brut33 Posted February 1, 2007 Report Share Posted February 1, 2007 I think the real issue here is the difference between law and morality. Unfortunately the two don't always match up. When it comes to practical ethics and the concerns of physicians there is a need to abide by the law of of the land - those set forth by the State, in this case Canada. The Jehovah's Witness parents and others are abiding by their faith based morality. When we do no harm we have an obligation to do so with the beleifs of the patient in mind. The case of children becomes muddled. If our first insticnt is to do no harm and protect these babies (the BC sextuplets) then we had best hope that the laws of the land precede the laws of morality that the parents hold true. remember the Charter does include religious freedom. It is a gigantic issue. Link to comment Share on other sites More sharing options...
Satsuma Posted February 1, 2007 Report Share Posted February 1, 2007 If our first insticnt is to do no harm and protect these babies (the BC sextuplets) then we had best hope that the laws of the land precede the laws of morality that the parents hold true. Well I think that is the case. Yes people have their religious beliefs protected, but religious beliefs cannot violate our human rights. That is why in Canada the crown (I'm pretty sure in Canada we refer to the crown not state) or province is able to step in. I will bring up what I think is a more interesting case for you all to ponder. I do not know how this case ended, if it has been resolved at all. A case of a teenaged girl with leukemia, I believe she was 16 years...so just boderline when the province could intervene. She was from out west, perhaps Alberta? Her father wished for his daughter to receive transfusions but the mother and daughter did not want them (the were all Jehovah's witnesses I believe). So I believe the province made the decision to have the 16 year old receive the blood transfusions, but then she turned 17 and refused them. She died. Now, obviously the case of a teenager is somewhat different than that of a newborn. However, the part I find interesting is that the father then decided to take both the mother and the church to court...for implying to the girl that she would go to hell etc. etc. (go to hell = my words, not necessarily theirs but that is the point) if she accepted the treatment. So, I personally find this a more interesting ethical dilemna since the girl is old enough to have at least some understanding of her choices. (though if I remember from my psych of death and dying class from undergrad, a 16 year old understanding of death is not still 100% developped). Unfortunately, I don`t know how this ended...maybe someone else here does! Link to comment Share on other sites More sharing options...
The Law Posted February 1, 2007 Report Share Posted February 1, 2007 Holy cow this thread is on FIIIIIIIIIIII-UHHH This is a very difficult scenario. I'm personally of the opinion, that while it is important to respect the rights of an individual, children are exceptional cases. Yes, we live in a country where we respect peoples' freedoms, their freedom to express and live out their religion as they please... however, in situations of life or death, you cannot treat it as though the case was simply "black and white." There is definitely no clear methodology of deciding something like this. I think it's in the best interest of the child to carry out the transfusion... even though it is taking the decision of a majority and kind of forcing it on a minority of people. Since you are dealing with a child, I do not think that it is fair to the child to simply assume that they should follow the beliefs of their parents. I know that many people disagree with their parents on certain matters - which is an indicator of how people change as they grow up. Since this case is a "life or death" situation, not going through with the transfusion is preventing the child the opportunity to grow up and decide on their beliefs for these matters on his or her own. I think that it is important to differentiate between the BELIEFS of the PARENTS and the "BELIEFS of the CHILD"... just because the parents believe in one thing, that doesn't mean the children should be forced to wave the exact same flag... Link to comment Share on other sites More sharing options...
Smurfette Posted February 1, 2007 Report Share Posted February 1, 2007 I think that it is important to differentiate between the BELIEFS of the PARENTS and the "BELIEFS of the CHILD"... just because the parents believe in one thing, that doesn't mean the children should be forced to wave the exact same flag... That's true. That's why I think that in the case of the babies (totally unable to speak for themselves) that the state has the right to intervene. The problem becomes a lot more complex when the child does have beliefs - only those beliefs are not quite independent of the beliefs of the parents. For example, a child of 10-16 years may have the capability of SAYING "I don't believe in blood transfusions," but may not have the capacity of fully UNDERSTANDING the consequences of NOT having a blood transfusion and may not have an independent adult understanding of the concept of death. When the child disagrees with the parents, then you may have an argument for independent thought. For example, if the parents are Jehovah Witnesses and don't want their 14-year-old daughter to have a blood transfusion, but she wants one, then I would argue that she is capable of thinking for herself. But if she agrees with her parents, then it is unclear whether she agrees because that is her independent thought or not. Link to comment Share on other sites More sharing options...
