Refusing Treatment and Medical Principles

What should a doctor do if a parent refuses medical treatment that could possibly save the life of their child? That can include refusing something as serious as a blood transfusions, photon and proton therapy, or chemotherapy. Parents will refuse medical treatment for deep personal reasons. They can be deeply held religious beliefs, or just the fear of the side effects. There are various medical principles that should guide the decisions of the doctor. However, they are conflicting when used in situations where parents are refusing treatment for their children. In cases like these, doctors and others in the medical field should make decisions by exercising personal judgment and using the existing laws to indirectly help the child.

Reasons parents refuse medical treatment

Parents may refuse to seek treatment for their child for multiple reasons. One reason a parent may refuse medical treatment for their child is the quality of life. Sometimes medical treatments can cause side effects that may make living less comfortable. For example, chemotherapy can cause various side effects that make life miserable. Children lose their hair, lose weight, feel pain, and experience multiple unpleasant side effects. Many adults refuse this treatment for the same reasons. The thought of their children experiencing pain and discomfort is sometimes enough make parents refuse the medical procedure. Overall, the decision to refuse care based on the possibility your child may suffer is understandable. However, the consequences of not receiving treatment can be even greater than the side effects. For example, blood pressure medications can cause multiple side effects, but the side effects are not as debilitating as a stroke. Nevertheless, some parents feel the short-term risks outweigh the long-term benefits.

Another reason a parent will refuse medical treatment can be religious. Sometimes patients hold religious beliefs that do not agree with certain medical treatments. For example, people may feel that faith healing may be an option, and the power of prayer and belief may be the only solution. According to a TIME/CNN poll, 82% of the respondents believed in the healing power of prayer. Furthermore, 73% of the respondents believed praying for someone else can help cure their illness .Relying on faith healing alone can be fatal to the child. For example, a Philadelphia couple lost two children because the relied on praying for the child rather than getting medical treatment. They lost the first child to pneumonia in 2009. They lost their second in 2013 after experiencing diarrhea and breathing problems. Both of these were treatable conditions, but the parents declared that they did not seek medical treatment because ” …we believe God wants us to ask him for healing," and “Our religion tells us not to call a doctor” . Despite how unlikely it may seem to those working in the medical profession, these beliefs are valid to the patient, and they have the right to refuse on those grounds. Regardless of a parent’s reason for refusing medical treatment for the child, medical workers must make their decisions in what to do next according the guiding principles of medical ethics.

Adults sometimes refuse treatment for themselves, and that is within their rights. However, sometimes parents refuse treatment for their children, and that is a very complicated matter. According to the law, the parents have the right make the decision for the child. Even if the child is openly supporting the treatment, the parent makes the final decision. The only time this is not the case is when the parents have been deemed unfit to care for the child. Nevertheless, even a competent parent has the legal right to refuse lifesaving care for their children. Furthermore, they have made this decision knowing the full scope of the treatment involved, known as informed consent. Informed consent involves the doctor informing the patient about a particular treatment and the patient making the decision to undergo that treatment based on that information. There are four vital requirements for informed consent. First, the patient must have the full capacity to understand the information that is being given to them. Secondly, the patient must be provided with all the potential benefits and risks of the treatment. Third, the patient must be able to comprehend the relevant information. Finally, the patient must give consent without being pressured. If these criterions fail to be met, the patient cannot truly give consent . After knowing all the aspects of medical treatment, a parent may still refuse treatment. This puts the provider of care in a very difficult situation.

Ethical Dilemma

The refusal to accept medical treatment based on religious and other personal convictions create a dilemma. There are multiple guiding principles of biomedical ethics. The principles that come in to play in these cases are respect for autonomy, nonmaleficence, and beneficence, They work well when dealing with a patient that wants to be treated. However, they all contradict each other when it comes to making the right decision for a child whose parents do not want medical treatment.

The respect for autonomy principle asserts that the patient has the right to make their own decisions, and the physician should respect those decisions. If you strictly adhere to this principle, the parent has the right to refuse lifesaving care for the child, and the physician must respect it. In addition, the physician must decide not to take action out of respect for the parent’s decision for the patient.

Based on the principle of respecting autonomy of the patient, a doctor should not treat the child. However, there are also principles in the medical field that suggest that action should be taken. One of those principles is known as Nonmaleficence. Doctors take the Hippocratic Oath that establishes that doctor will” above all, do no harm”, and “To keep the good of the patient as the highest priority” Although not taking any action at all is not directly doing harm to the patient, omitting care is also harmful to the patient. This principle is also related to principle of beneficence.

Not taking action and administering care for the child is in conflict with the principle of beneficence. According to this principle of beneficence, everything that a worker in the medical field does should be for the healing of the patient In this case, when the parent is intent on refusing the treatment for the child, a physician still has a duty to make the decision that will help the patient. However, deciding to take action can come into conflict with the respect for the autonomy for the patient.

Evidently, the established principles of medical ethics do not clearly solve the complex ethical issue that arises when a parent refuses care for their children. They can help guide the decision-making process, but they do not lead to an ultimate decision. This is because the principles advocate treating the patient, and they also promote respecting the right of the patient to not receive treatment. Therefore, if a physician is to take an action, there has to be some amount of personal moral judgment that comes from outside the rigid set of principles. In addition, physicians must also utilize the existing laws to ensure that the child receives the treatment that they need.

