“Alas” reader Kathleen emails:
Anyway, I wanted to send this article your way. A young Canadian cancer patient has refused a blood transfusion (she’s a Jehovah’s Witness, and her religion prohibits the procedure), but the government’s ruled that she has to undergo the treatment, as “the teenager’s constitutional right to choose medical treatment does not override the courts’ authority to protect her life and safety.”? I thought this was interesting, especially in light of the conflicts in the US over abortion and the colliding moral values of patients and doctors. There’s been a lot of discussion about when and if a doctor can refuse to provide treatment, but what if a pregnant woman has a life-threatening condition? Can she decide she’d rather die than have an abortion?
The article Kathleen points out, and the issues it brings up, are interesting. Here’s a few quotes from the article:
A 14-YEAR-OLD Canadian Jehovah’s Witness who is suffering from cancer has lost her court fight to refuse a blood transfusion which her faith forbids.
The teenager broke down in tears when the decision was announced by Justice Victor Paisley in a Toronto courtroom, before she was taken away in an ambulance under police guard.
The girl – identified only as Sarah – had reportedly fled across the country with her parents to Ontario after a judge in her home province of British Columbia ruled she could not refuse a blood transfusion if her doctors believed it was medically necessary. […]
The girl’s lawyers had argued that she was not seriously ill and that, even though she was a minor, she still had a right to refuse treatment.
Shane Brady, the family’s lawyer, said they came to Ontario only to receive a second opinion and had hoped to begin alternative therapy in the United States soon.
Mr Brady said: “She was seeking competent medical care. The young woman was devastated. This is a matter of patient choice.
“To be denied that choice and be told, ‘Look, you’ve got to go back to British Columbia to be treated by a doctor that you’ve lost trust in’ – that’s difficult for anybody to stomach.” […]
Jehovah’s Witnesses believe blood is a sacred source of life and not to be misused or tampered with under any circumstances, even life-saving.
If the girl really isn’t that sick and doesn’t really need the transfusion, then obviously she shouldn’t be forced to have it.
But what if the judge is right, and she really is that sick? My tendency is to say that the decision to die for your religion is not one a 14 year old should be allowed to make. If we don’t allow 14 year olds to drink, to have sex with grown-ups, or to get married – all based on the belief that they aren’t old enough yet to fully understand the consequences of these decisions or to make a genuinely informed choice – then we shouldn’t allow them to decide to die, either.
But even as I say that, I have to admit I’ve very unhappy with the idea of the government forcing medical treatment on anyone against their will. I’m a fence-sitter on this one.
UPDATE: Kathleen sent me a link to another article, and pointed out this quote in particular:
She had already consented to chemotherapy, surgery and even possible amputation of her leg. But in a court document, the teen says a transfusion would be a violation of her person, not unlike a rape.
“It’s no different than somebody getting sexually assaulted or raped or robbed or something. You’d feel violated because it’s not anybody else’s property, it’s you.”
She makes a good case.
I’m personally of the opinion that 14 year olds are too young to make theological decisions for themselves. This girls’ beliefs are essentially the result of her parents’ beliefs. I don’t have a problem with the government looking out for the best interest of the girl in this situation.
I’m also, however, willing to admit that it’s a very slippery slope and if that same argument were carried into areas like assisted suicide I would not be supportive.
I guess I don’t know what I think about it.
Naive as I am, I thought we had the right to choose our own treatment here – a minor or not. What do I know.
She “consented” to chemo, surgery, and the possibility of amputation? Now I’m worried: would they have forced *any* of those unpleasant outcomes on her if she *hadn’t* consented?!
This is a tough area to make a moral decision about. I think it brings decisions to have or not have an abortion sharply into focus. If she really wants to die, I think she’s articulating it well enough to do so.
That said, I hope the Jehovah’s Witnesses get hammered by the press over this.
Well, she doesn’t want to die. She wants treatment, but not a blood transfusion. I absolutely believe that both the medical officials and the government need to respect her autonomy and decision-making capacity. I don’t think because we, as a society, fear dying we should impose our ethical or religious values on a 14-year-old. If a blood transfusion will violate her bodily and spiritual integrity, she has a right to make her own decisions regarding treatment.
