November 2000
Treating children of parents with personal or religious beliefs that affect their health care can be difficult. Adults have the right to refuse medical treatment based on the doctrine of informed consent, which requires health care providers to obtain consent before performing a procedure on a pa tient. This right to refuse treatment is based on the due process clause of the 14th Amendment to the Constitution. Similarly, when the refusal is based on religious beliefs, such conduct is protected by the First Amendment.
The right to refuse medical treatment, however, is not absolute. The state may intervene in a given case if the state believes its interest outweighs the interest of the patient. Generally, courts consider four state interests: the preservation of life, the prevention of suicide, the protection of third parties, and the ethical integrity of the medical profession when deciding whether to override treatment decisions.
In a non-emergency involving an adult, the patient and the doctor agree upon treatment. If the patient is informed of the risks and potential problems and signs off on the fact that certain treatment was refused, then the doctor can proceed and everyone has a clear understanding. In most cases, everything goes smoothly, procedures are successfully completed without any problems and there are no legal issues.
Also, in the case of an adult with a serious health problem where the chance of a recovery is remote, if that patient does not want to undergo any further treatment, that decision is typically honored. The patient must be informed of the consequences, be competent to make the decision, and be under no coercion to refuse treatment for the consent to be valid. This is true even if the patient later becomes incompetent.
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A different scenario occurs in the case of minors. The question is whether an adult family member with specific religious beliefs has the authority to impose those beliefs on a minor. If health care providers have concerns about a treatment decision made for the minor, they can ask a court to intervene. Situations like this arise typically in the case of blood transfusions for children whose parents are Jehovah Witnesses. Jehovah Witnesses believe it is a sin to accept a blood transfusion, based on their interpretation of a biblical passage which states one must "abstain from blood" (Acts 15:29).
In such a case, the hospital can go to court to ask that a guardian be appointed for the child. This is usually readily done. The guardian then has to answer the legal question of what is in the best interest of the child. Almost always, the answer is to treat.
In emergency situations, the issues are different. This is a situation that typically does not involve a terminal illness and has come up unexpectedly. For example, a complication during a routine surgery.
Generally, health care providers have three options. If there is time, they can go through the courts. As a practical matter, the only way to get this accomplished is to have a system or procedure set up in advance, because time will be important. There are also procedural issues involved. For example, if the patient is conscious, the court may want his or her testimony for the hearing to be fair. So, health care providers who want this option should contact their legal counsel or the hospital administration and discuss the situation in advance.
Another possibility is to honor the patient or parents' wishes and not administer otherwise necessary treatment. Obviously, this alternative comes with some serious downsides on an emotional and moral level. However, courts have found that a doctor is not legally responsible for not giving treatment to patients in this type of situation, upholding a patient's right to refuse treatment.
A third alternative is to treat the patient in spite of the patient's or parents' expressed desire not to be treated. Again, this can cause some moral-ethical dilemmas. Legally, a health care provider can be sued and found responsible for giving treatment when a patient has refused it. A suit by a patient claiming that a doctor should not have saved his life does not seem appealing, but such cases have been brought and won.
It is clear that the issue of patients' or parents' refusal of treatment is murky. It appears that health care providers may be in a no-win situation. The correct legal decisions can carry with them some serious downsides, morally, ethically and emotionally. My advice is to decide these issues in advance, before the emergency presents itself on your doorstep.
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