[I am tired, having engaged in a knockdown, drag-out session on legal ethics with a lively group of Federal bar practitioners. This was not the issue I wanted to come home to for the last post of the day. In fact, I gave up and am posting it this morning. Funny, the issue isn’t any easier now than it was yesterday.]
Charles Taze Russell, founder of Jehovah’s Witnesses, and still getting kids killed since 1879.
A pregnant woman who was a Jehovah’s Witness checked into a Sydney, Australia hospital suffering from leukemia. She directed the staff that her treatment could not include blood transfusions, as her religious beliefs forbade them. She suffered from acute promyelocytic leukemia (APL), which is treatable, and often successfully. According to The American Cancer Society, “more than 90% of patients with APL go into remission with standard induction treatment.” Pregnant women with the cancer have an 83 percent remission rate, and their babies have a high rate of survival when their mothers are diagnosed in their second or third trimesters.
In the end, the fetus and the mother died for want of proper treatment. “Staff were distressed, grappling with what was perceived as two ‘avoidable’ deaths,” doctors at the Prince of Wales Hospital in Australia wrote in a letter published this month in the Internal Medicine Journal.
Well, they should be distressed: they aided and abetted negligent homicide.
The Australian doctors wrote that not giving the woman any blood products “undoubtedly contributed” to the deaths of the woman and her fetus, but that they didn’t give her any blood transfusions because “maternal autonomy was respected.” That’s maternal autonomy to get her own baby killed. This is not a case in which the mother, following current pro-abortion cant, had decided that her fetus was the equivalence of an annoying, career or convenience-obstructing wart or cyst, and thus should be excised as part of her sacred dominion over her own body. For the purposes of this issue, I’ll accept that intellectually dishonest construct, but that isn’t how this mother saw her unborn child.
She wanted it to live; she believed it was (as in fact it is) a living human being and not a wart or cyst. Under that set of facts, the hospital could not ethically do otherwise than pursue a course that maximized the chances of the child’s survival. The women, being in the thrall of a toxic, dangerous, reality-denying religion, may not have understood or believed that she was placing her child at mortal risk by insisting that he be left “in God’s hands” (ignoring the wise maxim “God helps those who let medical professionals help them”), but that was what was occurring, and the doctors knew it. Unfortunately for the fetus, they talked themselves into non-action.
“Refusal of a lifesaving intervention by an informed patient is generally well-respected, but the rights of a mother to refuse such interventions on behalf of her fetus is more controversial,” the doctors wrote. “A doctor indeed has moral obligations to both the pregnant woman, and perhaps with differing priority to the unborn fetus.”
This is self-serving blather. There’s no “perhaps” about it. The unborn baby isn’t a Jehovah’s Witness; the child requires protection from a deluded mother whose blind faith will kill him unless someone sane, responsible and zombified by an eccentric cult takes charge. In the U.S., that would almost certainly have occurred. The issue was settled, if not conclusively (states vary in their approaches), in the Supreme Court case of Prince v Massachusetts, where in another Jehovah’s Witnesses case, the majority stated…
The family itself is not beyond regulation in the public interest, as against a claim of religious liberty. And neither the rights of religion nor the rights of parenthood are beyond limitation…The right to practice religion freely does not include the right to expose the community or the child to communicable disease or the latter to ill-health or death…
Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves. Massachusetts has determined that an absolute prohibition, though one limited to streets and public places and to the incidental uses proscribed, is necessary to accomplish its legitimate objectives. Its power to attain them is broad enough to reach these peripheral instances in which the parent’s supervision may reduce but cannot eliminate entirely the ill effects of the prohibited conduct. We think that with reference to the public proclaiming of religion, upon the streets and in other similar public places, the power of the state to control the conduct of children reaches beyond the scope of its authority over adults, as is true in the case of other freedoms, and the rightful boundary of its power has not been crossed in this case.
It would be interesting to see if the fervent conservative advocates of the new religious freedom protection laws would want them to block government measures designed to protect the unborn when a religiously-addled mother regards her fetus as a human life and wants the child to be born, but by her actions is ensuring that it will not be. My guess is that we would see yet another hypocritical flip-flop on the Right.
There is no ethical basis by which the child should have been allowed to die because the mother refused treatment. Doctors are required to render medical aid to save lives, heal the sick, and to do so in a beneficent manner that “does no harm.” Allowing a baby who didn’t have to die to perish because of inadequate treatment is harm.
Providing excuses and cover for the Australian doctors is Columbia University Medical Center’s Cynthia Gyamfi, an associate professor of obstetrics and gynecology, who is quoted by the Washington Post as saying,
“[T]here’s “another ethical principle that comes into play in the management of a Jehovah’s Witness is nonmaleficence, or ‘do no harm.” Although a provider may believe that allowing a bleeding patient to die by not transfusing her with blood is clearly causing harm, a devout Jehovah’s Witness may perceive far more harm in the belief that eternal damnation will ensue from such a transfusion.”
