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religion + medicine

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Chrisobean

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every situation that one can encounter in life has been an episode of "law and order".

let me tell you about one I started watching last night...
there was this very religious family (religion was not stated) who had a very sick child, and a nanny who was not of the same religion. the nanny insisted the mother call an ambulance, as the kid was in very bad shape, but the mom refused. so the nanny runs out and flags down some cops, who bust in and bring the kid to the hospital. in the ER, doctors were trying to get the mom's consent to intubate the kid and whatever, but she refused citing religious reasons, they dont believe in modern medicine.. then the kid codes, and dies on the table after being hit with the defib.
this is where i fell asleep, so i dont know if there were any charges brought against the parents or the outcome of the trial (im assuming there was one, this is law and order after all..)

so what does everyone think of this situation?

doctors are obliged to treat everyone, and it is assumed that if a patient is unable to consent to treatment, he would want it anyway. but what happens in this case, when a parent knowingly refuses treatment that will save their kid's life? children do have rights, which is why the docs ran to help her when she coded... but if her heart didnt stop, does the parent have a right to take her child home and refuse any treatment? if so, can the dr then get the cops involved for negligence and endangerment? what if the doctor does NOT involve the police, is he responsible then?

i would like to hear some opinions on this.... let's get the debate on!!
 

LauraMac

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i think the child should get the care. i know that i would be really upset now if i knew my parents had refused some treatment for me based on religious views. that is like imposing your views on someone else... even though it is your own child. anyway, i'm sure the child does not want to die and doesn't even fully understand religion yet, so i think he/she should get all treatments possible. i don't know how this stuff works in the real world, though... just my thoughts.
 

illyire106

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yeah - in acute cases like that - the ethical/legal thing to do is treat the kid. in one of the landmark cases about this the judge basically said - adults can make martyrs out of themselves but can't make martyrs out of their kids.

it's a little more tricky for things like chronic disease tx and surgery. it depends on the state, the age of the kid and the predicted effectiveness of the tx. like parents can reject chemo for their kids and some courts will agree but others will take the child away from the parents.
 

Rendar5

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The parents also had another child die of Influenza B because they didn't seek medical treatment. However, charges were brought against both parents on manslaughter in the second and on child endangerment. That happened mostly because they weren't completely true to their religion and were aware of the consequences. They had argued over treatment. On a previous occasion when a plane was crashing (temporarily), the woman's sister told cops that she had been scared and didn't trust that God would save them (the husband was true). The woman had also gotten coffee with three shots of brandy, which was against her religion (it was due to the stress of this). The two parents had argued over whether to seek medical attention. And the father had placed a 911 call about his daughter, but didn't follow through.

They were found innocent on all but one of the child endangerment charges, and weren't going to get jail time, but the prosecutor was happy that because they had managed to get one conviction, it might make a parent think twice before letting a child die of something treatable like strep throat.
 

Chrisobean

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thanks rendar... its nice to know im not the only law and order junkie!
 

klooless

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This is very similar to a scenario asked of me on my very first interview. The parent refusing modern medicine was a J. Witness, and the child in question needed a transplant of sorts (it was a real case, but I forget the name of the parties involved). My interviewer basically agreed that a doctor is to provide necessary care to a child, regardless of parental approval. In the case "cited" above, the parent actually sued the practitioner and lost....

Sorry I couldn't be more articulate....
 

Chrisobean

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i think there is a similar case going on right now, in the midwest perhaps, but it has to do with chemo for a child, the parents cant afford it and dont want to exhaust all their money for something that is not guaranteed to work.. i think the city is suing the parents or something like that...
im not sure of the details, does anyone know about this?
 

Jonathanamine

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geesh- sounds like an interview question! :)

my thoughts on it are this: i respect that some religions do not believe in modern medicine. by respect, i mean i acknowledge their beliefs, but i don't agree with them. i'm not one of those relativist people who says "whatever works for you, is right for you..."

I'm a Christian, and I don't believe our lives belong to us. God created us, and we belong to Him. It's not our place to decide who lives or who dies. So in the above example, it's not the right of the parent to decide the child's outcome. We have progressed in science, developed pharmacology, machines, etc. to extend human life. And those things aren't "from the devil" because they're modern--it's common sense to use them. We should preserve and honor life above all (I think). Now it gets tricky with death and dignity, chronic patients, etc. but in an emergency situation like this--trying to save the kid's life is the right thing to do.

