Does Refusing Medical Treatment Mean Refusing Life?

ASK yourself, “Do I have the right to decide which, if any, medical treatment I will accept?” That is an important question for you to consider, because some claim that a person shows lack of appreciation for his life if he refuses a therapy that doctors recommend. Further, it can be asked whether it is unloving for parents who have weighed the risks involved to decline a certain treatment advised for a sick child.

Some people who speak dogmatically on this matter often reduce it to the assertion: “Saying no to the therapy means saying no to a child’s life.” But you can easily see what an oversimplification, what a superficial view, that is. It plays on the emotions while ignoring (1) conscience and fundamental ethics, (2) your personal and family rights and (3) medical and legal aspects of an issue that now has been given worldwide attention.

Conscience is an intimate and inviolable part of you and of every sane, moral human. Well-known Catholic cardinal John Henry Newman held ‘that the way to the light is to be found through obedience to conscience.’ Thus when Nazi war criminals said that they were only obeying orders, moral people earth wide replied that despite orders these people should have followed their conscience. Similarly, in January 1982, Pope John Paul II ‘raised his voice to God that consciences not be suffocated.’ He said that forcing someone to violate his conscience “is the most painful blow inflicted to human dignity. In a certain sense, it is worse than inflicting physical death, of killing.”

His remarks may harmonize with your own feeling that conscience should play a vital role in medical decisions.

Conscience and Medical Questions

Here is an example: Whatever your faith, likely you know that Catholic doctrine condemns a woman’s seeking an abortion, even when a pregnancy presents risks for mother or child. Imagine what a problem this poses for a Roman Catholic physician in a land where abortion is legal, as it is in Italy since Law Number 194 of May 22, 1978 was enacted. This law allows for conscientious objection to abortion on the part of medical personnel. However, article 9 specifies that “conscientious objection cannot be invoked” by a doctor when a woman’s life may be in danger. What, then, is a sincere, practicing Catholic doctor to do?

If no other physician were around and he did all he could, short of violating his conscience, would we accuse him of being a murderer? On the contrary, it ‘would be worse than killing’ to force the doctor to violate his conscience even if a woman or the authorities insisted. This illustrates how demands of conscience can affect medical decisions regarding health and life.

Parents, Children and Life

We can see this clearly, too, from what the early Christians did. You probably know that they refused to burn incense before the emperor’s statue, considering the act to be idolatry. But their religious and conscientious view had a direct bearing on their health and life, and that of their children too. Why? When forced to choose​—‘Offer incense or your family will die in a Roman arena!’​—the Christians would not deny their convictions. They were loyal to their faith even when that course was risky or fatal to them and their children.

The Christians were also tested as to blood, since the Bible commanded them to ‘abstain from blood.’ (Acts 15:20) Tertullian, a Latin theologian of the third century, reports that as a supposed cure epileptics drank the fresh blood of slain gladiators. Would Christians take in blood for such “medical” reasons? Never. Tertullian added that ‘Christians would not even eat the blood of animals.’ In fact, when Roman officials wanted to test whether someone really was a Christian, they pressured him to eat blood sausage, knowing that a genuine Christian would not, even on pain of death, eat it. This is worth noting since the Christian witnesses of Jehovah today also refuse to take in blood.

Now we might ask, Did those early Christians have little regard for life or did they want to be martyrs? No, it was the Roman authorities who forced death on them and their children. And do we not respect the memory of those devoted Christians who knew, as the pope recently said, that violating their conscience would have been worse than death?

If someone feels that this is in a different field from medical decisions, note what Dr. D. N. Goldstein wrote:

“Doctors taking this position [forcing a treatment on people who refuse it] have denied the sacrifices of all the martyrs that have glorified history with their supreme devotion to principle even at the expense of their own lives. For those patients who choose certain death rather than violate a religious scruple are of the same stuff as those who paid with their lives . . . rather than accept [forced] baptism. . . . No doctor should seek legal assistance to save a body by destroying a soul. The patient’s life is his own.”​—The Wisconsin Medical Journal.

Choosing Real Life

Most of us would agree that “life” means more than a mere biological existence. Life is an existence centered around ideals or values (political, religious, scientific, artistic, etc.); without such, existence may be worthless. Thus during World War II patriotic men and women risked their lives to defend political ideals, values such as democracy and freedom of speech, worship and conscience. As a result of this defense of ideals, many children died. Countless others became orphans.

Indicative of this is the dramatic case of Italian statesman Aldo Moro. He was barbarously murdered in 1978 when authorities refused to comply with terrorist demands. Clearly, at times lives are sacrificed in the name of higher interests.

You can thus appreciate that a moral person could decide to risk his biological existence rather than compromise his ideals. In doing so he is making a choice of real life, life in its fullest sense. This certainly applies to Christian ideals.

Christians view human life as sacred, as a precious gift from God. Consider the apostle Paul, who was an intelligent, educated person. He suffered beatings and life-threatening situations but said: “I have taken the loss of all things and I consider them as a lot of refuse, that I may gain Christ . . . to see if I may by any means attain to the earlier resurrection from the dead.”​—Philippians 3:8-11.

