You are a doctor responsible for the care of a 13 year old boy whose parents are Jehovah’s Witness Church members. Your patient is severely anaemic and you would normally recommend a blood transfusion. However you know that this would be going against Jehovah’s Witness rules. Jehovah’s Witnesses normally forbid blood transfusions believing that they are ‘unnatural’ and preventing the will of God. What do you do, how would you approach this situation?
All the different points of view need to be taken into account.
- The doctor’s. The doctor needs to act in the best interest of the patient [termed beneficence] and would want to give the transfusion.
- The parents. We do not really know what the parents would want to do.Never assume just because they belong to the Jehovah’s Witness Church they would not agree to a transfusion. The Pope does not agree to most forms of contraception but most Catholics use them.
- The boy’s point of view. The boy is 13 yrs and so may be able to understand the situation he is in and the treatment involved and be able to make a decision for himself. [This is termed Gillick Competence and children can give consent for treatment and have the right to confidentiality from according to the Fraser Rules [see p81-82 Medical School Interviews All You Need To Know The Knowledge for more details]
- Society’s. Is it right for society to allow parents to refuse potentially life saving treatment for a child? Do parents really have that right? Sometimes such cases are referred to court and sometimes the child is made a ‘ward of court’. The ‘court’ is then the legal guardian and gives consent for the child to have treatment. Each case has to be judged on its own merit.
In practice if such a patient comes in an emergency requiring an immediate transfusion you would treat them. Consent does not have to be obtained when immediate, life saving treatment is needed. Usually such patients are not in a fit state to make a calm rational decision.
If it was a non emergency and the parents were present and they refused treatment you would have to assess whether the child was competent and what his wishes were. This should be done in private, away from the parents. If he was competent and wanted treatment you would give it. If he is not competent you would have decide if other treatment such as fluids could be substituted or whether the boy should be referred to be made a ‘ward of court’.
Always mention that you would not make such a decision alone and that you would discuss it with senior colleagues, hospital ethics committee and hospital lawyers.