If “do no harm” only means “do no harm including imaginary harm that the patient believes due to ignorance, indoctrination or insanity,” the medical profession’s bedrock ethics principle is nearly worthless.
The Australian doctors’ ethical judgment was warped by an excessive reverence for a woman’s right to choose stupidly, unreasonable submissiveness to demonstrably absurd religious requirements, and insufficient respect for human life and their own ethical standards.
The doctors allowed an unborn child to die, and that is indefensible.
[More on the issue here]
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Pointer: Althouse
Facts: Washington Post
Ethics Alarms 
” For the purposes of this issue, I’ll accept that intellectually dishonest construct, but that isn’t how this mother saw her unborn child.”
Sorry Jack, but I don’t see how you disentangle the two. You can’t decide that it is OK for a doctor to outright kill a fetus because their mothers view them as an inconvenience at 9 AM then say the same doctor is negligent for not forcibly treating a woman who is endangering her fetus because she believes some medical procedures are sinful at 1 PM. So, the viewpoint of the mother determines whether or not it is OK for her to cause the death of her fetus? That’s like saying White Supremecists shouldn’t face murder charges if they kill black people if they view them as animals, not truly people (animal cruelty charges for them?). The fetus either deserves the doctor’s protection and care, or it doesn’t. Choose one.
I don’t. My point is that the conduct of the doctors is unforgivable even if the feminist magic baby theory is taken as reasonable, that the fetus is human or not depending on the mother’s ideology and needs, and woe be it to anyone who challenges her. I agree with you. In this case, however, the mother cut off that excuse by clearly seeking to save the baby’s life, meaning that she acknowledged that it had a life. If she had said, “don’t worry about the “baby”–it’s just a part of my body that I want to get rid of anyway,” then the pro-choice cant would be involved.
But that issue doesn’t control here.
“The women, being in the thrall of a toxic, dangerous, reality-denying religion, may not have understood or believed that she was placing her child at mortal risk by insisting that he be left “in God’s hands””
Most religions are. However, having said that, nowhere in the Christian Bible or the Islamic Koran do I find a passage requiring the lack of medical treatment is required because of God’s Will or Inshallah. In fact, God is pretty much on record as having said that people have free will and must make their own decisions.
Actually quite the opposite for Catholics, the doctor is to be honored and trusted:
“Then give the doctor his place lest he leave; you need him too,
For there are times when recovery is in his hands.
He too prays to God that his diagnosis may be correct and his treatment bring about a cure.” (Sirach 38:12-14)
Full context: https://www.biblegateway.com/passage/?version=NABRE&search=Ben%20Sira%2038
I was referring to the KJV, as I am unfamiliar with the Catholic version.
I suspect there are no prohibitions about doctor prescribed treatments on that one either. 🙂
If there are, I have failed to find them. From what I can tell, God was pretty sure he wanted his minions to stay alive. Too much trouble providing for them in Heaven, I guess.
If I recall it correctly, the Hippocratic Oath, which all MDs take, includes “first, do no harm.” We have seen this oath ignored multiple times throughout the years (e.g., the Tuskegee (sp?) experiment with black men with syphilis), but this one case stands out horrifically for me. How many times have hospitals and doctors demanded psychological examinations of patients who want no treatment, who demand alternative forms of treatment, etc., based on religious, societal or psychopathic beliefs? Many, many times. I’d like to see the research on the number of times Christian Scientists, for example, were forced into treatment, or left to die “at God’s will.” It would be interesting and enlightening. All of us can refuse treatment; none of us can lawfully commit suicide to avoid treatment. But when another innocent person is involved (in this case, a full term baby about to be born), where does the law and the Hippocratic oath shake out?
We all know that women can now kill their fetuses (by law, at whatever stage they choose) for a variety of reasons. This we have to live with. But when a clearly misguided (being kind) or mentally incapable person refuses treatment that would save herself and the child she WANTED TO BE BORN, what responsibility do the doctors have? It’s a small case in the grand scheme of things, but only demonstrates the pressure MDs are under, their fear of malpractice suits, and the general degeneration of the medical profession per se.
Ethical decision-making — despite your blog, Jack — is rapidly becoming a thing of the past. No one seems to know HOW to analyze a situation and come to an ethical conclusion. Or to take the chance that an ethical decision may have negative personal impacts later on, but that it might well be worth it in the end.
Sad, sad. But I don’t think it’s without precedent.
I don’t think there is a right for a mother to kill her child at all, ever, for any reason except self-defense. (Self-defense means it’s the child’s life or the mothers.) The state has the right/responsibility to try to prevent the child’s death no matter what the mother thinks of it. The mother’s choice should not be a determining factor. Murderers don’t get to murder without consequences just because it suits their pathology at the time.
