Articles and Case Studies

A Question of Faith

11 Dec 2018

Alice Cran

by Ms Alice Cran

pregnant young woman

Few cases are so ethically vexed as when the offer of life-saving treatment is pitted against a patient’s religious beliefs.

In the case of a 17-year-old woman of the Jehovah’s Witness faith, her decision to refuse human blood products risked harming both herself and her unborn child.

Case study

The patient was 38 weeks pregnant when she consented to delivery of her baby via induction of labour and, if necessary, a caesarean section. She was assessed to be at significant risk of a post-partum haemorrhage and was advised of the possibility that a life-saving blood transfusion might be required. Adhering to her faith, the woman refused to consent to the hospital administering human blood products. Her mother, also of the Jehovah’s Witness faith, refused to consent to the treatment on behalf of her daughter.

On 31 August 2018, the hospital made an urgent application in the Supreme Court of Victoria seeking a declaration to authorise the administration of blood and/or blood products as considered reasonably necessary by the patient’s treating medical practitioners to save her life or to prevent serious injury during the course of induction of labour, labour, caesarean section and related procedures, and the postnatal period in regard to her pregnancy.

The application was opposed by the patient.

Exercising the Court’s parens patriae jurisdiction, the judge considered all the welfare interests of the 17-year-old patient – medical, spiritual, personal autonomy and identity – when deciding what was in the patient’s best interests.

Some of the factors impacting on that evaluation included:

  • opinion from a Child Psychiatrist who, following his assessment of the patient, was not confident that the patient understood the complexity and full implications of her decision to refuse human blood products should they be medically necessary
  • opinion from the Medical Director of Maternity who felt that the patient’s decision was partly motivated by her desire to please her mother and the support person from their faith community
  • several factors (including an earlier transgression of one of the principles of the Jehovah’s Witness faith) that cast some doubt on the patient’s maturity and the extent of her personal adherence to the tenets of her faith.

Outcome

After weighing the evidence, the judge was not satisfied that the patient had sufficient understanding of the consequences of her choice.

He remained unconvinced that “… overriding [the patient’s] expressed choice would so rob her of her essential self as to outweigh the loss she would suffer through losing her life or sustaining a catastrophic injury. In summary, I do not consider that allowing her, in effect, to choose to die or only survive with serious injury is in her best interests taking into account a holistic view of her welfare (physical, spiritual and otherwise).”

After accepting the hospital’s undertaking to only administer blood products as a last resort, the judge made the declaration sought by the hospital.

Alice Cran
Claims Manager (Solicitor)

alice cran

Consent, Regulation and Legislation, Intensive Care Medicine, Obstetrics and Gynaecology
 

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