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Refusing treatment on religious grounds

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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    JavaKrypt wrote: »
    The issue isn't that, which is why this topic is now about something totally different.

    Haha this is why i never post in debate, i always start out trying to hit the point, but end up going somewhere completely unrelated
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    And some people equate quality of life judgements with the violation of religious principles - i.e. they will deem the person to not be able to enjoy the same quality of life if they had had violated their religious principles by having the blood transfusion.
    Well actually, I'd say the issue is more a case of not wanting your kids to go to hell. If I believed in hell, and that having a blood transfusion would send you there (and there's no doubt that someone who's actually willing to go to these lengths genuinely does believe it), then I'd make that decision too. It's the obvious moral choice. But then again, if I believed everything the 9/11 bombers did, then flying a plane into a building full of non-muslims would be an obvious moral choice too. So we end up with the question of when it's ethical to overrule the unsubstantiated personal beliefs of others. And it always comes back to the second they start to infringe on people who may not necessarily share them. And that applies as much to parents beliefs towards their children as it does to someone's beliefs towards complete strangers, imo. So I think the idea that parents should automatically be able to decide in a case like this is a complete non-starter, and we just end up back at the debate about when the individual is capable of deciding for themselves. And there's no right or wrong answer there, but there are obviously some that are more right than others, and I think a simple age definition would be the best place to start.

    I guess the only other area of contention is whether you consider the possibility of saving someone who didn't want to be saved to be more of an infringement than letting someone die who didn't want to die. Because one of them is going to happen. Of course at least you won't hear about the latter. ;) But personally, I think erring on the side of caution would be the saving people option.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Nothing. But your argument fails to define informed consent.

    Informed consent is directly related to the individuals ability to understand the treatment being offeredm it's benefits and risks.

    Whether a person refuses because they don't want the risks, don't believe that the benefits will meet their needs or believe that the treatment is against any moral beliefs is irrelevant. If they are considered capable of understanding the implications of refusal to treat, then they can refuse.

    If we didn't apply those rules then a doctor could do whatever he wanted, and that is step much further than the one being claimed about here.
    In every other field, we define these things with an age at which you can be considered capable of making a particular decision. So what is it? The age of criminal responsibility? The age at which you can have sex? The age at which you can decide who you want as your MP and go into frontline military service? The age at which you can teach someone else to drive? And of course all of these examples have safeguards in place for people who clearly can't make such decisions after that age.

    In this case there isn't an age limit, but a capacity limit. Incidentally the criminal responsibility limit is 10.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    jamelia wrote: »
    Indeed. My whole point was, whether or not someone has this capacity is not clear. There are loads of difficult cases, like 15 year olds, and people with ridiculous religious beliefs.

    Ridiculous in your opinion because you've been taught something different.

    The doctors approach in this case will not have been based on a ten minute chat. Not only will the doctor have spent ages with the imdividual but there will have been hours of discussion with the parents and legal advisors.
    You're making out it's far, far clearer than it actually is whether someone has the mental capacity to give informed consent.

    Actually, I'd argue it's you that is trying to suggest it's easy. Your argument is based on the premis that anyone who belives that transfusion is wonrg shouldn't be allowed that choice and should automatically be considered incapable of giving informed consent.

    I disagree. I'd argue that each case should be considered on it's own circumstances and there is no reaons to make any automatic judgements.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Slightly surprised people aren't more aware of how medical consent works in the UK, it's been a much discussed issue.

    The basic way it works is that all people of 16 and over are considered to be old enough to make judgements about their own medical treatment unless something prevents this ability. This would be judged the same for a 16 year as it would be for a 40 year old.

    Below 16 a Doctor is required to decide if the young person is legally competent to make a decision about their own treatment. The wording for this is -

    The courts have determined that such children can be legally competent if they have "sufficient understanding and maturity to enable them to understand fully what is proposed".

    This is the Gillick competency - the legal decision which allowed an under 16 year old to be allowed to receive contraception without a parent's consent.

    An overview of this very important case is available on wikipedia, it's pretty much as important to the UK as laws such as Roe vs Wade are to the US.
    http://en.wikipedia.org/wiki/Gillick_competence

    You can see the full 1985 judgment here -
    http://www.hrcr.org/safrica/childrens_rights/Gillick_WestNorfolk.htm

    And Patient UK has a really good overview of how medical consent for children and young people works in the UK. I've pretty much shamelessly cribbed it here -
    http://www.patient.co.uk/doctor/Consent-to-Treatment-in-Children.htm#ref6

    And this has been slightly complicated by the recent changes to the Children's Act requiring Doctors to inform Social Service or Crisis team's about particular damaging behaviour - but that's about child safety not about consent.