Making the right decision

In order to make the right decision for the child, the physician must exercise some degree of personal moral judgment. Doctors hold religious beliefs too, and most would agree that refusing care to a child is even wrong from a religious perspective. From a religious standpoint, parents argue that humans should not interfere with god’s will. Well, if that is the case, then men and women who have saved children from burning cars should not be considered heroes. Maybe we should even stop looking for missing children, because maybe there were not meant to be found. What you believe may or may not be true. Nevertheless, the child in front of you is definitely there. Not abstract, or subject to interpretation. Based on that moral reasoning, physicians should do whatever is in best interest of the child, even if parents, or other caring adults present had to commit the sin of interfering.

The ability to act on personal conviction depends on the urgency of the medical issue. For example, if child is bleeding to death and needs a blood transfusion, the physician can take action right there. However, if the child’s health is in danger in the long run, then the physician can do their part in informing them of the possible risks, and then notifying the proper authorities to deal with the issue. One of those authorities is Child Protective Services. Medical workers may operate under the principle of respecting the autonomy of the patient, but the government does not. It has the duty to protect the lives of its citizens, even children. When it comes to the safety of the children, the government operates under the doctrine of “Parens Patriae”. This doctrine asserts that the state has the best interest of the child, and it will not allow the parent to harm the child based on personal beliefs. There is frequent precedent for government intervention in matters involving parents and children. Child Protective Services exists primarily because there are parents that make very poor decisions for their children. For example, sometimes parents have poor ways of disciplining their children, or do not provide the right nutrition. These types of decisions made by their parents put their children in danger. Fortunately, a government agency is able to step in, and makes the right decision regarding the health of the child. Therefore, it is not hard to believe that parents will sometimes make poor decisions regarding the medical treatment for their children.

Some people may argue that government intervention is a violation of their constitutional rights to hold personal beliefs. However, the U.S. constitution does not protect the right to any religious practices that could be harmful to society. For example, would the government allow a religious practice that involved human sacrifice? The government would not allow a religious act like that because it would be considered murder. Furthermore, what if a certain religion believed starving a child for a short amount of time served a purpose? The government would consider it neglect because most people would agree that food is necessary for the overall wellbeing of the child. Although we have the right to practice the religion of our choice, laws in this country are based on the ideal of protecting the general welfare of this country’s citizens. The government would not allow a practice that would harm or infringe on any other rights of other citizens. For that reason, why shouldn’t the government use its power to coerce parents to get medical treatment for a child?

Principles in the medical field make it difficult to make a decision to treat a child despite parent consent. That is why those in the medical profession must use personal judgment in and use the existing laws to get the child the treatment it needs. Some may say it is a violation of parental rights over the child, and a violation of religious belief. Nevertheless, refusing to treat a child is a violation of their right to live.

Conclusion

Considering all of the advances and success in modern medicine, why would a parent still choose faith healing or the use of alternative medicine such as medical marijuana over modern medical treatment? Science is difficult to understand for the common person, and because it is difficult to understand, many people do not trust in the medical procedures. In contrast, faith healing or seeking alternative methods to treatment are simpler concepts to understand. You do not need a degree to understand having faith, or to pray for healing. In addition, the alternative treatments to illnesses are seen as natural, and therefore, a safer method of treatment. In addition, seeking help from a higher power and using natural remedies are ingrained in human culture. Before modern medicine, humans regularly relied on the spiritual leaders in their communities to heal. Although many would look at the parent decision as unreasonable, considering the role that faith healing and alternative medicines have played in wellbeing throughout human history, it easy to understand why these practices still exists. However, once a physician has been presented with a patient that needs their care, they have the duty to provide care using the best methods available in modern medicine.

Workers in the medical field have been charged with the duty to heal the sick. However, there are barriers to the goal that may come from the patients themselves. Sometimes, parents refuse to allow their children to receive medical treatment based on strong personal beliefs. I do believe that those in the medical profession should make their decision with the established medical principles in mind. However, those principles are not the only factors that a decision should be based on. There are moral and practical reasons why the parent’s decision should be overridden. The best option would be to get the authorities involved. The government is not restricted by these guidelines in the medical field and has the legal authority to force the parents to make the right decision. Some may believe that their personal beliefs should be respected by everyone. Nevertheless, the child also has the right to live, and that should be respected too.

Bibliography

Ameling, Ann. "Prayer: an ancient healing practice becomes new again." Holistic Nursing Practice 14, no. 3 (2000): 40-48.

Beauchamp, Tom L., and James F. Childress. Principles of biomedical ethics. Oxford university press, 2001.

Coleman, Korva. "Second Child Of Philadelphia Faith-Healing Couple Dies." NPR. http://www.npr.org/blogs/thetwo-way/2013/04/23/178593383/religious-parents-lose-second-child-after-refusing-medical-care (accessed April 6, 2014).

"Informed Consent." eMedicineHealth. http://www.emedicinehealth.com/informed_consent/article_em.htm (accessed April 6, 2014).

"parens patriae." LII / Legal Information Institute. http://www.law.cornell.edu/wex/parens_patriae (accessed April 6, 2014).