Ughh. When to and when NOT to wait for a court order.... (Ethics Question)

[Knicks]

OK,

it's not that my reading comprehension is poor, but it's like different texts I read say something different: if a child has a life-threatening condition and the parents don't give permission for you to use a simple, curative treatment, do you go to the courts to get an order, or not?

For the love of all that is good, can someone please clarify this.

Thanks.

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[Hoju]

OK,

it's not that my reading comprehension is poor, but it's like different texts I read say something different: if a child has a life-threatening condition and the parents don't give permission for you to use a simple, curative treatment, do you go to the courts to get an order, or not?

For the love of all that is good, can someone please clarify this.

Thanks.

The answer is maybe. Take it to the ethics board.

 

[FutureDoc4]

Parents are not allowed to withhold immediate life/limb saving treatments from a child. Period.

a) Immediately life threatening, treat anyway regardless of parents. Gets sorted out afterward by the courts who will likely appoint a "healthcare guardian."

b) If NOT life-threatening, than you can take it to court. But, if its not life-threatening, they will likely go with the parents wishes.

 

[Savage Henry]

Parents are not allowed to withhold immediate life/limb saving treatments from a child. Period.

I don't know if this is true. Have you ever taken care of a Jehovah's Witness child?

I once shot a bunch of trauma x-rays on a JW kid who didn't make it. The whole time, the mother was yelling "Don't give my baby any blood!" As far as I know, we didn't give any blood products. I don't know if that contributed to the child's death or not. Based on how that kid was bleeding, though - if the child were mine I'd have wanted some. Everyone else I've seen that was that messed up got some.

Even today it makes me angry to think about.

 

[Knicks]

I used to think I had this down cold. (and I did)

But for some reason I'm confused now.

SOOO if we have a JW, DO WE get a court order? Treat immediately?


What's the definitive answer to the OP?

 

[FutureDoc4]

Savage Henry, it is that clear cut. What isn't clear cut is what constitutes "immediate life/threatening" in your scenario.

The OP asked about boards. The boards specifically touch on this point. If a child had a serious trauma and needs surgery to live. The parents cannot tell the physician "no, we don't believe in western medicine, you cannot do surgery."

Your scenario is a little more gray cause other products might be used (albeit, less effective) and the situation may not be immediately life threatening

 

[justdoit31]

I don't know if this is true. Have you ever taken care of a Jehovah's Witness child?
.

I volunteered at a children's hospital through undergrad and when we discussed this in Ethics I ended up talking to the Hematology department about it- if a child has a bleeding disorder that requires blood transfusions (and other treatment methods have failed) then the hospital is obligated to give it to child until he/she is 18 and can refuse. They can and will get a court order for the blood products.

 

[ohboy]

I don't know if this is true. Have you ever taken care of a Jehovah's Witness child?

I once shot a bunch of trauma x-rays on a JW kid who didn't make it. The whole time, the mother was yelling "Don't give my baby any blood!" As far as I know, we didn't give any blood products. I don't know if that contributed to the child's death or not. Based on how that kid was bleeding, though - if the child were mine I'd have wanted some. Everyone else I've seen that was that messed up got some.

Even today it makes me angry to think about.

It is absolutely true. JW parents have no say in the life-saving treatment of their child.

 

[Savage Henry]

Savage Henry, it is that clear cut. What isn't clear cut is what constitutes "immediate life/threatening" in your scenario.

The OP asked about boards. The boards specifically touch on this point. If a child had a serious trauma and needs surgery to live. The parents cannot tell the physician "no, we don't believe in western medicine, you cannot do surgery."

Your scenario is a little more gray cause other products might be used (albeit, less effective) and the situation may not be immediately life threatening

Roger that, understood.

Like I said, there was a lot going on around that kid and I was focused more on doing my job perfectly as fast as possible than I was looking at what bags were hung. There may very well have been blood products up that I just didn't notice.

I'm glad to hear the policy is that cut and dried. Sometimes I think we're so open minded in this business that our brains fall out.

I volunteered at a children's hospital through undergrad and when we discussed this in Ethics I ended up talking to the Hematology department about it- if a child has a bleeding disorder that requires blood transfusions (and other treatment methods have failed) then the hospital is obligated to give it to child until he/she is 18 and can refuse. They can and will get a court order for the blood products.

I once asked a door knocking Jehovah's Witness missionary about this. The ensuing conversation did much to speed me on the way to atheism.

 

[Savage Henry]

Double post.

 

[justdoit31]

I once asked a door knocking Jehovah's Witness missionary about this. The ensuing conversation did much to speed me on the way to atheism.

I am a Christian and I disagree with the JW theology- I once looked at a "bible" from one of their members- it is their own translation that no other religious group uses and it was very different with what I had always believed/read in my Bible.

