Blood Transfusions for Jehovahs Witness Children - Research Paper Example

Running Head: BLOOD TRANSFUSIONS FOR JEHOVAHS WITNESS CHILDREN The Ethical and Legal Debate Over Blood Transfusions For Jehovahs Witness Children Student Name University Abstract The insistence of Jehovahs Witness parents on refusing blood transfusions for their children during the course of medical treatment raises a dilemma for the State on the appropriate level of intervention in family and religious life. The United States has evolved a mature-minor doctrine, which has allowed Jehovahs Witness children who can demonstrate decision making capacity to refuse blood transfusions. However, the courts have intervened on numerous occasions to compel a blood transfusion against the parents wishes in critical situations. The State has achieved a delicate balance between respecting religious liberty and ensuring the welfare of children. The Ethical and Legal Debate Over Blood Transfusions For Jehovahs Witness Children The insistence of Jehovahs Witness parents in refusing blood transfusions for their children can be viewed in the larger context of alternative religious beliefs and their effect on medical treatment. Many people in contemporary society are guided by religious beliefs which prohibit them from accessing medical care in favor of spiritual healing (Catalano, 2010, p. 157). Whilst adults have the right to refuse medical treatment, their behavior becomes controversial when they refuse medical treatment for their ill children (Catalano, 2010, p. 157). The decision to refuse medical treatment to children may necessitate intervention by the State in cases when children suffer from serious illnesses (Catalano, 2010, p. 157). Many Constitutional issues are raised by this situation, such as religious freedom, the right to privacy, and fundamental liberty issues related to parenting (Catalano, 2010, p. 157). In such cases the Courts are forced to decide between the religious liberty of the parents and the States interest in protecting the lives of minors (Catalano, 2010, p. 158). This matter if particularly controversial because no matter what the outcome of, somebodys rights are infringed (Catalano, 2010, p. 158). In some cases government intervention is secured too late and the childs life is lost (Catalano, 2010, p. 158). Between 1975 and 1995, 172 children died because they were denied medical care for religious reasons (Catalano, 2010, p. 158). The Role of the State The State must balance the interests of religious parents and their innocent children, respecting the welfare and autonomy of both parties. A fundamental concern of the state is the protection of the welfare of children, one for which it may intervene when it is absolutely necessary (Catalano, 2010, p. 159). Despite this fundamental concern, the United States gives parents ample autonomy to raise their children in the way that they feel is best (Catalano, 2010, p. 159). When the state does interfere in the family realm, it is to avoid abuse and neglect and to protect the physical and mental welfare of children (Catalano, 2010, p. 159). In the case In re Clark, an Ohio Court decided that the interests of the State trumped those of the Jehovahs Witness parents who refused to allow a blood transfusion for their three year old son who was suffering from sever burns (Catalano, 2010, p. 161). The Court affirmed the right of the parents to their religious belief and to act in accordance with that belief, but also emphasized that their right ends where their childs right to life begins (Catalano, 2010, p. 161). State and Federal governments have provided numerous exemptions for religious belief and defenses for child abuse and neglect, which have allowed parents to refuse medical care to their children (Catalano, 2010, p. 161). The first religious exemption allowing parents to refuse medical care to their children was passed into federal law in 1996 (Catalano, 2010, p. 162). The Child Abuse Prevention and Treatment Act allows parents to refuse a medical service for their child if it is against their religious beliefs (Catalano, 2010, p. 162). The Rights of Parents The United States legal system is always inclined towards preserving individual freedom within the framework of the US Constitution. Parents possess a well established legal right to take decisions for their children (Catalano, 2010, p. 162). Such a right is not absolute, however the State usually carries the burden of proving that intervention in the parent-child relationship is necessary to ensure the childs health and welfare or the protection of the public (Catalano, 2010, p. 