Should 14 Year-Old Make Life and Death Medical Decisions?
At what age should children be allowed to make their own medical decisions? It seems to me, that just as children can't sign contracts or vote, they shouldn't have the final say in whether they receive medical care? But in Washington, a court permitted a 14-year-old to refuse a blood transfusions for religious reasons, which resulted in his death. From the story:
When Skagit County Superior Court Judge John Meyer came to work he expected to be hearing a few small matters. Instead, he made a decision in a case that he said has "perhaps more profound interest and implication than any matter I have ever heard on the bench."Of some interest in this regard, what if Washington legalizes assisted suicide as a so-called medical treatment next year? (Booth Gardner, the very rich former governor, intends to try and buy such a law.) No doubt the law, if passed, will require adulthood. But if the above case applies, if fourteen year-olds can accept and refuse treatment, how can they be denied a poison prescription if they are an otherwise qualified patient?Meyer decided Wednesday to allow 14-year-old Dennis Lindberg of Mount Vernon to refuse blood transfusions--based on his religious beliefs--in his fight against leukemia. Lindberg died later that evening...
Lisa Kelly, director of the Children and Youth Advocacy Clinic at the UW Law School, said that while courts are listening more to adolescents, there's also the understanding that teens "have a developmental trajectory that is not yet like an adult's."
That tension is reflected in state law as well. For instance, those under 18 generally cannot receive health care without a parent's consent, though there are exceptions, such as in cases concerning birth control and abortion.
"It's a gray area when you have a 14-year-old making the decision," said Thomas McCormick, senior lecturer emeritus at the UW School of Medicine. Such instances need to be taken on a case-by-case basis, ethicists say, after conversations with the patient to assess his maturity, whether his beliefs are well grounded and arrived at without coercion, and whether he truly understands the consequences of his decision.
posted by Wesley J. Smith @ 11:32 AM
9 Comments
9 Comments:
The laws of infancy are there to protect children.
Are you saying that children (here, a 14 year old), must be protected from their own religion? Because that's precisely the implication of the analysis here.
I disagree vehemently with the idea that minors ought to get prescription birth control and abortions without their parents' consent. I know it is done and I think it is a huge mistake for many reasons.
It's done for political reasons, and it's an exception because as you say, teenagers as a rule are not mature enough to understand the ramifications of what they are doing.
As the article says, however, when life-and-death decisions have to be made for a teenager, an individual assessment has to be made as to how much input that person should have based on his or her own level of maturity.
In the case of this 14-year-old, his religion forbade him to have blood transfusions. It's not that he chose death. It's that he chose not to have life if that came at the expense of violating his religious beliefs. I don't have a problem with blood transfusions, but if I were desperately ill and the only hope held out to me required, for instance, a fetal tissue transplant, I would turn it down. If anyone tried to force it on me I would fight like hell. I think that way at 47, and I'm certain I would have had the same conviction 33 years ago.
Don't be too quick to enforce medical autonomy with artificial age boundaries.
The American Academy of Pediatricians have a sliding scale for patient autonomy, and that's probably the correct choice. Some of the things that define when a minor can start making their own decisions are when the minor is emancipated, sexually active, or demonstrating enough maturity to make decisions for themselves. One also must consider all the instances in which parents are psychotic controlling monsters, a problem of high frequency since its the kids from abusive homes and crappy parents that come in knocked up (or soon-to-be knocked up).
The problem with forcing kids to wait until 18 before they have any autonomy and privacy is that they will encounter adult situations long before this arbitrary boundary, and deserve to have control over their own bodies. It goes both ways, there is just as much probability a parent may force a kid to get an abortion or take contraception as prevent them, and since its their body it should be their choice. The medical ethics on this point are pretty much decided. Children are not chattel of their parents. They are individuals, humans, and if they're mature enough to make decisions for themselves it should be respected rather than determined by arbitrarily setting an age.
Now in this instance, the question is was the kid mature enough to make this decision for himself. A fourteen-year-old? Probably. Old enough to understand that refusal means death. He's not refusing because of mental illness or fear of needles. He's made an adult, albeit foolish, decision. So says the judge. As a doctor you'd do everything in your power to convince them otherwise, but the law is clear. Personal autonomy is not conferred at 18.
I think Richard Dawkins would have quite a few apt remarks about this entire affair... grrr
people should definitely be protected from their religions.. or else... more people will die from insane decisions like this :(
This whole thing leaves a bad taste in my mouth. How many religions really forbid blood transfusion? As far as I personally know (and I'm happy to be corrected) there's only one, an offshoot of Christianity that takes a line about not ingesting blood farther than the rest of us do.
It's something I've had serious debates about - I don't believe that's what the Bible actually states, and I've seen evidence presented by Catholics, Presbyterians, and a Southern Baptist, as well as Jack Chick (I'm not sure what he claims for himself - head scratch), that refutes the belief that blood transfusions are forbidden by God.
Now here's the big question - do religious people (Hindus, Christians, Wiccans, Buddhists, Muslims, etc) usually permit their family members to be taken in by cults?
There are cult deprogramming groups that help family members rescue their loved ones and break them of cultish thinking. Some folks believe that Scientology is a cult because of its isolationism, secrecy, reported violence towards outsiders and toward those trying to leave the group. I'm using Scientology 'cause outside of Heaven's Gate and Jonestown it's the best known case of possible cultish activity, and so far they haven't suicided en mass, so they're a better example than HG and Jonestown for this comparison.
