.)
 
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I've seen a few practice questions with this already...

A 42-yr-old man and his wife and 8-yr-old child are in a car accident. They are all BIBA to the hospital. The father is completely normal, conscious, aware, etc., but the mother and son are unconscious and need urgent transfusions for survival. The father is competent and absolutely refuses transfusions for both of them, and he even presents a card proving that they're all Jehovah's witness.

A general rule is that, in an emergency situation, you always transfuse JW children, even if the parents show proof of JW.

For adults, they always have their autonomy and can refuse Tx irrespective as to whether they're JW or not. If the father can show proof of the mother's JW, then the mother shouldn't be transfused, otherwise the physician can be sued for assault/battery.

In a non-emergent situation regarding transfusion of a child, don't transfuse, because, once again, irrespective of whether the child is JW, it is the parents that always are righted to give consent for any medical/surgical Tx for their children, and in this case, there's nothing immediately life-threatening. The physician can pursue a court-order, however, if there's enough time to do so and the pt's condition is serious enough where, although the situation isn't an emergency, his or her condition is serious enough to warrant it.
 
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Phloston said:
I've seen a few practice questions with this already...

A 42-yr-old man and his wife and 8-yr-old child are in a car accident. They are all BIBA to the hospital. The father is completely normal, conscious, aware, etc., but the mother and son are unconscious and need urgent transfusions for survival. The father is competent and absolutely refuses transfusions for both of them, and he even presents a card proving that they're all Jehovah's witness.

A general rule is that, in an emergency situation, you always transfuse JW children, even if the parents show proof of JW.

For adults, they always have their autonomy and can refuse Tx irrespective as to whether they're JW or not. If the father can show proof of the mother's JW, then the mother shouldn't be transfused, otherwise the physician can be sued for assault/battery.

In a non-emergent situation regarding transfusion of a child, don't transfuse, because, once again, irrespective of whether the child is JW, it is the parents that always are righted to give consent for any medical/surgical Tx for their children, and in this case, there's nothing immediately life-threatening. The physician can pursue a court-order, however, if there's enough time to do so and the pt's condition is serious enough where, although the situation isn't an emergency, his or her condition is serious enough to warrant it.
Click to expand...

👍
 
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Situations not requiring consent in treatment of minors:

Emergency treatment
Pregnancy care (abortion variable by state though I think)
STD treatment
Substance abuse treatment

I'm not sure what the full stipulations of the substance abuse treatment are though. I would assume there's still frequently a need to inform of the behavior, depending on whether it's continuing, but they just may not have the choice in treating. I would think the same would hold for certain exceedingly risky sexual activity
 
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loveoforganic said:
Situations not requiring consent in treatment of minors:

Emergency treatment
Pregnancy care (abortion variable by state though I think)
STD treatment
Substance abuse treatment
Click to expand...

As far as I remember from BRS Behavioral Science, most states require one or both parents to consent for a minor's abortion. If in the case the parents do not consent for the abortion, the minor has the option, in all states, to pursue a court order to have it. However, this rarely occurs not because of lack of interest in pursuing it but because minors are generally unaware of such an option or have decreased access to care/courts. If the parents and minor have deviating views on abortion vs birthing the baby (even if it's the other way around, where a minor with mental ******ation wants to keep the baby but the parents want her to abort), facilitate discussion between the parents and minor, even if the views are already seemingly and irrefutably dogmatic.

Washington DC is notably the location where physicians do not need parental consent for a minor's abortion.
 
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