Those are my thoughts and my opinion. I'm not trying to impose on anyone elses ideas---just wanted to get my beliefs accross.
 

AlternateSome1

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A similar case, parents of a child who are Jehoviah's Witnesses cannot refuse their child a blood transfusion based on religious beliefs. If they child is not old enough to choose their own care then they must be protected until they can. Religious choices cannot be imposed on a child when they will endanger the child.

~AS1~
 

musiclink213

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but if choices cannot be imposed, why do they need consent then? Why do they wait around for a parent to show before doing any kind of procedure? (unless it's an emergency, and they get another doc to sign, but I'm talking consent).
 

tugbug

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No way an adult should have the right to prevent care for kids in acute emergency situations. As the situation becomes less acute and the treatment less clearly helpful the waters get muddy.

What about the other end of the religion/medicine spectrum... although admittedly objections here are often not based on religion... What about an adult who chooses to forgo lifesaving treatment? Noone has problems with DNR orders, but what about situations where an adult wants to stop treatmen or simply end their life?

I say that if the adult is competent to make the decision they should have the right to make it... whatever the details surrounding the situation. If their reasons are good enough for them then they are good enough for me. Go Kevorkian.
 

Hallm_7

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I don't agree with the parents not giving consent, but if they are truly committed to their beliefs I sort of understand where they are coming from. What would you do if you believed with all your heart that your child would spend eternity in hell if they received medical attention? If I believed this (which I don't) I don't think I would be treating my child for anything. However, at the same time I understand how the parents would be forcing their beliefs on their child, and that's not right either. This is a hard question.

BTW, would it be unconstitutional to pass a law that said medical treatment must be provided regardless of religious beliefs? Isn't this in violation of the first amendment's freedom of religion, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof?"
 

Chrisobean

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Originally posted by tugbug
What about the other end of the religion/medicine spectrum... although admittedly objections here are often not based on religion... What about an adult who chooses to forgo lifesaving treatment? Noone has problems with DNR orders, but what about situations where an adult wants to stop treatmen or simply end their life?
I say that if the adult is competent to make the decision they should have the right to make it... whatever the details surrounding the situation. If their reasons are good enough for them then they are good enough for me. Go Kevorkian.

i agree... but thats why i asked about children. since the kids cant make these decisions for themselves, if the parents refuse consent they are in essence killing their kids.
but if the parents are totally informed and competent to choose, and still refuse treatment for their child, is it a doctor's job to interfere?
to some people, an eternity in hell is the worst possible thing in the world.. and if receiving a blood transfusion will save your life but make you a sinner, i guess there are some people who would rather die.
i really have no idea what i would do if confronted with this situation. i'm glad it got people thinking!
 

tugbug

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Originally posted by Chrisobean
i agree... but thats why i asked about children. since the kids cant make these decisions for themselves, if the parents refuse consent they are in essence killing their kids.
but if the parents are totally informed and competent to choose, and still refuse treatment for their child, is it a doctor's job to interfere?
to some people, an eternity in hell is the worst possible thing in the world.. and if receiving a blood transfusion will save your life but make you a sinner, i guess there are some people who would rather die.
i really have no idea what i would do if confronted with this situation. i'm glad it got people thinking!

Chris, my post wasnt clear... sorry about that. I meant to say up front that I did NOT think parents had the right to withhold life saving help from their children, and society and doctors have a moral obligation to intervene.

IMO, that interventionist thinking only holds for children. I believe an adult should legally be able to make any decision regarding their own care definitely... including the decision to end care and/or life. I cant understand why suicide is illegal.

I mixed the two ideas and confused the issue.

For me, this situation is not that difficult ethically. If a person is competent to make a decision, and the decision's harmful effects fall only on the decision maker... why do we as a society believe we know better?
 

tugbug

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Originally posted by Hallm_7
I don't agree with the parents not giving consent, but if they are truly committed to their beliefs I sort of understand where they are coming from. What would you do if you believed with all your heart that your child would spend eternity in hell if they received medical attention? If I believed this (which I don't) I don't think I would be treating my child for anything. However, at the same time I understand how the parents would be forcing their beliefs on their child, and that's not right either. This is a hard question.

BTW, would it be unconstitutional to pass a law that said medical treatment must be provided regardless of religious beliefs? Isn't this in violation of the first amendment's freedom of religion, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof?"

