Jehovah's Witness, Blood, Ethics and Children

[edge_w]

I've been doing some thinking about the whole ethical problem surrounding the refusal of jehovah's witness to accept life-saving blood transfusions. (actually in the news today)

 

For an adult refusing treatment, I think the answer is a relatively simple, although certainly not pleasant, one. Ultimately, you cannot 'force' treatment on someone who has legitimately stated their refusal, and so you would not administer treatment.

 

When it comes to children, everything gets muddled up... If the child isn't capable of speaking, should it be the State (i.e. you, as a doctor) or the Parents who decide? Can the parents extend their religious beliefs to their own child, without their consent? Furthermore, when should the child be deemed capable of making such a decision? When he first talks? When he learns to write? When he turns 18?

 

Probably more in depth than you'd ever be expected to answer in an interview, but nonetheless....

[temp_degoo]

The "safe" answer, if there is one, is that while the child is in the legal custody of the parents, they have the legal right to decide what's best for him/her.

 

But you raise a good point, one brought up in a Dawkin's film "The God Delusion", where he says: You wouldn't consider the child of a liberal or a conservative as a liberal or a conservative, you would state that they are too young to make the decision. Why is religion branded on the young before they can decide for themselves?

[KennethToronto]

I've been doing some thinking about the whole ethical problem surrounding the refusal of jehovah's witness to accept life-saving blood transfusions. (actually in the news today)

 

For an adult refusing treatment, I think the answer is a relatively simple, although certainly not pleasant, one. Ultimately, you cannot 'force' treatment on someone who has legitimately stated their refusal, and so you would not administer treatment.

 

When it comes to children, everything gets muddled up... If the child isn't capable of speaking, should it be the State (i.e. you, as a doctor) or the Parents who decide? Can the parents extend their religious beliefs to their own child, without their consent? Furthermore, when should the child be deemed capable of making such a decision? When he first talks? When he learns to write? When he turns 18?

 

Probably more in depth than you'd ever be expected to answer in an interview, but nonetheless....

 

If I'm not mistaken, your hypothetical situation involving a child requiring a blood transfusion with Jehovah's witness parents who are opposed to it has in fact occurred.

 

In such a situation, if the child cannot make an informed decision whether or not s/he will receive a blood transfusion (and the parents oppose), then the courts will most likely side with the hospital and allow the blood transfusion to proceed. In general however, I think the agreement is that the state has no business telling parents how to raise their children - but this is an exception I would argue.

[Smurfette]

In such a situation, if the child cannot make an informed decision whether or not s/he will receive a blood transfusion (and the parents oppose), then the courts will most likely side with the hospital and allow the blood transfusion to proceed. In general however, I think the agreement is that the state has no business telling parents how to raise their children - but this is an exception I would argue.

 

Regarding the point that the state has no business telling parents how to raise their children...This is not true. There are a number of instances where the state does dictate what is an acceptable way of raising children. Examples include various forms of child abuse: physical, sexual, neglect. In those cases, the state can take the child away from the custody of the parents. I'm not saying that the Jehovah Witnesses case is analogous since abuse usually does not deal with the question of different values (I don't think anyone can reasonably argue that subjecting a child to sexual abuse is a religious belief).

 

You wouldn't consider the child of a liberal or a conservative as a liberal or a conservative, you would state that they are too young to make the decision. Why is religion branded on the young before they can decide for themselves?

 

No, you wouldn't consider a child a liberal/conservative, but you'd certainly allow the parents to raise the child as a liberal/conservative. For example, if the parents were strong believers of environmental causes, they could make sure that their children always recycled paper/cans, walked/biked to school, and used recycled products. The same thing is true for religion. If the parents are Catholics, they might make their children go to a Catholic Church every Sunday. In the end, the child will get to choose their own politics and religion when they are adults (obviously with their childhood influences). The only difference is that religion usually goes a lot deeper than political views because it deals with issues like life and death. That's when we've got ethical scenarios such as that with the Jehovah's Witnesses.

