Forced or Mandated Medical Care?

406C

I was wondering how many of us are agreed with forced medical care?

This last month saw a forced transfusion for a Jehovah's witness child in Dublin whereas in the UK a child fought and won the right to choose to die.

This is something that often involves an individual or family faith or wish how to live their lives.

I would like to state off the bat I am not a Jehovahs Witness, it is simply an issue I am personally undecided upon, which seems to be coming to the fore more and more often and which I would like to examine opinion upon - if allowed.



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wheresthebeef

personally, i feel that if a child requires a blood transfusion and the parents refuse it on the basis of religion i think its up to the courts and the doctors to decide what is accepted best practice for the patients condition based on medical evidence and research.
I would have no problem participating in a blood transfusion to a jehovahs witness providing there was something legal to back me up.

tallaght01

wheresthebeef wrote: »

personally, i feel that if a child requires a blood transfusion and the parents refuse it on the basis of religion i think its up to the courts and the doctors to decide what is accepted best practice for the patients condition based on medical evidence and research.
I would have no problem participating in a blood transfusion to a jehovahs witness providing there was something legal to back me up.

Agreed. Was in that situation only a few weeks ago.

nesf

I'd have no problem with an adult refusing treatment for themselves but I'm really not sure that a parent should have that right over treatment for a child. If it's a clear cut and dry case of they get this treatment or they die then I think the child should get the treatment. The child has a right to live and the rights of the parent should not exceed this in my view.

Amnesiac_ie

It's a difficult area, ethically, legally but especially for the children, parents and medical staff who actually find themselves in these situations. It is complicated in Ireland by the "special place" accorded the family in the Constitution and a lack of a ruling such as "Gillick" in our own courts.

Personally I think dialogue is hugely important in these situations. With good communication compromise solutions can often be found that are acceptable to the child, parents and medical team.

In the case of children of Jehovah's witnesses who require blood products, I think it is important to exhaust any suitable alternatives whilst liasing with the parents. If it becomes absolutely necessary to transfuse a lot of parents will agree to the transfusion having seen that genuine efforts were made to utilise alternatives first. If consent is not forthcoming there is no option but to refer to the courts.

In an emergency; I'm not sure. I think any medic's duty of care has to be to the child and if in extremis blood should be given and the aftermath may need to be dealt with by the courts.

As regards children making their own decisions I think Gillick competence is a good ruling. Basically, this ruling in an English court set the precedent whereby a minor can give consent for medical treatment; even if their parents are opposed; if the medical team feel the child is mentally competent to make their own informed choice. This obviously applies to older children and I certainly feel that the child's views should always be taken into account and if mentally competent should be provide the overriding direction.

What's interesting about Gillick is that it has been rarely used by medics to allow a minor REFUSE treatment. In the case highlighted above a young teenage girl refused a heart transplant. Despite the fact that her parents agreed with her, the PCT in the UK went to the courts to try and overurle her decision. Even had her parents sided with the PCT, I think a teenage girl of her age has the right to refuse treatment herself but as far as I'm aware the Gillick ruling has yet to be used to defend such an action.

A very interesting area; fascinating to debate in a lecture hall or an online forum but a truly ghastly nightmare for people who are caught up in real life situations.

406C

It is definitely a minefield. For many of us the primary focus is saving lives, but faith and living their faith is the most fundamental aspect of their lives and their whole reason for being.

I spoke once with a Jehovah’s Witness and he was adamant there were other options to transfusions. I don’t remember them and had meant to investigate them but truth is I never did.

I have a different view of the Gillick Judgement it was in regard to the prescription of contraceptives rather than a medical issue and was in deference to the mother’s religious beliefs.

I think the reason why the ruling has never being used to back up a child’s wishes was that at the time those opposing Gillick had strong backing from those espousing a liberal pro choice opinion that wanted parental guardianship removed, simply to fit their agenda, rather than in the best interests of the child or to preserve life.

Personally I don’t think it’s a great idea to introduce strong hormonal contraceptives to what is essentially a growing body but it’s a personally held belief.

Amnesiac_ie wrote: »

A very interesting area; fascinating to debate in a lecture hall or an online forum but a truly ghastly nightmare for people who are caught up in real life situations.

Agreed.

RobFowl

I'm aware of the Jehovah's witnesses objection to blood transfusion is the one thats always used as an example. I always think we can be a bit too quite to use blood products anyway. (remember all those women who got Hep C from contaminated blood in the late 80's and early 90's).
Was quite interested to see this on the RTE site

"The Health Service Executive has confirmed that there are currently two people detained against their will in hospitals in Ireland because they are considered to be probable sources of infection to others. One of the cases is that of a woman from South Africa who is currently detained in a hospital in Cork with a suspected case of TB that is drug resistant.
This woman has refused medical treatment and has been detained against her will for the last 11 months. She lost her High Court challenge to her continued detention this week."


Basically people are being detained against their will because they are refusing medication even though they are (as far as I can tell) fully informed and able to refuse consent.

wheresthebeef

the jehovahs witnesses have position papers on a number of alternatives to blood transfusion including a number of synthetic blood substitutes that simply do not really work. they also have a number of ideas regarding how low a persons haemaglobin can be before its actually life threatening, suggesting levels that are light years below what medical science would class as severe anaemia.
personally, i don't agree with their policies which are dictated by those in ivory towers and is drilled into members. there is something very suspect about how their organisation is run. and for that reason, i would be reluctant to withold a blood transfusion from someone who really did need it based simply on their faith in Jehovahs Witness doctrine.
Its a strange conundrum because I would never force a person to take a medication they didn't want.
Really and truly, i think if a Jehovahs Witness refuses a blood transfusion, they should have a psychiatry assesment to see if their decision is compos mentis. I think nowadays someone who would risk their life in a serious way based on the teachings of an organisation strongly resembling a cult, needs to be assesed.

Taken from wikipedia: "In English law, the rule of non compos mentis was most commonly used when the defendant invoked religious or magical explanations for behaviour."
(and yes i acknowledge the possibility for inaccurate info taken from wikipedia, but thats just my opinion)

Piste

RobFowl wrote: »

"The Health Service Executive has confirmed that there are currently two people detained against their will in hospitals in Ireland because they are considered to be probable sources of infection to others. One of the cases is that of a woman from South Africa who is currently detained in a hospital in Cork with a suspected case of TB that is drug resistant.
This woman has refused medical treatment and has been detained against her will for the last 11 months. She lost her High Court challenge to her continued detention this week."


Basically people are being detained against their will because they are refusing medication even though they are (as far as I can tell) fully informed and able to refuse consent.

That's slightly different though because it's not just about her, she's highly contagious so she's being detained for the safety of others. I think any adult has the right to refuse treatment, but not if it could cause others to be easily infected like in this case.

nesf

RobFowl wrote: »

Basically people are being detained against their will because they are refusing medication even though they are (as far as I can tell) fully informed and able to refuse consent.

You don't have the right to spread infection though which trumps the right to refuse treatment. You only get the second right where your refusal does not pose a threat to anyone else. Morally speaking, I image the legal argument follows along similar lines.

eth0_

I think if you're responsible for a child as in the case of the jehovah's witness woman who needed a transfusion during labour, you should be forced to take it.

The girl in England is a completely different story, she was told her chance of survival even with a transplant was not great. She was sick of having operations and she is old enough to make an informed decision.

However - that bloody idiot South African woman who has been bed-blocking in a hospital in Dublin refusing treatment for her TB should have no choice in the matter, she is putting everyone she comes in contact with at risk of infection and she can't expect the HSE to pay for her to lie in a pressurized room forever.