Im no constitutional scholar, but there are definitely certain behaviours that are not/and would not fall under "freedom of religion"... It is still illegal to murder, steal, abuse, etc... whether an individual claims it is part of his/her religious beliefs or not. I think emergency care for kids should be seen in the same way.

If someone I know told me that, for example, in their religion... the first child had to be starved (sorry, I know this is ridiculous, but im trying to prove a point... and any word could be substituted for starved (confined to a closet, lashed for his sins etc...))... anyway, if they told me this I probably wouldnt wait for them to put a period on the sentence before I called the authorities. The religious protection umbrella should not extend to any clear damage/danger to children. Adults on the other hand can drink all the Kool Aide they want in the name of religion if thats their choice IMO.
 

Daniel vD

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I'd make sure the child gets the treatment he/she needs.

If the parents would object, I'd first try talking to them (when the child is not in immediate life danger). If I couldn't get them to agree and they would (physically) threaten me, I'd call the police and ask for the police to keep the parents under control.
 

Chrisobean

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Originally posted by tugbug
Chris, my post wasnt clear...

its weird to hear someone call me Chris.. :)

i think i need DNR tattooed on my ass.

but for a child, their health has to be above their parents beliefs.

how great would this be if i got asked this on an interview!
 

DrBodacious

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I saw something on Trauma: Life in the ER, or some similar show. Where a child had a quarter stuck in her throat and they couldn't find the parents to give consent. The ER doc had to get another doctor to sign saying that the situation was indeed an emergency and that they should go ahead w/ treatment w/o consent.

A little different than parents actually being opposed to treatment. But I think that more than one doctor should determine the treatment to be critically needed, so that patients' religious beliefs are not unneccesarily trampled. Is this the case in real life, with the laws and regulations? :confused:

How much do laws vary from place to place? I'd like to know a bit more about the laws in place for these situation. Illinois and Pennsylvania laws in particular.
 

ewing

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Originally posted by Chrisobean

i think i need DNR tattooed on my ass.

I think it'd be a more effective tattoo on your chest or better yet right over your trachea.
 

Chrisobean

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Originally posted by ewing
I think it'd be a more effective tattoo on your chest or better yet right over your trachea.

good point... lol
 

kiahs

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I think situations like this are especially troubling because the when people go in to medicine they usually do so to help people and save lives and so on. ( I haven't read all the posts so if I'm repeating what someone else said sorry.) As doctors, (or potential doctors) though I think it's our job to realize that we are there to provide options regardless of what we as individuals might think. In this situation because it is a child I think one is more prone to be like well we should save him and so on which is my personal feeling as well. But that's not my decision, religion, culture, ect..these are all things people hold very dear and we can't expect them to see things through our eyes even if the consequences are as dire as death. I think that's why we have to go through so much to become doctors, in the end we are people and we treat other people and we have to respect their decisions no matter how we would personally handle the situation ourselves.
 

exilio

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Originally posted by AlternateSome1
A similar case, parents of a child who are Jehoviah's Witnesses cannot refuse their child a blood transfusion based on religious beliefs. If they child is not old enough to choose their own care then they must be protected until they can. Religious choices cannot be imposed on a child when they will endanger the child.

~AS1~

Naturally, all parents make decisions affecting their children's safety and life: Will the family use gas or oil to heat the home? Will they take a child on a long-distance drive? May he go swimming? Such matters involve risks, even life-and-death ones. But society recognizes parental discretion, so parents are granted the major voice in nearly all decisions affecting their children.

In 1979 the U.S. Supreme Court stated clearly: "The law's concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life's difficultdecisions. . . . Simply because the decision of a parent [on a medical matter] involves risks does not automatically transfer the power to make that decision from the parents to some agency or officer of the state."?Parham v. J.R.

That same year the New York Court of Appeals ruled: "The most significant factor in determining whether a child is being deprived of adequate medical care . . . is whether the parents have provided an acceptable course of medical treatment for their child in light of all the surrounding circumstances. This inquiry cannot be posed in terms of whether the parent has made a 'right' or a 'wrong' decision, for the present state of the practice of medicine, despite its vast advances, very seldom permits such definitive conclusions. Nor can a court assume the role of a surrogate parent."?In re Hofbauer.

So while you, me or any practicing doc agrees or disagrees, it really doesn't matter. It's a slippery slope to decide what care we can force on patients and what choices they have.

I may not agree with all opinions I may face, but I don't have to.
 
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