The right to refuse treatment can’t be revoked simply because we think the reasons for refusing treatment are fishy. It’s a shame that this girl feels this way, and it’s likely she’ll change her mind. But damn, if she feels like it’s rape, then let her refuse it.
From a political standpoint, it’ s a shame that the patient in this case is a member of an unpopular religion–if she were refusing medical treatment because of a Southern Baptist belief, that would be quite interesting to watch the pro-feeding tub faction wrestle with their unwillingness to let girls and women make their own decisions vs. their belief that parents should be able to force religion on kids, as long as that religion is an approved version of Christianity.
I don’t like that some religions feel that medical treatment is unholy, but the notion of forced treatment is far more odious. There are a lot of things some religions do that I don’t like, but I think the standard needs to be extraordinarily high for the government to overrule a person’s private faith. If she was being coersed or brainwashed, yes step in. But I assume there is no reason to think that, so I think the state needs to step away.
The issue really is age of consent,fourteen year old, ten year old, six year old, at some point society has to draw a line which will necessarily be arbitrary but agreed upon. Hopefully ,with maturity will come an understanding which allows her to differentiate between a blood transfusion and the intent with which it is given and rape and it’s intent.
This points out the ability of religious dogma to overshadow reason.
Treating Jehovah’s witnesses surgically is so difficult that there is actually a hospital in California (Lima Linda) that specializes in it — where a doctor has developed blood sparing surgical techniques building on what he learned when he trained in India, where it is very difficult to arrange a safe blood transfusion. He now trains other surgeons in other places to try to cut down on the number of transfusions for everybody — transfusions are, at some level, risky in their own right.
Okay, that’s not an ethical argument — the point is, frequently, doctors are given credence by courts over matters based not just on religious, but frequently, technical bias — and a desire to salve their own concerns (think fear of dying, think VBAC, think liability). The possibility that such concerns played a role here is substantial to the point of presumptive — this is really an obscene result. It would be a different issue if she were younger (say, under 11/12), then one would be concerned about undue parental influence, but 14 is old enough to understand the possibility of death. I hope her parents and her pastor are flexible enough to address her feelings of guilt in a constructive manner.
I’ve thought about this further, and it seems to be a case of determining where religion crosses the line to cult. That’s a pretty fuzzy line. As mentioned above about Southern Baptists, it all depends on whether it’s a *popular* (read: powerful) religion that determines how much we respect the choices of its members.
And how many parents have we seen are willing to let their children die (without trying even minimal medical treatment) because of their religious beliefs? A scary number. This could be seen in that light – surgery is okay but blood transfusion is not? They think no blood is affected during surgery? How is surgery *not* a violation of the body? It’s all so contradictory. But she’s still right that this is violating her bodily integrity (since that’s how she perceives it). Damn.
Thanks to religion, this is a no-win situation >_
The point that strikes me from this post is that it is not the 14 year old whose consent/wishes are being ignored and overridden, but that it is the parents whose consent is held as worthless. It seems to me, whether we agree with it or not, that as a parent of a minor it is your right to make that decision. I’m willing to accept that the choice is not one given to a minor, but I don’t understand why there is no mention of her parents rights in this post.
>surgery is okay but blood transfusion is not?
Jehovah’s Witnesses believe that blood transfusions are a form of ‘drinking another creature’s blood,’ which is prohibited in the Bible. The Old Testament also equates blood as equivalent to life.
It’s sad, and stupid, and yes, it doesn’t make sense.
The girl in Canada. It is her nationality, not her religion, that causes this to be an issue. JW in the US have long had their religious beliefs respected when it comes to medical questions. Canada is less free.
Not that I agree with the position, but the reason that surgery is not a violation where blood transfusions are is that blood transfusions put somebody ELSE’S blood into your body, and JWs believe that blood is the source of life, something very personal that cannot ethically be transfered from one person to another. Other religions have other medical procedures they frown upon. The Catholic church does not condone the use of donated eggs or sperm for the conception of children, for example.
