YAHANDA: Don't stop believing
Pediatricians are right to intervene when parents try to prevent their children from receiving life-saving medical treatment for religious reasons
Children, however, should not let their parents’ spiritual beliefs shorten or adversely affect the rest of their lives.
The field of bioethics constantly addresses medical situations in which disagreements arise based on religious beliefs. Organ transplants, stem cell therapies and ending life support or artificial nutrition and hydration are commonly condemned on religious grounds. Moreover, people of certain religious faiths may even refuse potentially life-saving treatments like blood transfusions, abortions and — in this instance — chemotherapy.
When patients are mentally competent and legally adults, patient autonomy typically prevails, and physicians respect their patients’ wishes to forgo treatment — even if that treatment is lifesaving. That doesn’t mean that the physician must conclude that a patient is making the right choice or agree with the ways in which the patient justifies his decision. Rather, this practice accords with the commonly held view that medical professionals should not administer treatments against their patients’ wills. Practicing medicine paternalistically — that is, acting in a way that is contrary to a patient’s competent and voluntary decisions — is usually deemed unethical. But what if the patient is not an adult? A new bioethics decision seeks to address this.
On Monday, the American Academy of Pediatrics Committee on Bioethics issued an advisory statement regarding how parents’ religious beliefs may affect their children. Currently, most states have clauses in their child-abuse legislation that exempt parents from prosecution if they fail to obtain medical care for their children for religious reasons.
According to the committee, pediatricians should feel obligated to intervene when parents’ religious beliefs lead to children not receiving necessary medical treatment. If parents do not acquiesce to doctors’ wishes, child abuse agencies can step in. The committee further recommended that states close loopholes in child abuse and neglect laws that may result in children being denied necessary care because of parents’ religious beliefs.
The committee’s statement is no doubt going to face backlash from religious communities who will view the decision as oppressive to religious freedom, perhaps much in the same way as Christians rebelled to the idea of health insurance providers covering contraceptives. And, if the ruling applied to adults as well as children, those opponents would be vindicated. Competent adults are free to make autonomous medical decisions regardless of how they justify those choices. But when children are concerned, the distinction between paternalism and autonomy becomes less clear. I believe the committee made the right choice. A child in need of medical care should not be bound by his parents’ religious beliefs.
To be sure, the consequences of the committee’s ruling are difficult to ascertain since it is hard to tell when a child’s wishes are based on his own thinking and when they are derived merely from his parents’ beliefs. Based upon their obligations as medical professionals to provide the best care possible, however, pediatricians should always seek to give children life-saving treatments. Regardless of the child’s situation, that seems like the most beneficial option.
Take, for instance, the simplest case, where a child’s desires are different than his parents’. Maybe the child is not religious, or his personal spiritual beliefs do not preclude him from wanting a necessary medical treatment. It would, and should, be considered unethical for a doctor to allow the parents to control their child’s health based upon their religious beliefs. It is irrelevant what the parents believe in that situation. The child, whose health is actually in jeopardy, should not be denied care simply because he is not of legal consenting age. Admittedly, this situation is more clear-cut, and the committee probably would not have to sway many people to adopt this stance.
What if, though, the child mimics the parents’ beliefs and refuses a lifesaving treatment on religious grounds? Here, the committee’s ruling still promotes the best decision. A young child may not be competent enough to truly know what he wants. He may mindlessly mirror his parent’s beliefs because that is all he knows. Or, he cannot fully comprehend all his options, in which case he cannot be considered entirely autonomous. A necessary treatment, then, may be permissibly administered to the child.
This decision could be justified in a couple of ways. It may very well turn out that the child grows up to have different beliefs than his parents. In that situation, the child’s life would have been saved or prolonged by his pediatrician’s decision to go against the parents’ beliefs. Additionally, a person’s religious beliefs are largely influenced by where he was born. That is why, for example, those in predominantly Arab or Christian countries tend to be Muslim or Christian. One’s religion is heavily influenced — though not necessarily determined — by one’s upbringing, family, ethnicity, educational exposure and other circumstances. There is nothing that proves that a person is of a particular faith because that faith is objectively right. Indeed, sheer chance plays a large role in predisposing people toward some particular religion. So why should a child be denied a treatment simply because he happened to be born in a family with certain religious beliefs? He shouldn’t. The doctors have an obligation to provide those under the legal age of consent with the most beneficial care, which means giving necessary treatments even if they clash with a child’s religious beliefs.
Denying a child required medical care would be much harder to justify in our society if it were on non-religious grounds. If, when I was 8 years old, my parents refused to let me have a needed blood transfusion simply because they didn’t want me to have it, it would be viewed as irrational and parent negligence. But, if a child is denied that same treatment because his parents are Jehovah’s Witnesses, it is permitted under the law. The decision is also more acceptable in society because the rationale is bolstered by religious ideology. Such thinking should be altered. Religious beliefs have very little grounding, and should not be used to alter how children are treated. In the end, the committee’s ruling provides more benefit than harm. Those above the legal age of consent can still follow their religious beliefs without opposition. Children, however, should not let their parents’ spiritual beliefs shorten or adversely affect the rest of their lives.
Alex Yahanda is a senior associate editor for The Cavalier Daily. His columns run Wednesdays.