    Of course that doesn't go to the original point - which is whether religious belief should be seem as a personal choice and human right or something that interferes with a young person's (or anyone's) competence to make a medical judgement.

    But figured it might be helpful to try and bring some clarity to the issue of medical consent for under 18s in the UK.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Oh and for my tuppence worth, I think this is still pretty much on topic, consent and views of religion are pretty relevant to what happened here.

    Also be worth remembering that the lad's parents haven't made any comment so far about what happened. So worth being careful about any judgment of how they feel about this.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Mist wrote: »
    If a person's convictions are that strong then it should not be for the state or doctors to impose decisions upon them. Similarly, it is not for us to decide whether or not the convictions are misguided.

    Of course I can decide if its misguided. It's my opinion and I'm entitled to have it. Otherwise you can extend that argument to almost anything and no-one would ever take action about anything. Personally, if I had was still at his age, I may well have taken his route in religious conviction. But just a few years later, now that I am more mature and perhaps somewhat more cynical, my decision is that there is no personal god and I would take the blood transfusion. In my opinion, he has died for nothing.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Teagan, that's a reasonable position to take, but it cannot be taken by the doctors involved in this case.

    They have to look at the person in front of them. If, at the moment consent is required, he is deemed competant then that's enough. The fact that his opinion may change in five years time is irrelevant.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    The kid was insane, he should have been sectioned or whatever and had the treatment to save his life.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    MoK wrote: »
    Teagan, that's a reasonable position to take, but it cannot be taken by the doctors involved in this case.

    They have to look at the person in front of them. If, at the moment consent is required, he is deemed competant then that's enough. The fact that his opinion may change in five years time is irrelevant.

    I know what you're saying but I am still entitled to an opinion and even, in this case, disagree with the state. The state only allows doctors to let him die because there is no law against it (presumably). And opinion/debate does help to change things for the better in society. This boy can't legally drink, or drive a car, and is not allowed to view 18+ movies etc, but he can make a decision for himself based on something completely intangible that will likely lead to his death? You can bet I have the right to debate that! ;)

    Personally, I'd like to see 21 - but I'd compromise on at least 16.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Teagan wrote: »
    I know what you're saying but I am still entitled to an opinion and even, in this case, disagree with the state. The state only allows doctors to let him die because there is no law against it (presumably). And opinion/debate does help to change things for the better in society. This boy can't legally drink, or drive a car, and is not allowed to view 18+ movies etc, but he can make a decision for himself based on something completely intangible that will likely lead to his death? You can bet I have the right to debate that! ;)

    Personally, I'd like to see 21 - but I'd compromise on at least 16.

    That is the crux of the debate - do you want to ban any one access to the pill, or support for self-harm without their parents consent. Wouldn't that mean that someone under 16 was entirely constrained by their parents religious views. Far more commonly than this extreme situation...
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Will read through this thread properly later.

    For now.... this website is quite helpful in explaining the ethics of medicine.

    http://www.ethics-network.org.uk/ethical-issues
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Jim V wrote: »
    That is the crux of the debate - do you want to ban any one access to the pill, or support for self-harm without their parents consent. Wouldn't that mean that someone under 16 was entirely constrained by their parents religious views. Far more commonly than this extreme situation...

    :yes:

    I'd far rather we stick with the system we have... with Gillick competency, Fraser guidelines and fair rules on confidentiality for under 18/16s. If the system were to be changed, we couldn't have it both ways, and many more young people (i believe) would suffer as a result.

    I think its a shame that this boy died, but he held certain beliefs which we don't really have much of a right to question. I mean sure, his upbringing may have had something to do with it, but not all children who have parents as Jehovah's witnesses share their beliefs. And his beliefs were tested in probably one of the most extreme of situations; life or death. And in that situation he stuck by them, so OK.... yeah his beliefs may have changed later in life, but at that time, he was willing to die for what he believed in, which I think says a lot. And I'm not sure, but I think it would take a hell of a lot of "brainwashing" to achieve that.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    I mean sure, his upbringing may have had something to do with it, but not all children who have parents as Jehovah's witnesses share their beliefs.

    If you leave the Jehovah's Witnesses, you are ostracised from the family and their community. Few would be brave and insistent enough to lose those ties.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Jim V wrote: »
    That is the crux of the debate - do you want to ban any one access to the pill, or support for self-harm without their parents consent. Wouldn't that mean that someone under 16 was entirely constrained by their parents religious views. Far more commonly than this extreme situation...

    None of the above usually lead to death. This is far more important.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    But that's the question here isn't it. In a medical setting the idea of patients consent to or from a medical procedure isn't based upon whether someone may die or not, but based upon the patient's own view.