162). Believers in faith healing have advocated numerous Constitutional arguments to defend their right to refuse medical treatment to their children (Catalano, 2010, p. 164). They have highlighted their First Amendment right which allows them to practice their religion without undue interference by the State (Catalano, 2010, p. 164). Parents have also argued for their Fourteenth Amendment right to due process, asserting their liberty and privacy interests in their family relationships (Catalano, 2010, p. 164). They argue that their basic right to raise their children involves the autonomy to determine which medical services their children should receive (Catalano, 2010, p. 164). Some parents assert that they are not harming their children by refusing medical treatment, but are simply investigating medical alternatives (Catalano, 2010, p. 164). The Doctors Dilemma Doctors are placed in a difficult position when the wishes of parents conflict with their professional medical ethics. Medical professionals are the first to intervene when parents are considered to be harming their children by denying them medical treatment (Catalano, 2010, p. 165). Withholding medical care to children can be difficult for doctors as the cure rates for many childhood illnesses are greater than fifty percent with normal medical treatments (Catalano, 2010, p. 166). Doctors have to balance the autonomy of the parents, with a concern to benefit their patient or at least do nor harm to their patient (Catalano, 2010, p. 166). The success rate of conventional medical treatment in cases where parents refuse such treatment for their child often dictates whether a doctor will override the wishes of the parents (Catalano, 2010, p. 166). Doctors also often take into account the physical and emotional toll that life saving medical treatment takes on the patient and their family (Catalano, 2010, p. 167). The difficulty for doctors lies in defining the threshold of the likely success of a treatment, at which point they should seek judicial intervention to provide medical treatment to the child despite the parents religious objections (Catalano, 2010, p. 167). The Informed Consent Doctrine Cases of refusal of blood transfusions are decided on the issue of capacity for consent of the child. The informed consent doctrine recognizes that children are often incapable of giving informed consent for their medical care and so parental consent is allowed on their behalf (Catalano, 2010, p. 168). Recently the courts have begun to recognize the mature-minor doctrine, in which children above the age of twelve may be allowed to prove that they have sufficient maturity to take their own medical decisions (Catalano, 2010, p. 169). However, in the majority of cases the courts do not deal with mature-minors, but with infants who have been put in danger of death by their parents refusal to allow for medical care (Catalano, 2010, p. 169). In these cases, the religious beliefs and autonomy of the parents can be restricted by the courts (Catalano, 2010, p. 169). The courts weigh the interests of the parties according to each individual case, taking into account the childs particular illness and prognosis, the therapeutic risks and the possibility of complications, the religious beliefs of the parents and the sincerity of those beliefs, and whether any alternative therapy is being undertaken by a licensed doctor (Catalano, 2010, p. 169). State Intervention in Medical Care Whilst respecting religious freedom, the United States legal system has intervened in critical medical care cases. American courts are almost unanimous in allowing state intervention over the religious based objections of parents, to give blood transfusions to children who require them (Diaz, 2007, p. 86). Some courts have held that Jehovahs Witnesses who are pregnant or have young children may have their right to refuse blood transfusions curtailed by the States compelling interest to protect innocent third parties (Diaz, 2007, p. 88). A pregnant womans right to refuse a blood transfusion during a caesarian birth is often outweighed by the States parens patriae interest in protecting the healthy fetus (Diaz, 2007, p. 88). The Jehovahs Witness Position Jehovahs Witnesses seek to exercise their right to determine the nature of their medical treatment in a way which will not transgress the perpetual commands of their religion (Ziebart, 2007, p. 246). The belief system of Jehovahs Witnesses is derived from the Christian Bible which recognizes Jehovah as the supreme source of life (Ziebart, 2007, p. 220). In Biblical stories, blood is often depicted as a symbol of