Medical Treatment: Decisions and the Law

12. Religious Objections to Treatment

INTRODUCTION

On occasions, patients will object to proposed medical treatment on religious grounds. The circumstance in which this has arisen most frequently has been in relation to the administration of blood transfusions. The best-known religious objectors to the use of blood in treatment are Jehovah’s Witnesses. They believe that the use of blood and some blood products is prohibited by laws laid down in the Bible, such as:

‘You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off.’

Where the refusal of treatment involves, in the view of the medical attendants, the inevitability of death, very difficult choices and decisions face all concerned, whether the patient is a young child whose parents are seeking to limit medical treatment or a competent adult with a settled and principled view.

This chapter seeks to set out the considerations which will apply in such cases. While the emphasis is on the administration of blood transfusions, the same principles will obviously apply to any refusal of potentially life-saving medical treatment on religious grounds. It is essential in any well-run medical institution, where treatment which might be objected to on religious grounds is offered, for the practitioners and management to have considered the problem in advance, to have ensured that the staff are informed of the issues, and to have developed a general policy for the handling of such cases. Often problems in this field can be foreseen and managed with sensitive counselling, discussion and consideration of alternative approaches to treatment. Nothing can be more destructive of the necessary confidence between doctor and patient than a hurried decision to impose treatment on a patient against his will or against the demands of the parents of a child.

Contents

  • A Introduction  12.1
  • B Competent adults 12.2
  • General principle  12.2
  • Power to treat under s 63 Mental Health Act 1983 12.3
  • Steps to be taken  12.4
  • Confirmation that the patient has the mental capacity to make the decision in question 12.5
    • Ability to understand the information relevant to the decision 12.6
    • Ability to use or weigh the information as part of the process of making the decision 12.7
  • Advice  12.8
  • Undue influence  12.9
  • Scope of the decision  12.10
  • The role of relatives and close friends 12.11
  • Recording of decision against medical advice  12.12
  • C Incapacitated adults 12.13
  • General principle  12.13
  • Advance decisions  12.14
    • Reported oral advance decision 12.15
    • The effect of uncertainty 12.16
  • Written declarations 12.17
  • D Children  12.18
  • General principle  12.18
  • Best interests  12.19
  • The ‘Gillick competent’ child 12.20
  • E Procedural issues with children’s applications 12.21
  • Anticipation  12.21
  • Notice and consultation 12.22
  • Evidence  12.23
  • Change of circumstance 12.24
  • F Conclusion  12.25

updates and appendices will be provided for this chapter in due course

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