[peachy]

The "safe" answer, if there is one, is that while the child is in the legal custody of the parents, they have the legal right to decide what's best for him/her.

That is not at all a safe answer. If you were asked this question in the interview, and answered point blank that it's up to the parents, I doubt you would score too highly!

[KennethToronto]

Regarding the point that the state has no business telling parents how to raise their children...This is not true. There are a number of instances where the state does dictate what is an acceptable way of raising children. Examples include various forms of child abuse: physical, sexual, neglect. In those cases, the state can take the child away from the custody of the parents. I'm not saying that the Jehovah Witnesses case is analogous since abuse usually does not deal with the question of different values (I don't think anyone can reasonably argue that subjecting a child to sexual abuse is a religious belief).

 

Hi Smurfette,

 

I think the examples you illustrate are the self-apparent exceptional instances where the state does have a say in how parents raise their children.

 

However, what I mean (and probably failed to convey) is that a vast majority of decisions are deferred to the parents.

[temp_degoo]

Damn, I thought that was the safe answer.

[peachy]

Damn, I thought that was the safe answer.

For any ethics question, the "safe" answer involves, at the very least, being able to articulate both sides of the program clearly. It is never enough to simply choose one side, because that doesn't show understanding of the ethical dilemma!

[Jochi1543]

Hi Smurfette,

 

I think the examples you illustrate are the self-apparent exceptional instances where the state does have a say in how parents raise their children.

What about attending school up to a certain level? I'm not sure whether it is the same in Canada, but in the States you as a parent are obliged to send a child to a primary/secondary school for so many years.

 

I also think that "neglect" may fully apply to this particular situation.....Most of us would tend to think of a more traditional situation e.g. mother is a drug addict, took drugs all throughout the pregancy, her child has serious problems due to that, she doesn't feed the child adequately, child dies. I think the Jehovah's witness situation may easily be interpreted as a less shocking case of neglect. Think of it as "child on deathbed, mother refuses to bring child to hospital" - sounds like a National Enquirer expose' once rephrased.

 

This reminds me of a story that ran through a few chapters in "The Intern Blues....." I don't remember the exact details, but it boiled down to the fact that the guy had this newborn/baby patient who was brought by his mother to the hospital every week or so, and despite the fact that they kept administering treatment, the baby kept coming back ridiculously sick in a week or two. They eventually figured out that the mother was purposely harming the child and was attempting to garner attention and pity through her child's illness. So if I remember correctly, the child ended up being passed on to the child protection services, either temporarily or for good, because his mother's parenting was not considered to be the best situation for the child.

[Smurfette]

For any ethics question, the "safe" answer involves, at the very least, being able to articulate both sides of the program clearly. It is never enough to simply choose one side, because that doesn't show understanding of the ethical dilemma!

 

It's nice to understand the arguments on both sides, but you can't just sit on the fence either. Otherwise you would never make any decisions - not making a decision is in itself a decision. I think most of the time ethical situations involve analysis of a case-by-case scenario. Eg. you might argue that the state should intervene if the child is a baby and cannot speak for him/herself. But you think the state has no right to intervene if the "child" is 16 and able to demonstrate that she clearly understands the consequences of not having a blood transfusion and is ready to accept those consequences.

 

My apologies to KennethToronto - I misinterpreted your statement. Of course, in general, parents have a right to make choices for their children.

 

To Jochi: I'm not sure that Jehovah's witnesses are "neglecting" their children in the purest sense. The word "neglect" implies that the parents are harming their children by carelessness. In the case of Jehovah's witnesses, the parents think they are doing the best for their children, but their values are inconsistent with the values generally accepted by society.

[Jochi1543]

To Jochi: I'm not sure that Jehovah's witnesses are "neglecting" their children in the purest sense. The word "neglect" implies that the parents are harming their children by carelessness. In the case of Jehovah's witnesses, the parents think they are doing the best for their children, but their values are inconsistent with the values generally accepted by society.