    If you break the right of consent for cases where someone might die, as opposed to their general right of consent, then are you reaching a point where, for example, a young person wouldn't have the right to refuse treatments for conditions that may kill them. That could include possibly terminal illness and many other conditions.

    I just really worry about starting to say that a doctor gets to decide when consent applies and when it doesn't. Medicine isn't an exact science, a doctor may think with a treatment it could be a 1 in 3 chance, without 1 in 10.

    At that point you're asking him to decide whether or not to override the patient's personal views based on a guess. What if 2 surgeons think it's a better chance than 2 others, which 2 do you go with.

    It seems that for all the tragedy this case represents, and it is really difficult to read about, isn't the alternative dehumanising the rights of a person under 16?

    Removing the clear rules around consent would seem to lead to a situation where you're saying that a 14 or 15 year old no longer has the right over their own body, that a doctor can make that judgment over a sane and reasoning person.

    And removing that right of consent could open the door to many less serious situations where a doctor or parent could control the body and medical treatment of a young person, against their wishes.

    It seems to me it's a horrible situation but it's the ultimate consequence of rightly deciding that reasoning people do have the right to decide how their body is treated.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Jim has said all that much better than I could
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    The posters who have diagnosed the cause of death here have not revealed if they were present at the scene of the incident, the death or the post mortem.

    Or, indeed, how they came to that particular conclusion.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    -Edited out
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    MoK wrote: »
    Jim has said all that much better than I could

    However, I am hoping I've not killed the debate :(
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Jim V wrote: »
    However, I am hoping I've not killed the debate :(

    I kind of hope that you have but then that's because I agree with you :thumb:

    For me the informed consent issue is sacrosanct for many of the reasons you have said. The minute we put an age limit on soneome ability to give informed consent then we harm many of those who need the protection that patient confidentiality gives - expecially for those youngsters needing terminations and/or birth control. We limit a child's ability (in cases like this) to over rule their parent religious or moral beliefs. Gillick gives us a method of assessing that ability.

    If we then also argue that someone's religious belief reduces their ability to give informed consent then we enforce our moral or religious beliefs on them and I could never sanction that.

    What the current system gives us, is the protection from having surgical interventions carried out on us regardless of our wishes - when we are deemed mentally capable of refusing - or from consenting when our next of kin don't want us to.

    The problem here, with this thread, is that people seem to think that their moral values should affect how others are treated. Doctors cannot do that and that's something which we try very hard in the health service to uphold. Staff that object to terminations, for example, opt out of taking part in those proceedures and are required to refer the patient to someone who will do it - they cannot simply refuse to have anything to do with it.

    It's not, and should never be, the doctors morals that decide whether a person has surgery. It should be the patient's.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    MoK wrote: »

    If we then also argue that someone's religious belief reduces their ability to give informed consent then we enforce our moral or religious beliefs on them and I could never sanction that...

    Surely this is already done though? If a person goes on about their dead friend or relative coming back to life, it is used as evidence of their insanity/mental instability but, if it's some bloke from Bethleham it's suddenly alright? Isn't that then a judement that doctors make based on their own beliefs?
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    That wouldn't be grounds, on it's own, to argue that they didn't have the capacity to give consent.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    I would hope that if I were in hospital refusing treatment that would save my life when I were clearly insane, that my wishes would be ignored on the grounds that I were insane and be forced to receive treatment.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    MoK wrote: »
    The problem here, with this thread, is that people seem to think that their moral values should affect how others are treated.

    Not the only one I can see, but one I agree with.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    katralla wrote: »
    If a person goes on about their dead friend or relative coming back to life, it is used as evidence of their insanity/mental instability but, if it's some bloke from Bethleham it's suddenly alright?

    If it is the same bloke from Bethlehem that I am thinking of, I heard that there were several witnesses that substantiated the original claim.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    If it is the same bloke from Bethlehem that I am thinking of, I heard that there were several witnesses that substantiated the original claim.

    There are far more witnesses that Derren Brown predicted the lottery. But he still didn't.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    katralla wrote: »
    I would hope that if I were in hospital refusing treatment that would save my life when I were clearly insane, that my wishes would be ignored on the grounds that I were insane and be forced to receive treatment.

    If you were clearly insane then you wouldn't be asked for consent, your next of kin would.

    ETA. Hang on, please tell me that you aren't suggesting that insanity and religious belief are the same thing.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    MoK wrote: »
    If you were clearly insane then you wouldn't be asked for consent, your next of kin would.


    Great! And then if they are Jehovah's Witnesses, they can decide to let you die instead. Hurrah! :yippe:
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    There are far more witnesses that Derren Brown predicted the lottery. But he still didn't.

    Does that depress you ?
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