When I try to put myself in the shoes of this girl and her parents, it is easy to see how, if I truly believed that sharing blood was a violation of the very meaning of life and a person’s being-ness, having a blood transfusion forced would be extreme spiritual harm, as that foreign blood will now be in this girl forever (I believe… must check medical facts there).
Jake, even in the U.S., in a situation like this, the wishes of the parents would not necessarily be given a lot of deference. These are awful cases, but parents have been prosecuted for failing to provide their children with medical care based on the parents’ religious objections — the younger the child, the less deference shown. It’s an inversion of the normal rule, but it’s considered somewhat extraordinary and more than a little suspicious that a parent would make a choice that results in the death of a child. I know of prosecutions in Indiana and Massachusetts (not normally considered to be politically synchronous jurisdictions). Christian Scientists have a special lobbying arm that tries to have state laws amended to make such prosecutions impossible, and in some states have apparently succeeded. I think if you talk to a young child and come to the firm conclusion that he or she has no concept of the choices involved — death, hell, etc., then it’s really tough to just go with what the parents want.
Robert:
I was under the impression that JW’s and Chritisan Scientists refusal of treatment in the US is unresolved when it comes to minor children: that is, that parents may not neccesarily refuse treatment on behalf of their children if that refusal will likely result in death. I could be wrong about this. I say: case by case basis, burden of proof to fall on the shoulders of those requesting parental consent override. Adults have absolute veto for their own health.
Well, the age of consent thing becomes a lot less relevant, in my opinion, if the parents and the teenager agree on the issue. The issue is essentially whether the family or the state has guardianship over the girl. In such a case, the choice is either should the state get involved or not; seeing as without the state’s involvement, the decision would be clear. If the parents don’t want a transfusion, and the teenager doesn’t as well, I ‘d be hard-pressed to support a transfusion.
On the other hand, if the teenager had religious objections but her parents had none, or vice-versa, then the question becomes an issue of autonomy and age-of-consent, i.e. which one has the right to make medical decisions? In this case, the issue wouldn’t be whether or not the state has a right to get involved, but rather, when the state gets involved, whose authority, the girl’s or her parents’, will be respected?
I’d imagine this is not about Canada being “less free” but that its religious intolerance extends to certain Christian religions as well as non-Christian religions. In America, we are intolerant on non-Christian religions, which puts us on rather equal footing.
Being in Canada and hearing about this case all the time on the radio and TV, it is my understanding that the court decision has little to do with her religion and everything to do with her age. Since she is a minor she cannot refuse treatment on religious grounds and the parents cannot do it for her because it is considered abuse. If she was not a minor she would be able to refuse on religious grounds. The issue is made even more difficult by the nature of health care here. Since it is socialized the right to care (whether you want it or not) is a very sensitive issue.
I could be wrong, but this is what I have taken from the press coverage (which is intense on this case up here). In general I think Canada is about equal to the US on medicine and religious issues, but it only applies for adults.
I’ve thought about this further, and it seems to be a case of determining where religion crosses the line to cult. ”
You don’t consider modern medicine to be a cult? [I mean this question seriously] I don’t mean the techniques per se, but the mindset of all-powerful doctors vs. the common person where it is more likely for us to question the common person’s choices and beliefs than that of the doctors.
Going slightly off topic here, Canada is differntly free. More so in some areas, and less so in others. In this particular area, they’re less. In the case of giving religions the right to ahve marriages recognized by the state without respect to the gender of those married, they’re more free. Of course, Robert might not see that as freedom, but if that’s so, that’s his myopisa at work.
Canada is also not burdened with the idiotic two party system the US is. In that sense, they’re a lot more free.
Q Grrl:
You don’t consider modern medicine to be a cult? [I mean this question seriously] I don’t mean the techniques per se, but the mindset of all-powerful doctors vs. the common person where it is more likely for us to question the common person’s choices and beliefs than that of the doctors.
If a non docto disagrees with a doctor about a health issue, I’m more likley to give creedence ot the doctor. Likewise, if a non physicist disagrees with a physicist about physics, I’m incliend to look more favorably on the physicist. The same goes for auto mechanics, computer technicians, air conditioning repair technicians, and house building contractors.