Jochi1543 Posted February 1, 2007 Report Share Posted February 1, 2007 Finally, there is a difference between law and ethics, although they definitely intermingle. Just something to think about. Definitely.......I think it's safe to say that a person's ethics will change in their lifetime many more times than a corresponding law might. How many times have we heard the story of a Roe vs Wade activist who is now pro-life? While laws change, it takes a long time for that to happen AND requires a certain amount of input from the public. If the public doesn't care about a law, it will never change (think all these stupid "wife may not cut hair w/o husband's permission" type of laws). Which raises the second issue, which is that USUALLY the law results from the opinion of the majority - or at least is expected to arise in that manner. So if you are not part of the ethical majority, too bad. Link to comment Share on other sites More sharing options...
brut33 Posted February 1, 2007 Report Share Posted February 1, 2007 The whole thing revolves around the part of the Christian Bible that indicates that humans (or at least those who believe in it) basically shouldn't consume the blood of other humans. The Jehovahs's take this quite literally. I am glad the Judge took this into his hands and intervened in the case of the babies. The teenager is a different scenario. She could speak for herself - however misguided a non-believer of her faith might see it. She chose based on ehr beleifs. As physcians I think this needs to be respected. Afterall, just because we can do a procedure doesn't always mean that we ought to do it. Thanks the Crown for the law and the Charter. Link to comment Share on other sites More sharing options...
edge_w Posted February 1, 2007 Author Report Share Posted February 1, 2007 To me, I think, the case of the newborn is pretty self-evident: At this stage, the parent has become a seperate entity from the child and, since the child cannot ennunciate his or her belief, and this is indeed a matter of life and death, then the state his the right to intervene. The case of the adult is also pretty evident. An adult who is fully informed of the consequences of his or her decision has every right to govern their own treatment options, including the refusal of life-saving treatment. The grey area, as I think has been noted on this thread, is the part in between. It coms in defining the moment in which the former case develops into the latter one and what marks the development of adulthood and maturity? Can we legitimately, impose treatment by force on a thirteen or fourteen year old child? Would we shackle them to the bed? And yet, I think the analogy to child protection services can be enlightening. Child protection workers often have to drag kids of the same age, kicking and screaming away from abusive parents. Its terribly painful and heartbreaking, but, ultimately, necessary. By this logic, doesnt it apply to the above case? Link to comment Share on other sites More sharing options...
The Law Posted February 1, 2007 Report Share Posted February 1, 2007 That's true. That's why I think that in the case of the babies (totally unable to speak for themselves) that the state has the right to intervene. The problem becomes a lot more complex when the child does have beliefs - only those beliefs are not quite independent of the beliefs of the parents. For example, a child of 10-16 years may have the capability of SAYING "I don't believe in blood transfusions," but may not have the capacity of fully UNDERSTANDING the consequences of NOT having a blood transfusion and may not have an independent adult understanding of the concept of death. Very good point! I think that when the child is at a young age, they are very likely to believe what their parents tell them. Children at younger ages are still growing, and do not think as critically as children who are older. So, even if the child says "I agree with mommy, I don't want a blood transfusion"... that doesn't mean that the state should not get involved. Now if the case was a teenager, say 16 or 17 years of age, specifically saying that they do not wish to receive a transfusion - then, I believe that one's wishes are to be respected. Link to comment Share on other sites More sharing options...
brut33 Posted February 2, 2007 Report Share Posted February 2, 2007 I tall comes down to informed consent. Preemies can't beinformed because...well, they can't. A teenager can be informed. Link to comment Share on other sites More sharing options...
KennethToronto Posted February 2, 2007 Report Share Posted February 2, 2007 I tall comes down to informed consent. Preemies can't beinformed because...well, they can't. A teenager can be informed. Exactly. And the burden of proof is always on the health provider to evince that the patient is incapable of informed consent - not the other way around. It also has nothing to do with age, not in Canada at least. Link to comment Share on other sites More sharing options...
Jochi1543 Posted February 2, 2007 Report Share Posted February 2, 2007 A teenager can be informed. Or MISinformed.....all kinds of teens out there who have been told all kinds of ridiculousness by overzealous parents, esp. regarding sex (you can get pregnant from a kiss! ) Link to comment Share on other sites More sharing options...