Yeah, but I don't think neglect has to be premeditated and conscious.

 

I think I just recalled what I think could be an example of what you just mentioned - remember that NJ couple with 10 foster kids who had their kids locked in cages at night? They claimed it was for the kids' safety, and I easily understand how they could justify that argument; but most considered it to be morally apprehensible.

 

Anybody remember how the trial eventually ended, by the way (if it has yet)? I didn't follow it too closely.

[Kuantum]

I think this is a particularly interesting case in which the State may in fact have the right to intervene. Like someone previously mentioned, the State has certain rules that ensure a child's protection, and if they feel that the parents cannot ensure those protections are in place, they will take custody. For the blood transfusion case, adults are typically allowed to make their own decision to refuse medical advice because their beliefs disapprove of this. In the case of an adult, this is allowed to happen because they are deemed as understanding the consequences and simply stated, it is their life. Now, there is a whole philosophical debate about whether your life actually belongs to you or to a higher power, but I won't go into that.

 

Anyhow, I remember a case a couple years ago of conjoined twins in Europe. They weren't born in Europe, but the hospital that was taking care of them was in Europe. Since one twin essentially had most of the organs and the other was living of the first, they were debating whether they should separate and let one die, or keep them together knowing that both would die. The parents were devout catholics, and delibarately killing a person is against Catholic doctrines, however, the hospital was argueing that they weren't killing the weaker twin, but in fact letting her die, which I seen as two different things. When you pull the plug off an elderly patient, you are not killing them but letting nature take its course. In the situation with these twins, the hospital/state took custody of the children, separated them, and surely enough, the weaker one died almost immediately while the other lived.

 

So, what I am saying is that in a situation like the blood transfusion, if the courts deem that the parents aren't acting in the best interest of the child, then they can take over. The family can appeal it, but when it comes to children, I think the preservation of life tends to come above all else. Now, were this another case where quality of life was also an issue, I think that make things far more complicated...especially in some religious ethics were all life is infinitely valuable, regardless of the quality.

 

Religion is something that many people hold very dear to them because it is what guides the moral intuition and the way they conduct their lives. There are a set of beliefs for each religion that sometimes conflict with others' beliefs--that's why we have ethics. To try to determine what is right and what is not right, sometimes independant of religion (but a lot of times not).

 

Personally, I think the state really did the right thing. I believe the statement in the bible that Jehovah's witnesses refer to when the belief to not accept blood transfusions has many possible meanings. Thus, it is difficult to know whether that statement actually means that. In a situation like this where you are dealing with children that have the potential to live full and healthy lives, the preservation of life should really be a priority.

[Smurfette]

Yeah, but I don't think neglect has to be premeditated and conscious.

 

I think I just recalled what I think could be an example of what you just mentioned - remember that NJ couple with 10 foster kids who had their kids locked in cages at night? They claimed it was for the kids' safety, and I easily understand how they could justify that argument; but most considered it to be morally apprehensible.

 

Anybody remember how the trial eventually ended, by the way (if it has yet)? I didn't follow it too closely.

 

Well anyways, it's just terminology. I guess I'm thinking about my own experiences with neglected children. I volunteered with some foster kids who had been neglected in their original families (hence the reason they were in foster homes). Because the parents were drug addicts, they were not fed properly and did not have proper hygeine so that their teeth fell out. I don't think the parents consciously wanted to neglect their children - it was just that they were too high (and probably too poor) to properly care for their children. If you were to ask them when they were sober what they wanted for their children, I'm pretty sure they would have said the best food and care possible, lots of love, and a good education. Quite a different situation from Jehovah Witnesses where beliefs rather than social circumstances are the root cause.

[Jochi1543]

 

The parents were devout catholics, and delibarately killing a person is against Catholic doctrines, however, the hospital was argueing that they weren't killing the weaker twin, but in fact letting her die, which I seen as two different things.