Come to think of it, didn’t the Masons claim to get thier start as building contractors to the Egyptians?
Q Grrl, though I didn’t call it a cult, I was trying to make this point in my first post — courts rarely look behind assertions of medical facts by doctors. As I pointed out above, there are doctors that specialize in treatment so that JWs don’t need transfusions, who would likely view the risks of this treatment very differently than other physicians. Frequently (not always), what a doctor is saying in this situation is that he or she doesn’t want to do it the patient’s way for their own personal reasons, or because they or the hospital they work in aren’t really competent enough to rise to the technical challenges presented by the patient’s unique needs. But they present it as if it’s black and white medical science. One of my favorite headlines of all time, in a case in which a court ordered a cesarean after doctors asked for one: “Court orders surgery, mother nature reverses.” When mom went into labor she went to the ER of a different hospital where she delivered vaginally, and wouldn’t you know it, everything turned out just swell.
If we are comfortable with this statement, why wouldn’t we extend this to abortion policy as well?
I’m not confortable with this at all, mostly because her parents were with her on the decision. We’re essentially talking not only about the right to refuse, but parental rights as well. These are directly related to abortion in a legal level.
Damn the typos.
Q Grrl:
I wasn’t actually referring to modern medicine with my “cult” comment.
I was using the word “cult” here as short-hand for religion that endangers its members lives with its strictures. (Not the most precise definition, I realize.) Stuff like Christian Scientists. Are we supposed to respect someone’s religious beliefs, no matter how shocking or life-threatening they are, just because that’s their “religion”? Cults call themselves religions too. However I didn’t mean to get into this topic. Sorry.
If religion weren’t muddying the waters, it would be clear that a coerced medical procedure is a bad thing. It’s a violation of bodily integrity. Seems like yet another case of “experts” forcing women to submit their bodies to them “for their own good”.
“Seems like yet another case of “experts”? forcing women to submit their bodies to them “for their own good”?.”
I’m not certain why you bring up the gender angle – would this have been decided differently had it been a 14-year-old boy?
At what age to people actually have the right to choose a religion and practice it? Seriously, this is a question. When do we have the ability to say “This is my belief, it cannot be imposed on by the government, or my parents, is as this belief is personal”.
And if we’re not allowed to choose our beliefs until this magical age, then do parents have the right to spoon-feed children a faith? Does the government? If they don’t, why is there Sunday School?
I’m inclined to let her choose her own medical treatment. But, this is coming from a girl who was literally (as in, physically, the actually meaning of the word literally) forced to go to church every Sunday until she moved out of the house, even long after I had abandoned the dogma. So, I may be seeing this through the eyes of an individual that chaffed at the restrictions given to me at childhood.
Interesting drift, PS. There was a case in California, where a Jehovah’s Witness recieved an emergency blood transfusion while he was unconscious, and thus sued the hospital. The defense for the hospital said, “This case basically boils down to two things: Can we prove the prosecutor has an immortal soul, and does this court have an jurisdiction over it?” The JW lost the case.
Glaivester – it strikes me that way a little. There’s a lot experts here weighing in, religious, judicial, medical, and none of them seem to be listening to her.
Or maybe it’s solely because she’s a minor and I’m reading too much into it.
I’m SERIOUSLY on the fence with this one …
I mean, I think any religous perspective that bans access to needed medical treatment to be highly dumbarse and idiotic.
But, then, should the state have the right to force a medical treatment on anyone, let alone a child? (I mean, the ‘treatment’ – or rather mutilation – of intersex infants does pop to mind) I honestly don’t think they should.
But then Ted’s comments from within Canada about the debate there does bring an interesting perspective. Namely it being more related to her age than her religion, and denying access to medical treatment at that age being effectively abuse.
I’m just seriously on the fence with this one; I don’t trust my own opinions when it comes to religion, especially ones as fucked up as JV’s, so I am worried I am for the state intervention more on the basis of that rather than thinking through the complexities of the consequences. But then, where do we draw the line about where it is right for the state to step in against a child’s wishes? (no matter how brainwashed we may think them) … the girl in florida that wished to have access to abortion pops to mind but was prevented by the state agency initially; that was obviously wrong. But what’s the difference? Is it merely about both procedues (the abortion and the transfusion) being medically better for the child involved? But then to pick up Q Grrl’s very valid point; should we give doctors that kind of power?
