The issue of when a child is mature enough to consent to
various decisions is a complicated one and this debate focusses on just
one part; those decisions that relate to their medical well-being. There
are a number of areas where the consent of parents is required –
surgery, transplants, blood transfusion and others where the child is
not able to give consent because they are too young; circumcision being
one obvious example. Many jurisdictions stress that the child should be
involved wherever possible but, the decision lies with the parents, or
in their absence, a court.
Put simply, the doctor is free to use their medical judgement in an
emergency situation – an arrival in an emergency room or accident and
emergency department but where there is time available to ask for
consent it must be sought from both the young person and their parents.
For example the General Medical Council in the UK sets out;
22. You can provide medical treatment to a child or young person with
their consent if they are competent, or with the consent of a parent or
the court.4 You
can provide emergency treatment without consent to save the life of, or
prevent serious deterioration in the health of, a child or young
person.
23. You should involve children and young people as much as possible
in decisions about their care, even when they are not able to make
decisions on their own.[i]
In many case, parents are happy to take the advice of doctors for
their children, just as they would for themselves. However, and this is
the focus of this debate, there are occasions where there is a conflict
between the values or beliefs of the parent(s) and the general consensus
of medical opinion. The contention of some doctors is that it is unfair
for the parents to make a decision, that could cost the child her life,
and that she may not have taken that decision later in life.
This is further complicated by the fact that many children,
especially younger children, share the views of their parents, somewhat
uncritically. Therefore, the doctor and the courts face the question of
whether the doctor is able to overrule the opinions of both, let us say,
a teenager and their parents. This debate will focus on the issue of
blood transfusion for teenage children of parents who are members of the
Jehovah’s Witnesses (JWs).
In 1945, a ‘blood ban’ was introduced and, since 1961, the willing
acceptance of transfused blood by an unrepentant member of the faith has
been grounds for expulsion from the religion[ii].
Clearly the issue here, for the believer is one of conscience. Their
refusal of blood relates to the group’s interpretation of Acts 15: 28,
29[iii].
Set against that is the medical reality that a blood transfusion may
be vital for several life-saving procedures and are an important part of
many surgeries. The use of blood transfusions dates from the
early-nineteenth century but only came into widespread use is the 1930s
(Soviet Union) and 1940 (US and then other nations) so the position of
JWs has been relatively consistent since the inception of the technology
– although recent changes have continued to reject full blood
transfusion but have accepted plasma products[iv].
The issue of whether the rejection of transfused blood is in and of
itself sensible is irrelevant both legally and in this debate.. Nobody
disputes that the lack of medical action is a risk in medical terms –
and one that may lead to death. The issue for debate is whether the
religious views of the parents or the medical opinion of the doctors
should have primacy in determining the correct course of action. The
debate is about who should have the right to decide, not what that
decision should be. This is considered as an issue of conscience, the
implications for the soul of the patient are not considered here.
Although this debate relates to blood transfusion and JWs – we will
assume that proposition have defined it as such – it’s principles would
apply to other, similar, disputes such as whether parents have the right
to reject organs from a person of another race or reject drugs that
have been tested on animals.
[i] General Medical Council, 0-18 year olds.
[ii] ^ Muramoto, O. "Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses". (January 6, 2001)
[iii] 28 It seemed good to the Holy Spirit and to us not to burden you with anything beyond the following requirements: 29 You
are to abstain from food sacrificed to idols, from blood, from the meat
of strangled animals and from sexual immorality. You will do well to
avoid these things. (NIV)
[iv] Sniesinski et al.; Chen, EP; Levy, JH; Szlam, F; Tanaka, KA (April 2007). "Coagulopathy
After Cardiopulmonary Bypass in Jehovah's Witness Patients: Management
of Two Cases Using Fractionated Components and Factor VIIa" (PDF). Anesthesia & Analgesia 104 (4): 763–5. doi:10.1213/01.ane.0000250913.45299.f3. PMID 17377078. Retrieved 2008-12-30
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