This argument is not 100% solid though.....think about how some very devout Christians (and followers of some other religions as well, I'm sure - I'm just much more familiar with Christianity) behaved during the Teri Schiavo case....While the actual case revolved around her parents' vs. her husband's wishes for the outcome of her situation, religion and right to life came into major play. While the argument you mentioned sounds very logical, Schiavo's case illustrates that it can be worthless with its target group (i.e. very religious individuals who believe in the sanctity of life).

 

A more mundane example - some of the very devout Christians I know who will often say that god has the final say in who lives and who dies still go to the doctor when they are sick - even though following that logic they should just let things run their course.

[muchdutch]

I'm assuming this is in response to the BC sextuplet case? Well in that case, from what I heard this evening, the 'State' did intervene and gave one (or two? maybe three of them?) a transfusion. Rumors are that one more (maybe two) of them have died since, leaving only three since the first one died shortly after birth. (sorry for the lack of deets, my brain was fuzzy and I was 'studying' at the time:p )

 

It will be interesting to see how it plays out.

[muchdutch]

I'm assuming this is in response to the BC sextuplet case? Well in that case, from what I heard this evening, the 'State' did intervene and gave one (or two? maybe three of them?) a transfusion. Rumors are that one more (maybe two) of them have died since, leaving only three since the first one died shortly after birth. (sorry for the lack of deets, my brain was fuzzy and I was 'studying' at the time:p )

 

It will be interesting to see how it plays out.

 

 

*wait 30 seconds....wait 30 seconds... wait 30 seconds... holy mama - hot topic!*

[muchdutch]

how did that happen?....

[Jochi1543]

Religion is something that many people hold very dear to them because it is what guides the moral intuition and the way they conduct their lives. There are a set of beliefs for each religion that sometimes conflict with others' beliefs--that's why we have ethics. To try to determine what is right and what is not right, sometimes independant of religion (but a lot of times not).

I agree with your idea that religion and ethics are separate things. I know some people believe that there is a very strong relationship between the two, but personally, *I* think religion has NO place in these debates. Why? Well, say, I am an atheist (I don't believe in god or ANY spiritual life), and if a doctor came out to me and said he made a decision about my relative's medical situation and justified it by his religious beliefs, I would be livid. To me, a valid explanation could not involve anything related to god, because god doesn't exist. I know that atheists comprise a very small percentage of the population in the US (don't know about Canada), so I am in the minority, but I imagine this same situation can be applied to an ethical conflict between people of 2 different religions, or even 2 branches of the same religion. I am not going to try and think of an example, I'd rather leave it to someone who is more familiar with various religions, but at least I can make a generalization on why a person like me might completely discard an explanation based on religious beliefs. Of course, tolerance is a good thing, and I avoid criticizing other people's beliefs, but when you don't share the other's beliefs and yet they are used to majorly impact your life, I consider it unacceptable.

[Kuantum]

I agree with your idea that religion and ethics are separate things. I know some people believe that there is a very strong relationship between the two, but personally, *I* think religion has NO place in these debates. Why? Well, say, I am an atheist (I don't believe in god or ANY spiritual life), and if a doctor came out to me and said he made a decision about my relative's medical situation and justified it by his religious beliefs, I would be livid. To me, a valid explanation could not involve anything related to god, because god doesn't exist. I know that atheists comprise a very small percentage of the population in the US (don't know about Canada), so I am in the minority, but I imagine this same situation can be applied to an ethical conflict between people of 2 different religions, or even 2 branches of the same religion. I am not going to try and think of an example, I'd rather leave it to someone who is more familiar with various religions, but at least I can make a generalization on why a person like me might completely discard an explanation based on religious beliefs. Of course, tolerance is a good thing, and I avoid criticizing other people's beliefs, but when you don't share the other's beliefs and yet they are used to majorly impact your life, I consider it unacceptable.

