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Re: Jehowah witness medical care From: Robert J. Woolley (wooll005@gold.tc.umn.edu) Fri Oct 4 21:27:16 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Harrison Sheld: "Replacement of Norplant after 5 yrs" Previous message: Guttenberg Primo: "Re: Does prior DVT exclude use of HRT?" In message <199610041745.KAA04930@unixg.ubc.ca> writes: > > > > Being Devil's advocate for a moment, there is a hidden assumption in your > statement. The assumption is : just as taxes, line ups, and garbage > removal are ethically appropriate and should be adhered to, that the belief > system of the JWs is ethically appropriate and should be adhered to. I am > not debating their belief system, but logic such as yours only works if > their are no hidden assumptions A perfectly legitimate point. Our ethical system is usually described as having 4 main tenets: autonomy, beneficence, nonmaleficence, and justice. Autonomy is the one at stake here. It requires that we get the patient's implicit or explicit consent for everything we do. And it implies that the patient can choose to refuse anything and everything we offer him. Patients sometimes have completely irrational reasons for their refusals. But as long as they are of sound mind, we are obligated not to force any test or treatment on they contrary to their consent. We can explain, argue, reason, plead, pursuade, enlist other doctors or family members to try to get consent for life-saving interventions, but if the freely-given consent does not come, we can and must do nothing. Some patients are simply gripped by irrational fears, such as never waking up from surgery. Some refuse a drug because a family member had a bad experience with it. Some refuse because they are old and frail and feel their time is come. Again, as long as the refusal is informed, and is done by a person who is capable of understanding the consequences of the choices, our hands are tied, no matter how irrational we may judge the decisoin. I once had one of my own medical assistants, a SE Asian immigrant, refuse surgery for a ruptured ectopic because her husband didn't want the surgery, and her cultural prohibitions against violating the husband's directive was so strong that she literally would rather have died than go against him. So we did everything except operate: admit, tons of fluids, transfusions. Finally, hours later, he relented, gave his consent, so she gave hers. Then we operated. It was completely irrational, IMHO, but informed and competent, and therefore inviolable. Others have a religious basis for their refusal. A Catholic woman with 10 children may refuse all offers of contraception. A Christian Scientist may refuse all our cares. An evangelical Christian may refuse fetal cell transplant for Parkinson's. A Mormon may reject the suggestion of a daily glass of wine to raise his HDL. And a Jehovah's Witness may refuse a blood transfusion. We may disagree with any or all of these decisions, but the only way to say that it is not or should not be legitimate or binding on us for the JW to refuse blood is to throw out the principle of autonomy. And that is far too foundational to our ethical system to even consider, IMHO. --------------------------------------------------------------------------- --------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota "We're violently opposed to all the Amish. We figure this is safer than being against, say, the Teamsters." Click and Clack, "Car Talk," Sept. 28, 1996 Next message: Harrison Sheld: "Replacement of Norplant after 5 yrs" Previous message: Guttenberg Primo: "Re: Does prior DVT exclude use of HRT?"

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