I am not trying to debate religions, I just hope you would be willing to listen to other opinions- the Bible says "For the Life of the Flesh is in the Blood" Lev. 17:11. So it seems to me you would want life... maybe it is the concept of the flesh that bothers them not sure why though. I haven't needed blood products but I would take them in an instant if my life depended on them!

As far as I know the only other group that has specific medical beliefs is the Christian Scientist which usually tend to try their own healing methods. While the religion doesn't forbid medical usage many members will not see a physician. There have been several cases of children dying from DM-I because of the belief and if I recall right some of the parents were prosecuted for negligence- not sure what the result of the proceedings was.

 

[Savage Henry]

I think the Bible verse the JW folks go by is Leviticus 17-14:

For it is the life of all flesh; the blood of it is for the life thereof: therefore I said unto the children of Israel, Ye shall eat the blood of no manner of flesh: for the life of all flesh is the blood thereof: whosoever eateth it shall be cut off.

The Christian Scientist folks (so I've been told - I'm no student of comparative religion) base their particular theological quirks on James 5:14-15:

Is any sick among you? let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord:
And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him.

None of this concerns me. I am a devout Cargo Cultist (New Reformed Orthodox Church). All Hail and Welcome Our Lord C-47 and His Wrathful Right Hand, Lord B-29!

 

[seelee]

Parents are not allowed to withhold immediate life/limb saving treatments from a child. Period.

a) Immediately life threatening, treat anyway regardless of parents. Gets sorted out afterward by the courts who will likely appoint a "healthcare guardian."

b) If NOT life-threatening, than you can take it to court. But, if its not life-threatening, they will likely go with the parents wishes.

Not being argumentative, but I am wondering what you are basing this on. State laws or ethical principles? If it is a state law, then does every state have the same law in this instance. I know that Texas (where I am does) but I can't say for other states. If it is your ethical stance, then the OP needs to understand that there is no absolute answer ethically. Ethical dilemma's arise when two viewpoints of "good" contradict. As a society, we essentially pick which one we are going to support though that decision is rarely (if ever) unanimous.

If you need to know the answer for a test or a class, then the answer is "whatever the state law says", or "whatever the textbook for your class says".

In real practice, know where the law stands, and if the law is not clear, then double double check w/ superiors, ethics boards, etc. before you commit to a course of action. Many a doctor has been sued and fired for stepping into a controversial case without having done his homework first.

 

[PostLessOne]

I think the Bible verse the JW folks go by is Leviticus 17-14:

The Christian Scientist folks (so I've been told - I'm no student of comparative religion) base their particular theological quirks on James 5:14-15:

None of this concerns me. I am a devout Cargo Cultist (New Reformed Orthodox Church). All Hail and Welcome Our Lord C-47 and His Wrathful Right Hand, Lord B-29!

Sounds like it's saying "no vampires allowed". Nothing about transferring blood from one person to another via needles. This is a big problem with religion. Even if you really think it's literally true that the creator of our universe expects us to obey the rules in a vaguely worded book or else he will punish us after we die, it's pretty darn hard to determine what the alleged rules are.

Not to mention the sheer unfairness of the idea : the overwhelming majority of the world's population will never get a serious chance to look at the holy book of any particular religion (and each religion preaches that it, and only it, is the correct one and the followers of all other religions are doomed for eternity)

Anyways, I've heard this cogent argument for atheism. "Christians believe 99% of all religions are false religions. Atheists believe that just one more religion is false."

Technically, I suppose most of us "atheists" are really agnostics. Atheism is defined as a belief that NO supernatural power exists, and that the world is exactly what it appears to be. It requires a supreme act of faith to be an Atheist. Agnostics believe that the true nature of reality is unknown, and that any particular religion is more than likely wrong, but that nearly anything could be outside our observable realm.

 

[Savage Henry]

Ethical dilemma's arise when two viewpoints of "good" contradict.

It is amazing how often the gray areas you speak of arise. I had no idea until I got into health care. I've seen everything from the JW thing I mentioned, to a patient who refused treatment for a potentially fatal condition in favor of Ayurvedic medicine. My last patient today was a guy who refuses to see an endocrinologist (they're all over-educated idiots, apparently), in favor of Wikipedia and his interpretation of Web MD. He's getting hormones from overseas pharmacies that he ingests with abandon.
Every few weeks this dude comes in with a few tests he wants run. The docs I work for kind of give in to him, ordering the labs, figuring if they can maintain at least some communication with him, they can limit the harm he's bound to do himself. The dude just doesn't listen, and if the docs put their foot down too hard he's just going to use mail order labs and have no physician contact at all.

