help with an ethics question

[yoyohomieg5432]

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reading through the interview question part of SDN and came across this: what would you do if a child needed a procedure but the parents were Jehova's witness and refused the procedure?

it's fairly straightforward if it were a case of the person being an adult and a Jehova's witness... if they refuse the treatment you are not right in forcing your beliefs upon them and giving a treatment.

but to me, the situation totally changes if it's a kid. do the parents have the decision in life or death of their child? what if the child didn't share the same beliefs as the parents and actually wanted the procedure done, although still a minor... what do you do?

 

[kyamh]

A judge gets to decide in this case....the kid certainly doesn't.

 

[mcloaf]

It was explained to me that in cases where parents are denying medically necessary and life saving treatment (like bloods products, some pediatric cancer therapies, etc) the state takes custody at least temporarily to allow for treatment. I'm not an expert and obviously in real life things are more complicated.

 

[xTacocatx]

In cases of life and death, the parents don't get a say.

 

[V5RED]

A judge gets to decide in this case....the kid certainly doesn't.

That is a practical answer, but it doesn't really address what is the right thing to do.

Whoever the buck gets passed to still needs to decide whether it is best to allow the procedure or not.

If the procedure is not performed, then we are saying that parents' religious beliefs are more important than the child's life. If this is to be the case, then the parents had better have a good reason for believing those things. Unfortunately, religion is often predicated on unprovable stuff like mental conversations with God.

If the procedure is performed and the parents' beliefs turn out to be correct, then you may have damned the child for the sake of his temporary, mortal, life. You also are taking the position that the parents do not have the right to make life or death decisions for their child and parental consent becomes nothing but a formality in the hospital.

The atheistic answer is obviously that the procedure should be performed. People without medical backgrounds should not be making medical decisions for people who are considered unfit to make decisions for themselves(children in our society). The child comes to no physical harm, and it doesn't really take away a right from the parent. We already ban killing your children or letting them die deliberately, so denying them medical care should be banned if we look at it from an atheistic perspective.

From a religious perspective, the only way the decision to prohibit the procedure makes sense is if that particular religion happens to be the correct one out of the thousands of other religions out there. This seems unlikely, and forcing a child to die for a belief that is unprovable and unlikely to be the correct religion is likely to be both incorrect and sinful according to other religions.

The procedure should be performed.

A tough question related to this is what constitutes a child. At which point does a person really go from a child that cannot understand consequence to an adult that can? I don't care about legal definitions, I am wondering about the real answer which has nothing to do with the law.

 

[VolunteerMoose]

For all medical ethics dilemmas, I turn to the ethics treatise "Grey's Anatomy" which dealt with this issue head on. The doctor should charm the parents so much that they change their minds and allow the blood transfusion. eazy peazy.

 

[yoyohomieg5432]

A judge gets to decide in this case....the kid certainly doesn't.

how does that work, though? say a kid comes in and is bleeding heavily. you don't really have time to write up an extensive case report, give it to the judge and let him think about it. do you just do it?

 

[Catalystik]

reading through the interview question part of SDN and came across this: what would you do if a child needed a procedure but the parents were Jehova's witness and refused the procedure?

If a Jehovah's Witness, or any parent, refuses a procedure for their minor child in an emergency or life threatening situation, it is possible to quickly remove the child from parental custody with a court order from a judge. The situation presented does not specify an "emergency" so it might not need to be handled in the same extreme way.

Maybe the parents need to know all the options first. I have had Jehovah's Witness parents agree to surgery if blood substitutes only would be used. Giving all the options to the parents allows them to make an informed decision that might be more in accord with accepted medical practice (aka, what you think they should do).

 

[Pacna]

how does that work, though? say a kid comes in and is bleeding heavily. you don't really have time to write up an extensive case report, give it to the judge and let him think about it. do you just do it?

It's like any other ethical dilemma.

Imagine you're in the desert dying of thirst and a guy selling water will give you one if you agree to pay him $1,000,000 when you get back to civilization. A court would agree with you that you do not have to pay the exorbitant fee, and if you refused to pay, they would probably still back you if you attacked the guy for some water.

TL;DR: If you're a d***, courts will not side with you after the fact. I think killing your kids is a pretty d*** move.

 

[Maeby Funke]

Ha, just got asked this in an interview and it kinda threw me. I said it would depend on the context, but for a life and death situation with young child, I'd contact social work to try and gain temporary custody in order to authorize the procedure.

 

[IlDestriero]

how does that work, though? say a kid comes in and is bleeding heavily. you don't really have time to write up an extensive case report, give it to the judge and let him think about it. do you just do it?

In a real time limited life threatening emergency (GSW, trauma, etc.), you just do it. Of course we try to respect their wishes, allow lower than normal HCT, etc, but you have to do what you have to do.
If the kid is older that poses a problem of how old is old enough to refuse life saving procedures. However in an emergency, under 18 gets blood, over 18 gets your best effort and a pine box.

 

[VolunteerMoose]

hmmm. are these suggestions the wisest choices? I'm all for keeping lawyers employed but wow.