I think that is the only ethical position to have otherwise you find yourself trying to say a baby is only a person with it’s own rights if the mother thinks it is or if the mother’s religion will allow it. What utter bullshit.
The right to bodily autonomy is probably one of the most important fundamental rights that we have. And I don’t think we should lose that right, even if we would save someone else’s life in the process.
What should the hospital have done? Send police after the woman, strap her down, force her to undergo treatment against her will, knock her out, keep her forcibly restrained for however many weeks/times it would take to complete treatment, when she has committed no crime, is in her right mind, and is making a medically allowable decision?
I imagine different scenarios.
1. The fetus needs has a rare blood type, and needs a blood transfusion or it will die. The mom shares the blood type, but refuses to allow the transfusion for her own reasons. Would it be ethical for the medical staff to force the mother to undergo the transfusion anyway?
2. Same scenario, but this time it is the father with the same blood type that refuses the transfusion. He has indicated that he wants the fetus to live, but still refuses the transfusion. Should the medical staff strap him down, and force him to undergo the transfusion?
3. Same scenario, but a more distant relative. A cousin or uncle perhaps.
4. A stranger, whom the medical staff happens to know shares the same rare blood type.
I think this is a case of emotion overwhelming reason. As long as the fetus is attached to the mother, and is solely dependent on her, her rights to bodily autonomy should correctly trump the fetus’s, the same as anyone else’s rights to bodily autonomy trump the fetus’s. You should not be allowed to force someone to undergo treatment for the benefit of someone else, even if you might be related to that person. Just because a woman is pregnant doesn’t mean that she loses this right.
Thanks for weighing in with that analysis.
I don’t think I could possibly disagree more, but you make the best case possible.
It is not unprecedented for pregnant women to have their child treated within them forcibly, or even to be treated forcibly themselves. Just takes a court order, like force-feeding.
I don’t understand autonomy trumping life. That’s just not the right priority.
But, hey, I’m so glad to have you back, I’ll stop at that.
I think you do understand autonomy trumping life, just not in this case.
I think most people would disagree with the notion that people should be forced to donate blood or organs, even if the risks/pain were minimal, and it would save someone’s life, even if that someone were a child.
It is not unprecedented for pregnant women to have their child treated within them forcibly, or even to be treated forcibly themselves. Just takes a court order, like force-feeding.
As far as I can tell, there is only one controlling legal authority on the subject(by the time most get to appellate court, the situation has long past), but it clearly states that the woman in question should be the final arbiter of medical procedures upon her person. To decide otherwise invests the fetus with more rights than an already born person would have.
The Court of Appeals in In Re A.C. tackled two profoundly important questions concerning the treatment of pregnant women. First, who has the right to decide the course of medical treatment for a pregnant patient and, second, how is that decision to be made for a pregnant woman who is incapable of making it herself. The Court of Appeals held that “in virtually all cases the question of what is to be done is to be decided by the patient – the pregnant woman – on behalf of herself and the fetus.”
The court went on to hold that a pregnant woman who is unable to give an informed consent, like other patients, has the right to have her decision ascertained through the procedure known as substituted judgment and then carried out. In reaching its decision, the Court of Appeals expressly rejected the rationale that women may be compelled to undergo surgery simply because they chose to become pregnant, stating unequivocally that “a fetus cannot have rights in this respect superior to those of a person who has already been born.” Neither the viability of the fetus nor the potential harm to it are factors that can be used to justify overriding the woman’s wishes.
To tolerate compelled invasive medical treatment of pregnant women would vest the fetus with rights superior not only to those of the woman whose medical choice is subordinated, but also to those of existing children who have no right to compel parents to undergo surgery or to donate organs for their benefit. This ruling is consistent with other trial and appellate court decisions which have similarily rejected the argument that a pregnant woman has a legal duty to guarantee the health and well-being of her fetus.
http://en.wikipedia.org/wiki/In_re_A.C.
Proof only that laws and interpretations of laws cannot replace decency and common sense. The joy and duty of life is actually life and making I it better for others through compassion, sacrifice and hard work. It’s not quite as simple as it sounds, but that’s the gist of it. All the other stuff about self fulfillment, autonomy, self-will really comes as the result of losing yourself in the service of others. The happiest and most self-fulfilled people are people who can selflessly serve others. Cart before the horse and all that.
Here’s where most autonomy arguments fail IMO. They ignore the fact that the mother (to a lesser extent the father) is responsible for the child being in that situation in the first place. After a certain point, she’s had her chance to avoid the situation (I have zero issue with EARLY abortion) and is now committed. For your hypotheticals above, I’d go Yes on 1, conditional yes on 2, and No on 3 and 4.