the soul or life of a human being, which belongs to God (Ziebart, 2007, p. 220). The Mosaic law instructs believers to not store blood, but to pour it out on the ground like water and to cover the ground with dust, in order to symbolically return it to Jehovah (Ziebart, 2007, p. 220). This was to prevent the storage of blood and its use for mans own purposes (Ziebart, 2007, p. 220). The Israelites were permitted to use blood only during the performance of animal sacrifices to Jehovah in order to gain forgiveness for their inherently sinful state (Ziebart, 2007, p. 220). These animal sacrifices only predated the sacrificial death of Jesus, who poured out his own blood for the redemption of mankind (Ziebart, 2007, p. 220). Jehovahs Witnesses hold a firm belief that forgiveness lies in the presence of the blood of Jesus (Ziebart, 2007, p. 221). For this reason they believe that mankind is not permitted to use blood in any unauthorized manner (Ziebart, 2007, p. 221). James, the Chairman of the Council in Jerusalem, emphasized, in 49 A.D, that Christians were only bound to observe certain important divine commandments, which included abstention from blood (Ziebart, 2007, p. 221). Jehovahs Witnesses believe that this prohibition extends to the medical use of blood (Ziebart, 2007, p. 222). Blood was commonly used for therapeutic purposes during Biblical times, which lead to its explicit prohibition in scriptural passages in the book of Acts (Ziebart, 2007, p. 222). Jehovahs Witnesses do not accept whole blood transfusions, or any of the primary components of blood such as red or white blood cells, plasma or platelets (Ziebart, 2007, p. 222). It is left to the individual to decide whether they will accept secondary blood components such as albumin or haemophilia preparations (Ziebart, 2007, p. 223). The Bioethics Debate The case of Jehovahs Witness parents who refuse blood transfusions for the sick children has become a paradigmatic case in bioethics debates. The method of “principalism” can be sued to analyze the case of Jehovahs Witness refusal to allow for a blood transfusion for their child (Antommaria, 2006, p. 297). The method of principalism contends that moral deliberation and justification can be best understood according to an ascending order of four levels; specific judgments and actions, rules, principals as well as theories of ethics (Antommaria, 2006, p. 297). There are four main principles; autonomy, beneficence, non-maleficence, and justice (Antommaria, 2006, p. 297). These principles are justified by both deontology and consequentialism (Antommaria, 2006, p. 298). The principle of beneficence requires doctors or the courts to reject the refusal of a blood transfusion by Jehovahs Witness parents (Antommaria, 2006, p. 298). According to this view the concern of the parents that a blood transfusion will condemn their child to eternal damnation is not a legitimate expression of the childs welfare (Antommaria, 2006, p. 298). However, this principalist analysis is a formally rational framework which excludes Jehovahs Witness religious concerns (Antommaria, 2006, p. 300). The assumption of universally acceptable ends is problematic as Jehovahs Witness parents may value ends that others do not, including obedience of God, the maintenance of purity and the assurance of everlasting life (Antommaria, 2006, p. 300). Principalism may not recognize the stringent nature of Jehovahs Witness parents religious obligations (Antommaria, 2006, p. 300). This highlights the fact that there is a clear conflict over conceptions of rationality and morality (Antommaria, 2006, p. 303). Furthermore, the principalist approach only views the child as an individual rather than as a member of a family or religious community in which they may be shunned if they were to receive a blood transfusion (Antommaria, 2006, p. 303). A Balancing Act by the State The State, whilst discharging its duty, needs to both protect the vulnerable and uphold religious freedoms (Herrera, 2005, p. 824). The possibility of a preventable death sets the Jehovahs Witness case apart from other church-state issues (Herrera, 2005, p. 824). Most of the time the medical future of the child will be assured by a blood transfusion, yet their social and legal future may become complicated (Herrera, 2005, p. 824). Since the late 1980s the mature-minor doctrine has been applied to competent minors who are Jehovahs Witnesses. Such minors are recognized as being conscientious and having decision making capacities (Ziebart, 2007, p. 241). In Re E.G the Supreme Court of Illinois verdict stated that a seventeen year old minor was