I just don’t know on this one (one of the things I love about being a raving feminist liberal; the ability to admit to the gray nature of moral issues *smile*)
Not familiar with Canada, but in the US: a nonpregnant minor cannot consent for surgery/treatment; only the parents can. [A pregnant minor is considered emancipated, and can consent.]
So, legally, what the young patient wants is irrelevant. If her parents also refuse to consent, then the State can [and does] move in. They sue the parents for child neglect/abuse.
In comment #19, Ted alluded to this scenario, so I think it’s safe to assume this is what happened in this case.
One more thing you should be aware of: these are *not* medical decisions. In other words, once the MD recommends, say, transfusion and the patient, and her parents refuse, the hospital lawyer automatically gets involved, and determines the outcome of the case.
If the patient is a competent adult, who does not consent to surgery/treatment, you cannot treat. If you do, it’s considered assault.
Barbara,
Frequently (not always), what a doctor is saying in this situation is that he or she doesn’t want to do it the patient’s way for their own personal reasons, or because they or the hospital they work in aren’t really competent enough to rise to the technical challenges presented by the patient’s unique needs.
That is incorrect. What is being said in cases like this is that the hospital’s lawyer cannot allow the hospital to assume the liability of a potential child abuse case brought against it by some torter.
Ema,
Everything you just wrote is exactly how I have understood the case here in Canada. Seems the laws are very similar, if not identical. Only thing is that hospitals here really don’t have legal teams like the ones in the US do. I’m not sure how that aspect was worked out here, but the state (BC in this case), jumps in quickly in cases such as these to take over custody. The state is likely acting as the legal counsel for the hospital (since the hospital is run by the state anyway). I hope this girl doesn’t pop up in Quebec! That could get really messy.
Today’s Guardian has an article on patient autonomy too, though it’s about a man fearing he will be euthanized when his medical condition has deteriorated to a point where he can’t enforce his own wishes. His concerns are apparently valid since the debate is to “decide where the line is drawn between patients’ autonomy and doctors’ duty to act in what they believe is their patients’ best interests.” Only in this case, the “patients’ best interests” they speak of are actively killing him against his will.
No, Ema, that is not correct. Of course, the hospital’s and the doctors’ lawyers are involved, but that is the point: it is not one of medical judgment or facts, it is one involving considerations that are quite different. No hospital in this situation stands up and says: my facility is not competent to provide this service, but there are others that are . But this is in fact the case, and it is unquestionably the case with JWs, where hospitals do specialize in doing surgery without transfusion. How many hospitals advertise themselves as “full-service maternity” hospitals when, in fact, they do not provide one very important service that many women want and that many other hospitals provide, which is VBAC? Instead, they say: VBAC is risky! No, it’s actuall less risky than a c-section when you have an adequate anesthesia service. I’m not saying they should be forced to do that which makes them feel queasy or subjects them to heightened liability because of their particular circumstances, just that they not cast their lack of facilities and expertise as a bona fide, universal medical judgment.
Barbara,
No hospital in this situation stands up and says: my facility is not competent to provide this service, but there are others that are .
The “service”, for the case under discussion, is a guarantee of a favorable outcome in a noncompliant minor patient. [Remember, the issue is not medical competence, but rather liability.] No hospital can offer such a guarantee.
As to your specific point, most large & medium-sized hospital already offer the type of surgery you mentioned. [At smaller hospital, there’s usually a protocol in place to handle JW patients (referrals/consults/transfers).] This widespread availability has mostly come about as a result of a) technological advances, and b) more, and more people trying to avoid having a transfusion, for reasons unrelated to religion.
How many hospitals advertise themselves as “full-service maternity”? hospitals when, in fact, they do not provide one very important service that many women want and that many other hospitals provide, which is VBAC? Instead, they say: VBAC is risky! No, it’s actuall less risky than a c-section when you have an adequate anesthesia service.