 

[Captain Sisko]

Call an ethical consult. You're a premed and even doctors would get in trouble if they waded into it guns blazing. Give your put, admit that it's a tough topic, and say you'd consult peers, superiors, and experts. Because medicine's a team sport and you don't have all the answers.

 

[mcloaf]

Call an ethical consult. You're a premed and even doctors would get in trouble if they waded into it guns blazing. Give your put, admit that it's a tough topic, and say you'd consult peers, superiors, and experts. Because medicine's a team sport and you don't have all the answers.

And if it's emergent?

 

[Captain Sisko]

And if it's emergent?

Then the interview question isn't about what you would do, it's most likely a way to screen for either psychopaths, or people who don't think things through. In this case there are no wrong answers as long as you can back up your train of thought with something coherent.

 

[Goro]

I agree to a point. This is one of those questions where we, the interviewers, have inside knowledge, because we teach and know medical ethics and jurisprudence.

There's ample case precedent that the doctors get a court order to allow the life saving procedure. This isn't merely limited to the bleeding child, we see this all the time int he news about kids placed in protective custody because the parents wanted to treat the kid's cancer with prayer, or do nothing because it was "God's will".

Then the interview question isn't about what you would do, it's most likely a way to screen for either psychopaths, or people who don't think things through. In this case there are no wrong answers as long as you can back up your train of thought with something coherent.

I get nervous around people who think it's OK to let a child die because of a parent's religious beliefs. I tend to ask a variant of the Jehovah's Witness question because I want to know if my interviewees are too politically correct to make a sound medical decision, even with their limited medical knowledge. Some things really are black and white.

 

[Theralist]

I had this question in my interview. I said for a kid I would get an emergency court order. My dad is a doctor and he told me that hospitals have lawyers/judges that are on-call for this sort of stuff and that it can be done in something like 20 minutes. So getting an emergency court order would be your ticket to a good answer.

 

[VolunteerMoose]

I had this question in my interview. I said for a kid I would get an emergency court order. My dad is a doctor and he told me that hospitals have lawyers/judges that are on-call for this sort of stuff and that it can be done in something like 20 minutes. So getting an emergency court order would be your ticket to a good answer.

Hospitals have judges on call? That's better than the mafia.

 

[VolunteerMoose]

I agree to a point. This is one of those questions where we, the interviewers, have inside knowledge, because we teach and know medical ethics and jurisprudence.

There's ample case precedent that the doctors get a court order to allow the life saving procedure. This isn't merely limited to the bleeding child, we see this all the time int he news about kids placed in protective custody because the parents wanted to treat the kid's cancer with prayer, or do nothing because it was "God's will".



I get nervous around people who think it's OK to let a child die because of a parent's religious beliefs. I tend to ask a variant of the Jehovah's Witness question because I want to know if my interviewees are too politically correct to make a sound medical decision, even with their limited medical knowledge. Some things really are black and white.

Lawyers would love you.

 

[Kinch]

"A child over 14 years old may be able to provide their own informed consent, independent of their parents"

http://en.wikipedia.org/wiki/Informed_assent

This should be relevent in some way..

 

[Goro]

Just like the 2nd Amendment, you can't leave out parts.

The term informed assent describes the process whereby minors may agree to participate in clinical trials.

"A child over 14 years old may be able to provide their own informed consent, independent of their parents"

http://en.wikipedia.org/wiki/Informed_assent

This should be relevent in some way..

 

[Kinch]

great 2nd amendement reference..

I mentioned the topic of informed assent because I asked a practicing physician about this situation for a secondary question and he said to look into it. I would assume that although its used in context of clinical trials in the link, it has more application than that? Honestly, I have no idea.

Anyway, he advised me more generally to make sure I considered multiple viewpoints in my answer and tread very softly if giving a direct answer to the question that may come off as lacking in empathy for the parents (although their wishes likely will be overrided by someone else like a medical ethics board at the hospital).

 

[knv2u]

reading through the interview question part of SDN and came across this: what would you do if a child needed a procedure but the parents were Jehova's witness and refused the procedure?

it's fairly straightforward if it were a case of the person being an adult and a Jehova's witness... if they refuse the treatment you are not right in forcing your beliefs upon them and giving a treatment.

but to me, the situation totally changes if it's a kid. do the parents have the decision in life or death of their child? what if the child didn't share the same beliefs as the parents and actually wanted the procedure done, although still a minor... what do you do?

The answer appears straightforward to me. I would file an emergency petition with a local court of competent jurisdiction asking that a guardian ad litem be appointed for the child to make medical decisions in the child's best interest.

But I do have a question for the physicians in this thread; what happens legally when there is no time for a court order/appointment of a GAL (e.g. a major artery ruptured in the ER, no blood substitutes readily available, and the patient is within 2 minutes or so of bleeding out)? Are physicians typically authorized by statute to act in the patient's best interest or are the doctors left to act on their own accord? (I realize that the last question is an issue of state law that varies from jurisdiction to jurisdiction, but I'm sure there must be general trends). Would acting against the parent's wishes in the absence of the court order constitute an assault and battery (as treating a patient against his or her will typically is) or would saving the child's life be a legally recognized defense?

To the physicians on the board, for fun, what books or resources would you recommend that address medical issues and the law?