 

Hey Jochi,

 

I didn't say ethics and religion were two separate things. In fact, I'd say they are very intertwined and each one can affect the other. I am saying that sometimes, ethical decisions try to be made without religion because there are just too many different views that it can be difficult to find a universal right answer to a situation. I mean, there isn't always one right answer to every situation, but some are clear.

 

For example, killing a person for pure enjoyment is wrong any which way you look at it. However, some will say killing a person is always wrong and some will say that sometimes its justified. So, with the twins, the parents are entitled to their beliefs and are free to make decisions based on that because its what they believe is right. However, when the state who is also deemed responsible for the welfare of its societies members feels that the parents beliefs are conflicting with the welfare of the child, then they feel they need to intervene. In this situation the intervention went against the parents wishes. In other religions, blood transfusions isn't an issue.

 

That's why sometimes ethicists try to come up with solutions that are free from religious influence because it can be very applicable, however, sometimes its not possible. To say that ethics and religion are totally separate I think may be a little too absolute.

[Jochi1543]

Hey Jochi,

 

I didn't say ethics and religion were two separate things.

I thought it was implied in this sentence:

There are a set of beliefs for each religion that sometimes conflict with others' beliefs--that's why we have ethics.

I read as differentiating between the 2.

[Jochi1543]

 

That's why sometimes ethicists try to come up with solutions that are free from religious influence because it can be very applicable, however, sometimes its not possible. To say that ethics and religion are totally separate I think may be a little too absolute.

Yes, I did think about this while I was typing up the response. I absolutely think that even though a person may not agree with many major aspects of the religion that he or she was raised in, s/he was nonetheless affected by it, to whatever extent. I am sure that even though I am an atheist, a theological analysis of some of my ethical beliefs could provide proof of a strong Orthodox Christian influence; and maybe even Episcopalian, considering that I spent a year in an Episcopalian high school. I wish I could recall this precisely, but just a few months ago I totally had an "aha" moment because I was contemplating something and suddenly realized that my opinion on the situation was entirely a product of American Puritanism, which is not something I would ever consciously admit to following. I think it would be very interesting to analyze the ethical differences/similarities between non-religious individuals who were brought up in very different religious cultures (imagine Christianity, Islam, and Japanese Shinto).

 

However, while I do admit that there IS a correlation between religion and your ethics, whether it's a religion you consciously admit to practicing or simply the one that surrounded you when you grew up, I DO think that ideally there should be none. I know that no logical analysis will ever sway my very religious boss who bases every significant decision on what she believes the Bible and her preacher say, but at least the explanation I offer her allows her to connect on a different, non-religious level, as logic is something we both share. She may still not agree, but at least she can understand my reasoning.

[Jochi1543]

On a more important note, I've been sitting on my ass for 1.5 hours straight, and it hurts, so I'm going home for the night.

[peachy]

It's nice to understand the arguments on both sides, but you can't just sit on the fence either. Otherwise you would never make any decisions - not making a decision is in itself a decision.

Yeah, I agree. But in an interview situation imho you should always start with showing that you understand both sides of the issue.

[Kuantum]

I thought it was implied in this sentence: I read as differentiating between the 2.

 

Ok...sorry for the confusion.

[bumblebee]

Just wanted to add that I am currently listening to a CBC report about the BC family who recently had sextuplets. Long story short... Doctors wished to provide blood transfusions for several of the babies who had low hemoglobin levels. The parents are Jehovah's Witnesses are were staunchly opposed to transfusion. The state stepped in and provided transfusions against the wishes of the parents. Check the CBC website for more information.

 

Two quick points about ethical questions in interviews... I totally agree with peachy's suggestion to show that you have an appreciation for all sides of an issue.

 

Also, a child may be younger than the age of consent (e.g. 12) but can be determined to have the capacity to consent (i.e. understands the issues and the consequences of each course of action) and can therefore make decisions regarding his/her care.

 

Finally, there is a difference between law and ethics, although they definitely intermingle. Just something to think about.