The Law Posted February 2, 2007 Report Share Posted February 2, 2007 Or MISinformed.....all kinds of teens out there who have been told all kinds of ridiculousness by overzealous parents, esp. regarding sex (you can get pregnant from a kiss! ) That's true too. Link to comment Share on other sites More sharing options...
jamie_kee_mac85 Posted February 2, 2007 Report Share Posted February 2, 2007 This debate is very subjective, and indeed the parent's do have a right to make decisions for their child, provided the parents act with good intentions. A parent who abuses their child, physically or sexually, is not acting with the best interest for their child. In this case the parents, who are members of the Jehovah's Witness, are entitled to express their religious views and impart such beliefs on their child. However, I think we begin to cross the line when the subject deals with life/death. I do not agree that a parent should neglect the health of their child when the condition of their child is life threatening, regardless of whether they act with good intentions. The child is at an age where he/she cannot express their own veiws, or is even aware of his/her own impending state. The government should have a right to impinge on the parents rights over their child when they wanted to refuse blood transfusion. The government is simply saving a life that would otherwise have little chance of surviving. I would have to agree with the states decision in this case. Link to comment Share on other sites More sharing options...
Smurfette Posted February 3, 2007 Report Share Posted February 3, 2007 Exactly. And the burden of proof is always on the health provider to evince that the patient is incapable of informed consent - not the other way around. It also has nothing to do with age, not in Canada at least. That's true. My knowledge of health law is a little bit fuzzy, but my understanding is that informed consent has to do with the mental ability to understand a situation. Under normal developmental conditions, the mental ability to make decisions is correlated with age, but there is not a defined age at which a patient is capable or incapable. Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 3, 2007 Report Share Posted February 3, 2007 This is obviously one of those grey areas in medicine. An interesting ariticle in our local mid-island newspaper brought up the "argrument" that we as medical providers and North American society have a "fear" of death. North American society spends so much money on "miracle cures", crazy health fads and ways to stay younger/live longer...but, at what cost? With ethical dilemmas and any difficult medical decision the medical team always wants to make sure the benefits of a treatment outweigh the risks involved and that the end justifys the means.... A 25 week old baby is going to have many challenges later on in life....developmentally, neurologically, etc..... Most people, including myself, would take the chance and want human medical intervention to give my baby the best possible hope of surviving, but, at what cost? Where do we draw the line? As an OT who has worked with children that were prematurely born and as a result developmentally delayed, and neurologically impaired, I fully support what the courts did in this current BC case. The end does justify the means. I find it very difficult for my mind to wrap around thinking about it from the other perspective of the Jehovah's Witness parents...but, think it is important to try to in order to be able to empathise and provide better treatment. As someone else previously posted, as Richard Dawkins points out in his recent book, there is no such thing as a "Jehovah Witness baby"...rather the baby has "Jehovah Witness parents" and can not fend for him or herself or form an opinion yet. It is up to us as healthcare providers and the court system to protect these babies until they are able to make informed decisions of their own one day. When the consequence of the parent's decision is life or death, and the treatment to sustain life is readibly available and considered in "usual circumstances" a normal course of action, it would be neglectful not to provide it. Link to comment Share on other sites More sharing options...
brut33 Posted February 3, 2007 Report Share Posted February 3, 2007 Well, I guess it is a really good thing that bio-ethicists are part of the healthcare system in Canada to help us all wade through this tough challenges - the ones that fall between the law and morality. Link to comment Share on other sites More sharing options...
TimmyMax Posted February 3, 2007 Report Share Posted February 3, 2007 Hey, I don't think that you necessarily need a bioethicist to help you through every ethical scenario that you may come across in your lifetime, but it does help to have developed a solid foundation with which you can approach scenarios such as this rationally and soundly. Once you have a framework to apply to each situation, you'll find that a lot of the time, although there are a lot of issues to consider, the correct (and ethically just) answer isn't all that hard to come up with. Link to comment Share on other sites More sharing options...
TimmyMax Posted February 6, 2007 Report Share Posted February 6, 2007 Hey, In the news today... http://www.cbc.ca/canada/manitoba/story/2007/02/06/blood-ruling.html Link to comment Share on other sites More sharing options...
KMG007 Posted February 6, 2007 Report Share Posted February 6, 2007 Interesting article. Thanks for sharing. I have to say I agreed with BC giving the kids the blood transfusion, because you can not know what religion these children are. Many JWs leave the religion and they may chose life over their religion. The article you posted was a 15 year old who refused treatment. I don't know the case well and so I do not know if they did a psychological exam to see if she understand the decision she is making. However, if she understands you would think a 15 year old would be an adult in the eyes of the court. At 15 a 'child' can decide if she wants to give birth or abort a fetus growing inside her regardless of what her parents want. As much as I would hate to see a child die, if they understand the full impact of their decision then who are we to say that at 15 or say 17 they are a child while 18 they are not. Their is no age of adult in medicine like there is with sex or driving a car. It is based on the individual. I hope they looked at this individual before they made their ruling. Link to comment Share on other sites More sharing options...
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