Well, some folks think that the Jehova's Witnesses are a cult for many of the same resons, only I don't buy the whole "violence against outsiders and those leaving" thing because I've never seen any evidence of it myself. If anybody knows otherwise, lemme know.
Now, if people had known that their loved ones were going to suicide in the HG cult, wouldn't they have done everything possible, including going to the police, getting restraining orders against the leaders, kidnapping their family away from the cultists, etc., to try to keep them from suiciding?
And doctors do step in to help with cult deprogramming. They report abuses to the authorities and they work to rescue people.
So, where do we stand with the JWs? Some folks want to treat them like a cult and therefore override the decisions to prevent blood transfusion because they feel someone like that 14-year-old is being abused by an oppressive belief system that does more harm than good.
Other folks (and I lean in this direction) feel that the JWs are a legitimate religious choice, and therefore their beliefs should be respected. But how far can you respect a religion when it endangers the life of a minor?
The human brain doesn't fully develop until the early 20's. The decision making centers aren't up to par before then. You're asking a 14-year-old to make a life-or-death decision.
How can anyone fully expect a mature decision from someone who, in other circumstances, might find it perfectly fine to bungee jump from the roof of the house!
Religions are supposed to improve the souls of the participants, yes, but I don't know of any Catholic who believes Bloody Mary killing off the Protestants to save their souls from damnation was a *good* thing. In fact, most of us find it repugnant.
So you've got three things:
1) A religion, one some people are calling a cult, that advocates the refusal of blood transfusions, no matter how serious the situation.
2) An underage person whose brain isn't fully formed, especially in the decision-making department.
3) A society that believes that while saving the soul is important, life is important, too.
As usual, I think we ought to err on the side of life and do everything in our power to keep our young people alive. Does a blood transfusion equal instant damnation? Does it equal excommunication from the Jehova's Witnesses? Why?
Any way you slice it, I don't think a child should be held repsonsible for something done to save his life, and I don't think the decision should be his alone to make. This is too twisty.
All this strikes me as overly paternalistic.
If we allow 14 year olds to have religious beliefs, then we should respect this kid's decision. Period.
To second guess his decision means that we do not respect the religious autonomy of teenagers.
If that's something you want to live with, fine. I cannot.
And given that the US Constitution protects the "Free Exercise" of Religion, I think that pesky little document is on my side.
Royale... does that little document protect brain washing suicide death cults? Does it protect people every time their religion steps on the way of proper education and womens rights? And nevermind that religious autonomy is actually a bad name for brain washing when are kids (when do we "choose" to believe in god? When our parents say he exists of course! :D ) ... Man... your constitution needs a serious reform... :)
The US Constitution protects our rights, but there are occasions that courts consistently recognize when exercising those rights can cause grave harm. Those rights must then be limited. The classic example is shouting "Fire!" in a crowded theater. The same goes for religious beliefs when they become crackpot, cultish, or just plain insane and then lead to harm. We don't allow Satanists to practice human sacrifice—though perhaps Royale would. There are limits to the exercise of religion.
An unknown here is how much influence the 14-year-old's parents might have had on his decision. They might have pushed him and given him constant reminders about being required to make the "right" decision to refuse the life-saving blood transfusion.
Now, if the parents themselves had been the culprits who refused to allow him to have a blood transfusion, child protective services would have been likely to step in as it has in similar cases around the country, remove the boy from the parents' custody, and then get a court order permitting the transfusion. There would have been no question about Mom and Dad's "free exercise" of religion overriding their minor child's right to live.
Mounting research shows that teens, especially younger teens like this 14-year-old, simply are impulsive and immature in general, which is why states are beginning to reconsider the trend toward trying them as adults for many offenses. In addition, numerous teachers and others who worked with teens for decades have noted that today's are generally far more immature than those of the same age were, say, 30 or 40 years ago. Parenting guru John Rosemond has said that in his judgement today's 16-year-old has about the same maturity level as a 12-year-old did back then, and he and others have begun to advocate raising the driving age to 18 nationwide for that reason. That doesn't say much for the 14-year-old's autonomy in choosing to refuse the transfusion, especially when (as mentioned) we don't know how much persuasion his parents exercised on him to decide that way. Seeing today's kids and young teens convinces me that most just don't begin to comprehend the finality of death or their mortality at that age.
The birth control and abortion analogies are red herrings. Generally it is illegal under statutory rape laws for children that age to have sex, as they are considered too immature to do so. Unfortunately, as part of a larger leftist agenda pushing children's "rights" and undermining parental authority in industrialized countries worldwide, this reality has been greatly camouflaged by the push to allow underage children to have access to contraceptives and abortion. The problem is that if the child has medical problems or complications from birth control devices or an abortion, the parents must then be responsible again for the child's medical care. "Oh, Mrs. Jones, your 14-year-old daughter had an abortion without your knowledge, but now she's hemorrhaging from the abortion and needs to go to the hospital. Now we need you to get involved and sign this form to give permission to treat the bleeding."
Finally, I see a side issue that no one addresses here. Just as we don't know the parents' true role here, it's easy to picture parents persuading a young teen to make an "autonomous" medical decision that would cause the child's death if caring for the child has been a burden because of lifelong medical problems or expenses. As Wesley Smith has warned, the disabled need to watch out if decisions like this become the norm. They'll be next.
What a brave new world we now live in. This will be the first such case of many, I fear.
I've written extensively about how religions that hurt other people cannot be allowed.
That is not the issue here.
Here, the other commenters are saying that 14 year olds cannot have a religion. I say they do and they should, even if it is a minority one.
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