How to deal with Christian scientist who wont accept treatment?

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FocusOD

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So I was reading this article about a six-year-old that developed a high fever accompanied by violent vomiting and convulsions while she was at school. The child was rushed to a nearby hospital. The attending physician made a diagnosis of meningitis and requests permission to initiate treatment from the parents. Both parents are Christian Scientists, and they insisted that no medical treatment be given to her. The physician initiates treatment anyway, and the parents later sue the physician and the hospital. How do you resolve a dilemma like this?
 
Urg... Well if they sue, you can easily show the jury that the parents judgement was unfit and put the child at risk of death. I honestly find situations like this ridiculous and thankfully very few people are like this, but if i ever was in that situation and i was a hospital worker i'd immediately call the hospital lawyer and tell him to start creating a defense for me and start administrating treatments.
 
For minors, wards of the state, incompetent: Get a court order.
For adults capable of giving consent: Accept their decision, but open up a dialogue with them and describe the available options.

You may run into an issue with Jehovah's Witnesses as well. They refuse whole blood and may refuse blood products as well. Opening up a dialogue is what is best.
 
Thank you all for your thoughts on this.
 
You do the right thing, the child lives, the parents sue, the physician easily looses [sic], his malpractice goes up, and the parents get money ... welcome to the ugly love affair of medicine and lawyers.

The bottom line is that you probably have to accept patient's rights to their beliefs. Would it be really hard not to save this child's life? Of course. Would I personally do it and get sued ... as of now, I can honestly say yes.

No, for the most part this is incorrect. FutureCTDoc was most close to correct. In anything that allows a little time, you get a court order. Hospital ethics committees are usually involved ASAP (someone can get initiate contact with them immediately). There can be some time sensitive issues so emergent, life saving treatment cannot be refused by the guardian of a child. However, there may be more nuance to the case in the OP. While meningitis may have been the most likely diagnosis confronting the doc, six isn't out of range for a febrile seizure. In theory, the case may have been predicated on a final diagnosis of febrile seizure and failure to consider the DDx. However, that may be stretching based on a lack of intimate knowledge of the case. If it was felt that treatment was life saving in an emergent setting, then the doc was on solid ground and a suit wouldn't have much merit or get very far.
 
No, for the most part this is incorrect. FutureCTDoc was most close to correct. In anything that allows a little time, you get a court order. Hospital ethics committees are usually involved ASAP (someone can get initiate contact with them immediately). There can be some time sensitive issues so emergent, life saving treatment cannot be refused by the guardian of a child. However, there may be more nuance to the case in the OP. While meningitis may have been the most likely diagnosis confronting the doc, six isn't out of range for a febrile seizure. In theory, the case may have been predicated on a final diagnosis of febrile seizure and failure to consider the DDx. However, that may be stretching based on a lack of intimate knowledge of the case. If it was felt that treatment was life saving in an emergent setting, then the doc was on solid ground and a suit wouldn't have much merit or get very far.

I really wasn't trying to honestly analyze the situation .... more point out the litigious nature of the game.
 
We recently did a case study about treatment and care options available to Jehovah's Witness in adult patients. Isn't the treatment of adult Witness patients that upon presentation that are in immiment mortal danger and a history and informed consent cannot be ascertained, so then the physican falls under the protection of the Healthcare Consent Act or something of that nature. Unless of course they have an advance medical directive card found upon them ? That is of course what I know from my limited practical knowledge.
 
No, for the most part this is incorrect. FutureCTDoc was most close to correct. In anything that allows a little time, you get a court order. Hospital ethics committees are usually involved ASAP (someone can get initiate contact with them immediately). There can be some time sensitive issues so emergent, life saving treatment cannot be refused by the guardian of a child. However, there may be more nuance to the case in the OP. While meningitis may have been the most likely diagnosis confronting the doc, six isn't out of range for a febrile seizure. In theory, the case may have been predicated on a final diagnosis of febrile seizure and failure to consider the DDx. However, that may be stretching based on a lack of intimate knowledge of the case. If it was felt that treatment was life saving in an emergent setting, then the doc was on solid ground and a suit wouldn't have much merit or get very far.

Agree with J-Rad.


If you have a few hours and the case involves a minor, you contact your hospital's on-call attorney (and ethics committee if required by the hospital) to get an emergency court order (from an on-call judge) to begin treatment (ie giving blood, antibiotics, procedures). Any restrictions will depend on individual states and their laws (such as age-cutoffs, emancipated minors, etc). With a court order, the family will have little legal standing to sue.

This topic is popular in ethics discussion because there are several fundamental principles at odds with one another. Where does Freedom of Religion begin and end, where do parental rights begin and end, at what point can children make decisions for their own body, and where do state rights begin and end. These ethical discussion usually brings out passionate debate.

From a legal standpoint, the position is clear (with numerous court cases at state levels and a few SCOTUS cases)

Prince v Massachusetts gets cited a lot as the reigning legal principle:
""Parents may be free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children..."

Subsequent cases have been consistent with this viewpoint and usually leads to three main principle
- The child's interests and those of the state outweigh parental rights to refuse medical treatment
- Parental rights do not give parents life and death authority over their children
- Parents do not have an absolute right to refuse medical treatment for their children based on their religious beliefs


Source: Children of Jehovah's Witnesses and adolescent Jehovah's Witnesses: what are their rights? Arch Dis Child 2005;90:715-719
 
If it's a kid like in the OP's scenario - Get a court order.

If the patient is an adult - Easy! Let them die 😉
 
The main thing, which J Rad has already said. If this goes to court, whether you made the correct diagnosis will probably determine whether you win/lose the case.

If the kid ended up not having meningitis (which he would have needed a spinal tap to be 100% sure, and these parents would have decline this), the doctor's malpractice would be going up in the near future
 
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