It's a strange, terrible world out there. Many people don't trust "authority", don't understand or respect true expertise, and don't realize how complex medicine truly is. Throw some religion into the mix, and it's amazing how thick the bullheaded stupidity gets. If these type of people even get a whiff of a (perceived) paternalistic attitude, they're out the door on a beeline to the local woo practitioner's "clinic", or they'll use Dr. Google.

It is my sincerest wish that you all can walk that fine line with your future patients and get them to do the right thing by themselves, even if they don't believe what you're telling them.

If I was a religious type guy, I'd probably pray for it.

 

[psipsina]

I had this situation with a peds heme-onc patient who's parents didn't want blood products (though not JW interestingly). The kid clearly needed a blood transfusion to safe his life (was in sickle crisis) but was not currently unstable. The mode of action was to start the paperwork for a court order (which can take days!) and if the kid destabilized to transfuse immediately. In emergent situations you just act.

If you have the luxury of time but its a life saving treatment you get a court order.

 

[seelee]

I had this situation with a peds heme-onc patient who's parents didn't want blood products (though not JW interestingly). The kid clearly needed a blood transfusion to safe his life (was in sickle crisis) but was not currently unstable. The mode of action was to start the paperwork for a court order (which can take days!) and if the kid destabilized to transfuse immediately. In emergent situations you just act.

If you have the luxury of time but its a life saving treatment you get a court order.

My question was whether this varies from state to state. E.g. are there some states that hold the rights of the parents religious views over the minor child's medical treatments?

 

[PostLessOne]

My question was whether this varies from state to state. E.g. are there some states that hold the rights of the parents religious views over the minor child's medical treatments?

Kinda sounds like that isn't your concern. All you can do act to preserve life/limb/eyesight if you are forced to act immediately, and let the lawyers deal with the consequences. If you have time, file the paperwork, and let a judge be responsible for the decision. Sucks, but if you don't let a judge take the blame, you too will be facing a judge.

 

[Knicks]

Parents are not allowed to withhold immediate life/limb saving treatments from a child. Period.

a) Immediately life threatening, treat anyway regardless of parents. Gets sorted out afterward by the courts who will likely appoint a "healthcare guardian."

b) If NOT life-threatening, than you can take it to court. But, if its not life-threatening, they will likely go with the parents wishes.

So basically, is this the correct answer (USMLE-wise) to my question?

 

[seelee]

Kinda sounds like that isn't your concern. All you can do act to preserve life/limb/eyesight if you are forced to act immediately, and let the lawyers deal with the consequences. If you have time, file the paperwork, and let a judge be responsible for the decision. Sucks, but if you don't let a judge take the blame, you too will be facing a judge.

I don't think you are getting my question. I am curious if these laws respecting parents denying lifesaving medical care for their child for religious reasons are pretty much present in each state or are there states where such laws are not in place. Obviously this is relevant since the laws change based on where you live.

 

[psipsina]

I don't think you are getting my question. I am curious if these laws respecting parents denying lifesaving medical care for their child for religious reasons are pretty much present in each state or are there states where such laws are not in place. Obviously this is relevant since the laws change based on where you live.

When we were taught this by the lawyers the didn't add their "but check in the state you're working in in the future" caveat that is usually there when necessary. My impression was that the underlying ethical idea that a parent can't kill their kid over religious beliefs was black and white enough to be nationwide.

 

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[FutureDoc4]

Not being argumentative, but I am wondering what you are basing this on. State laws or ethical principles? If it is a state law, then does every state have the same law in this instance. I know that Texas (where I am does) but I can't say for other states. If it is your ethical stance, then the OP needs to understand that there is no absolute answer ethically. Ethical dilemma's arise when two viewpoints of "good" contradict. As a society, we essentially pick which one we are going to support though that decision is rarely (if ever) unanimous.

If you need to know the answer for a test or a class, then the answer is "whatever the state law says", or "whatever the textbook for your class says".

In real practice, know where the law stands, and if the law is not clear, then double double check w/ superiors, ethics boards, etc. before you commit to a course of action. Many a doctor has been sued and fired for stepping into a controversial case without having done his homework first.

People like to think there are no right answers on multiple choice ethics questions but there are. This is clearly one of those cases--I've learned this in class (lectures) and practice questions (USMLEWorld) for the boards. Of course, real life is complicated but for the OP the answer is clear (this concept is repeated over and over again), a parent cannot withhold immediate life/limb saving treatment (whether this is state or federal law I am not sure---however, I know it is true in all 50 states).

How do I know it's true in all 50 states? The USMLE cannot ask a question that varies the answer from state to state (cause obviously the answer will vary then there is no right answer!). This ethical principle seems to carry between states (again, I am not sure due to similar state laws or to a federal law).

But, for example, you won't see certain abortion questions on the USMLE that dwell on conset to abortion/age of abortions etc (parents premission) because the laws vary from state to state.