The child’s right not to be killed, once acquired, trumps the woman’s right to bodily autonomy. WHEN that right is established is an issue of course, but that is a messy argument I don’t want to get into here. The mother voluntarily concedes the right by getting and staying pregnant, assuming the events leading to the pregnancy itself are voluntary.
Ah, but there’s the rub. If we for the purposes of this exercise concede that that the fetus shares an equal status to a living child, even in that scenario, a child has no right force a parent to undergo medical treatments for its own benefit, even if the medical procedure is of a minimal impact. So how could a fetus have more rights than an already living child?
If that fetus in question already had a sibling, that sibling could not legally demand that a parent (or anyone else) undergo a blood transfusion to save its life. Pregnancy makes no difference in this analysis. You can’t give a fetus more rights than an already born person, nor can you impute ongoing consent to a medical procedure in the face of clear, indisputable evidence that such consent does not exist or has been withdrawn.
I am curious that you have a yes for scenario 1, but only a conditional yes for scenario 2. What would be the difference in your analysis? (I assume that you feel forcing people to undergo unwanted medical procedures is ok for parents because they have a higher duty to their children, which is why you answered no for 3 and 4).
More or less. The conditional was because I haven’t thought through all the ramifications, but I think mothers have a greater responsibility than fathers. I’m still mulling it over, and might shift to a no on all 4 scenarios as presented based on the donation aspect. I think it would be ethical to require parents to allow treatments, but not necessarily to require parents to provide the substance used in the treatment. The actual situation involved only receiving treatment, not providing it.
In general, I think choosing to become pregnant involves voluntarily partially giving up the right of bodily autonomy, such that it can’t be re-asserted while the fetus is a person not yet born.
Dr Giselle Kidson-Gerber the treating haematologist said “Legally in Australia the mother has the right to make decisions on her behalf and her foetus’s behalf.”
Are the doctors supposed to ignore any law they disagree with and put ethics ahead of the law?
If a law OK’s murder, does that make murder OK?
I doubt that law allows the mother to kill her baby with her decisions. If the mother said, “I’ve decided that my baby needs a kick,” and directed a doctor to kick her in the stomach, would that be legal? I think not. The case cried out for court intervention.
Legal killing is, by definition, not murder.
Not usually one to demand a source, but ahh, I’ll demand a source. Definitions for the phrase “legal killing” appear scarce.
Oh, and blah, blah, Hitler, blah blah blah, you know the drill.
A non-sequitur. What is wrong is wrong regardless of the law.
So use the term “unethical homicide”.
Ethical homicides are homicides which are ethically authoprized or mandated; see e.g. 1 Samuel 15.
Sorry to pile on, but “yes”, the law allows the woman to kill the baby by refusing treatment. An extremely ethical doctor would force the treatment and face the consequences (probably losing his license). It got to this point because we made laws that put autonomy ahead of the baby’s life (I won’t retread the details of your exchange with deery), so now we have a law that enables unethical conduct and no will to change it. It’s a terrible situation, but it’s hard to blame the doctors for following the legal prescription – pun definitely intended.
In a word yes. Then the law needs to be changed.
Go to Hell, you white male rapist. Individual freedom trumps your tyranny. I can’t wait to see your government fall to its knees.
Show of hands, real or parody?
Ref: http://en.wikipedia.org/wiki/Poe's_law
It’s real, Alex. The guy’s nuts.
First of all, medical treatment isn’t natural. Second of all, everyone dies. So, in the end, it’s simply a matter of who’s in control: the individual or the state. Personally, I favor the individual, and I don’t see why a truly free state should even care how many people live or die. Keep your hands out of other people’s bodies. It’s not your business.
I’m going to go eat some animal that was murdered to be put on my dinner plate. Then I’ll go watch the news and see how many soldiers were murdered in a foreign country yesterday.
Does this answer your question, Alex???
When I read Matthew’s extremely erudite posts, I imagine an intricate wall clock crafted by an apprentice who’s master never taught him anything. We all wait in anticipate at the minute hand creeps to the 12.
Then, once there the bird springs out “Cuckoo cuckoo!!” but then springs and gears and cogs and screws come flying out as the whole thing falls off the wall…
Across the room, is a silent wooden bird with the sound box on the floor slowly fading “cuckoo cuckoo….”
It’s not a difficult case as I see it. If this woman actually believes that a blood transfusion is wrong and would rather die than have one, that’s her option- suicidal though it may well be. BUT ONLY IN REGARD TO HER OWN LIFE. One of those annoying realities of life that the Left, feminists and some cults cannot subscribe to is that of women carrying another life within them; a process called “pregnancy”. When in that state, the old argument that “a woman’s body is her own” falls as flat as a cow pattie on the Chisholm Trail. Now, a woman’s body is sustaining the body of a tiny human being. Too bad, ma’m. The child ranks you on the natural hierarchy of life. Prepare for the needle and some fresh human blood that’s probably better than anything your body ever churned out.