sufficiently mature to understand the act of refusal of blood during medical treatment (Ziebart, 2007, p. 242). The basic test in the United States for the intervention of the State in the decision making of an individual, or the parens patriae, authority, is the lack of capability of an individual to make a competent decision concerning their own medical treatment (Ziebart, 2007, p. 242). The American approach is based upon the view that a competent person with decision making capability, even if they are a minor, does not require ethical guidance from the State during the course of medical treatment (Ziebart, 2007, p. 242). The American legal model of competence recognizes the right to self determination of a competent minor and also gives some legal protection to conscientious Jehovahs Witnesses (Ziebart, 2007, p. 243). The Case Against the Jehovahs Witness Position Arguments against Jehovahs Witness parents right to refuse blood transfusions for their children are based upon the misrepresentation of facts by Jehovahs Witness Society, and the relatively slight nature of the infringement upon religious freedom. There is only a tenuous historical link between incidents of medical refusal and a pattern of religious persecution in the United States (Herrera, 2005, p. 826). There is no grand tradition of religious persecution which state intervention in the case of refusal of medical care would continue (Herrera, 2005, p. 826). Only a very narrow amount of parental autonomy and religious freedom is subject to restriction (Herrera, 2005, p. 827). State intervention can be justified on the grounds that an effort must be made to transfer decision-making authority to an agent who can demonstrate that it has the childs empirically verifiable welfare in mind (Herrera, 2005, p. 828). In order to strike a balance between religious freedom and child welfare, American courts have upheld a competent adults right to refuse blood, but have ordered blood transfusions to save the life of a child (Louderback-Wood, 2005, p. 784). The Jehovahs Witness Society outlines its policy position on blood transfusions in the pamphlet “How Can Blood Save Your Life?” (Louderback-Wood, 2005, p. 784). It has been argued that this pamphlet misrepresents secular scientific facts and that the tort of misrepresentation can be used to sue the Jehovahs Witness Society by persons harmed by this policy document (Louderback-Woods, 2005, p. 784). The Jehovahs Witness belief that any Witness who accepts a blood transfusion is doing Satans work, is protected by the United States Constitution (Louderback-Woods, 2005, p. 787). This position hardens each believers stance on blood transfusions, yet such a belief may be flawed if it is based upon misrepresentations of secular facts in indoctrination literature (Louderback-Woods, 2005, p. 787). Jehovahs Witnesses rely strongly on the Societys literature which they study in classroom type environments and refer to as “the Truth” (Louderback-Woods, 2005, p. 788). The Jehovahs Witness Society strongly discourages its believers from independent thinking, and when combined with lower than average levels of educational attainment, this can distort the decision making capacities of believers (Louderback-Woods, 2005, p. 789). The Jehovahs Witness Society misrepresents the eighteenth century thinker Joseph Priestleys writings on the ingestion of blood, claiming that he was in favor of an absolute prohibition, when in fact Preistley had argued that nothing which is ingested could defile a man (Louderback-Woods, 2005, p. 791). The Society also distorts the writings of ancient historians such as Eusibius and Tertullian, claiming their writings as evidence that early Christian did not eat blood, when both writers prohibited the eating of human blood only in the context of murder (Louderback-Woods, 2005, p. 792). The Societys literature claims that blood transfusions harm the bodys immune system (Louderback-Woods, 2005, p. 793). These claims are based on studies which are inconclusive and only recommend further research (Louderback-Woods, 2005, p. 794). The Society also asserts that blood transfusions lead to higher risk of medical complications, but this assertion is based upon a data set in which a higher number of sick patients were given blood transfusions rather than healthier ones, and there was no data collected on patients who refused blood transfusions for medical reasons (Louderback-Woods, 2005, p. 795). Whilst the Society discusses the diseases which could be contracted by blood transfusions at length, it does not give its believers a sense of how remote the possibilities of