I’m not aware of any. If a hospital has OR capability, it’s equipped to offer VBACs. Any hospital with an L&D has to have adequate anesthesia, so that’s not a factor.
I think part of Barbara’s reference to VBAC (correct me if I’m wrong, Barbara), is that regardless of these capabilities, hospitals and primary care providers are refusing VBAC’s as a matter of generic principle, without letting them even be case by case. I know this for a -fact- because it’s something I’m currently going through. I was refused treatment by my primary care providers of 2 years if I did not agree prior to any physical diagnosis to not attempt VBAC, and consent instead to caesarian section. Just how hard things can become when we attempt to practice our ability to partake in our own care decisions came crashing around my head at that point, and now I’m faced with either a.) switching mid-pregnancy to another care provider and dealing with a lot of tricky insurance questions and potential problems, b.) accepting the terms of my primary care providers office and consenting to surgery that wasn’t proven to even be necessary (70% success rate, btw, of VBAC’s in the US), or c.) Jeopardizing my health or the health of the baby due to trying to hold out for hard labor to potentially hinder a c-section from occurring due to late stage of labor.
can we first spell out our abreviations so the rest of us can have some idea what is going on before googling around in search of terms? Thanks
Sorry Ted — VBAC = vaginal birth after cesarean. It’s so commonly used that I assumed most people would get the reference. Many hospitals are simply refusing to permit doctors to do the practice no matter what the patient profile, instead requiring as often as possible a cesarean that can be scheduled so that the hospital doesn’t have to institute a 24 hour labor and delivery anesthesia service. My hospital does them, but two counties over the main hospital won’t — and the chief of obstetrics smugly told my local paper that hospitals are “crazy” to continue letting women do VBACs. No, adequate facilities are not crazy — that is an example of what I mean by casting something as a medical issue when, in this case, it’s really an issue of medical economics, not medical science.
It’s true Ema that hospitals generally are using less blood, but there are hospitals and surgeons that specialize in JW surgery, not many by any means, but some. And their view of this case may be very, very different from that of a hospital that doesn’t so specialize.
I think the real issue here is that we are simply very reluctant to enable a decision by one so young that is so likely to result in her own death. The possibility that she would change her view is too strong for us to overlook. I think that the doctors in this case, instead of taking the issue to court, should try at least to explore whether there is any hospital that would feel confident doing the surgery as the patient and her parents desire, rather than assuming that their view is the only possible view. Perhaps they already did that. But I really don’t think the Canadian doctors here are worried about malpractice liability.
Thanks Barbara.
I can assure you the Canadian docs aren’t worried about malpractice. Moreover, what you stated as the real issue is exactly the basis for the ruling as I understand from the media coverage here.
this is a very difficult question with no clear cut answer. strong arguments could be made to support both sides. i have deep problems with the state being involved at all, much less having the final say. you need only look back at the attempted intervention of the state of florida in the terri schaivo case to wonder in what possible way the “state” is affected in cases such as these. here in the united states, if a competent patient makes a decision to refuse a procedure that his doctor views as medically necessary, and considers the refusal to be clearly an irrational choice, that is sufficient reason for the physician to question the competency of the patient. this has the direct effect of watering down the patient’s right of informed consent. if the patient is competent, he doesn’t lose his competency simply because the physician disagrees with his choice. the big question here is, does a minor ever possess a right to make their own medical decisions and what reasons will or situations will bring this about? just as i feel that an 18 year old, who is considered an adult when he is eligible to be drafted into the armed services and maybe to give up his life for his country, then they are also adult enough to legally purchase and consume alcohol., i also feel that if a minor is deemed to be emancipated as an adult when pregnant or married then they are adults, period. even if they are deemed too young to refuse a blood transfusion that may or may not result in any untoward outcome or death, then her parents should have the final say. i have much difficulty with the prevailing attitude that you have the “right” to something if, unless, something else occurs, if which case you really do not possess the right at all. i have absolutely nothing against doctor’s and feel that the overwhelming majority truly want the best possible outcomes for their patients. however the lawsuit happy environment which exists today causes doctor’s to be more concerned with what is the best method of me not being involved in a litigation, rather than what is best for his patient