catching these disease are (Louderback-Woods, 2005, p. 796). Particularly relevant for the case of Jehovahs Witness parents and their decisions on medical care for their children, is the Societys suggestion that premature infants often have low blood counts and that doctors unnecessarily push for blood transfusions (Louderback-Woods, 2005, p. 804). The Society cites a study by Dr John Stockman to justify this claim, but omits the circumstance in which Dr Stockman stated that blood transfusions would be necessary (Louderback-Woods, 2005, p. 804). The Society advises its believers that they, as parents, have a legal right to choose medical treatment for their child, but does not mention cases in which Jehovahs Witness children have needed immediate, life-saving blood transfusions and courts have intervened to allow for such transfusions (Louderback-Woods, 2005, p. 806). The Society misleads believers when it claims that Erythropoietin therapy can help patients to develop red blood cells “very quickly”, when it can actually take four weeks or longer (Louderback-Woods, 2005, p. 806). Although each misrepresentation when read individually may be relatively insignificant, when read together these statements warp the believers mind on the issue of the historical and medical perspective on blood transfusions (Louderback-Woods, 2005, p. 808). Case Study: The Sarah Bahris Case Sarah Bahris, a 15 year old cancer patient from British Columbia, Canada refused blood transfusions as part of her cancer therapy, and eventually sought treatment in a New York City Hospital which offered bloodless chemotherapy (Blackwell 2009). The British Columbia child welfare authorities obtained a court order during 2005 to ensure that Bahris would receive a blood transfusion if it was a necessary part of her treatment for the bone cancer osteogenic sarcome (Blackwell 2009). Provincial authorities in Canada allowed Bahris to travel to the United States to receive treatment at Schneider Childrens Hospital in New York, where chemotherapy is performed with blood transfusions (Blackwell 2009). She died in 2009 at the age of nineteen, yet her case changed the Canadian law bringing it closer to the American doctrine of the mature-minor. During her stay in New York she was protected by the American mature-minor doctrine as she was able to demonstrate decision making capacity. The American law protected her religious liberty when the Canadian law forced a blood based treatment on her. Bahris case was one of series of emotional disputes over the refusal by Jehovahs Witnesses to receive blood transfusions during medical treatment, which had been applied even to children under the age of consent in Canada (Blackwell 2009). However, the Supreme Court of Canada ruled in June 2009 that minors can sometimes refuse blood transfusions if they are deemed to be mature enough by the Court, bringing it into harmony with the American law (Blackwell 2009). Conclusion The American mature-minor doctrine, when combined with the willingness of American courts to intervene in critical blood transfusion cases, has succeeded in maintaining a balance between respecting the religious beliefs of parents and ensuring the physical welfare of infant children. This approach has set an example for other nations, such as Canada, where the law has developed in convergence with the American doctrine. Jehovahs Witness religious beliefs have been respected to the greatest extent possible, yet the medical rights of children have also been ensured. References Antommaria, A. (2006). Jehovahs Witnesses, Roman Catholicism, and Neo-Calvinism: Religion and State Intervention in Parental. Medical Decision Making Journal of Law and Family Studies, 8(2), 293-316. Blackwell, T. (2009, July 15). Teens Death Fuels Debate on Religions Blood Ban. National Post. Retrieved from http://www.faithandmedia.org/articles/show/1614 Catalano, E. (2010). Healing or Homicide?: When Parents Refuse Medical Treatment For Their Children On Religious Grounds. Buffalo Journal of Law, Gender and Social Policy, 18(1), 157-174. Diaz, K.L. (2007). Refusal of Medical Treatment Based on Religious Beliefs: Jehovahs Witness Parents. Journal of Contemporary Legal Issues, 16(1),85-90. Herrera C.D. Disputes Between State and Religion Over Medical Treatment For Minors. Journal of Church and State, 47(4), 823-840. Louderback-Wood, K. (2005). Jehovahs Witnesses Blood Transfusions and the Tort of Misrepresentation. Journal of Church and State, 44(4), 783-822. Ziebart, D. (2007). Jehovahs Witnesses- Medical Care, Minors and the Religious Rite/Right. Denning Law Journal, 19, 219-247. Read More