We can be sure that Paul would never have shared in something that he knew God condemned. Unquestionably, Paul would not have risked losing out on “the real life,” which for him would be life in heaven, just to extend his human life or health by a few years. (1 Timothy 6:19) But consider:

There are millions of churchgoers today who look forward to life in heaven; perhaps you do. So if a seriously ill person with a hope of future eternal life refused a therapy that he felt God forbade, it certainly would be unfair to accuse him of refusing life. Rather, he has lived on earth for years, and he may recover to live here longer. But in any case, and even if his doctors are unbelievers, it would be reasonable for him to consider his lasting future life and make medical decisions accordingly.

Physicians seldom discuss that aspect of things when recommending some therapy for you or your loved ones. But there is a vital aspect that they should inform you about. It could be called risk/​benefit. You owe it to yourself and to your family to consider this feature, for it may help you to make a wise decision and to understand the wisdom of what others have done.

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Health Care for Children​—A Jesuit’s View

John J. Paris, S.J., associate professor, College of the Holy Cross (U.S.A.), spoke at the conference Legal and Ethical Aspects of Health Care for Children. (April 1, 1982) He told of a Jewish judge who ordered that a blood transfusion be given to one of Jehovah’s Witnesses. Professor Paris said: “The judge obeyed his religion and did what he thought was right, but in doing so, violated the religion of the patient.”

He added: “Christian theology does not support that mere breathing is life. In the hospital, no one dies; they arrest. . . . [In the hospital] life is not sacred, it’s ultimate, and death is a failure. But in the Judeo-Christian tradition, death is part of the human condition, part of the journey of life. There is no avoiding the fact that these are quality of life decisions. Sometimes the best treatment is no treatment.”

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Eternity Changes the Analysis

Dr. Ruth Macklin is a philosopher at Albert Einstein College of Medicine (New York). In a class discussion of ethics a medical student told of a Witness patient who was a “victim of sickle-cell anemia [and] who risked bleeding to death without a transfusion.” The student said: “He was logical. His thought processes were intact. What do you do when religious beliefs are against the only source of treatment?”

In response, Dr. Macklin said: “We may believe very strongly this man is making a mistake. But Jehovah’s Witnesses believe that to be transfused is to ‘eat blood’ and that eating blood [may] result in eternal damnation. We are trained to do risk-benefit analyses in medicine but if you weigh eternal damnation against remaining life on earth, the analysis assumes a different angle.”​—The New York Times, January 23, 1984.

Your Right to Weigh Risks and Benefits

YOUR body is yours. Your life is yours. These statements may seem obvious, but they point to a basic right of yours bearing on medical treatment. That is your right to decide what will be done to you. Many exercise this right by getting a second opinion and then deciding; others refuse some particular therapy. A 1983 study by Dr. Loren H. Roth revealed that ‘20 percent of hospital patients refuse treatment.’

But if you were ill or injured, how could you decide? Not being a physician, how could you know the best therapy? Usually we turn to the experts, to doctors who have specialized education, experience and a commitment to help people. Doctor and patient should consider the “risk/​benefit ratio.” What is that?

Let us say that you have a bad knee. A physician recommends surgery. Yet what are the risks of the anesthesia and surgery or the risks to your leg function later? On the other hand, what are the potential benefits and the chances that those benefits will be achieved in your case? Once the risk/​benefit picture has been explained, you have the right to decide: to give your informed consent or to refuse the treatment.

Weighing Risks and Benefits

Consider the risk/​benefit ratio in a real situation, that of Giuseppe and Consiglia Oneda, mentioned earlier.

Their daughter Isabella was very ill, and doctors recommended (even demanded) that she be given periodic blood transfusions. The loving parents objected primarily because of their knowledge of Bible law. Still, how might the matter of risk/​benefit ratio have affected things?

Nowadays most people assume that the transfusing of blood into a patient is a safe, effective therapy. We should not forget, though, that in the 17th century bloodletting was a common medical practice, for young and old alike, often with fatal consequences. What would have happened in those days if a parent had refused to allow his child to undergo bloodletting?

Bloodletting has had its day; now medical men espouse transfusing blood. Although doctors have accomplished a lot in recent years, they have to acknowledge that transfusions are risky. Dr. Joseph Bove (chairman of the American Association of Blood Banks’ committee on transfusion-transmitted diseases) recently said that contracting hepatitis from blood was first brought up in 1943. He added:

“Now, some 40 years later, the transmission of hepatitis by at least four different blood-borne viruses is a recognized risk of transfusion, and numerous other infectious agents are listed as being transmissible by blood and blood products.”​—The New England Journal of Medicine, January 12, 1984.

If you are to weigh matters relating to your health and life, or that of your family, how much risk do such diseases pose? Even doctors cannot say, because death from these diseases can occur long after a transfusion is given. Take as an example just one type of hepatitis (B), for which screening is only partially successful. A news report (January 10, 1984) said:

“In 1982, some 200,000 Americans came down with hepatitis B, according to the Center for Disease Control (CDC) in Atlanta; 15,000 people were hospitalized due to the acute stage of the illness, and 112 died. Another 4,000 victims died from chronic complications attributed to the disease.”

How many others in Italy, Germany, Japan and elsewhere have died of hepatitis caused by transfusions? Yes, death from transfusions is a serious risk to be weighed.

Also in the risk/​benefit ratio of transfusions, the risk is growing. “As our knowledge increases,” stated Professor Giorgio Veneroni (of Milan) in May 1982, “we are finding an ever greater number of risks connected with homologous blood transfusions.” One discovery causing alarm among doctors is AIDS (Acquired Immune Deficiency Syndrome), which has an extremely high death rate. Dr. Joseph Bove continued:

“For recipients, physicians must weigh the risk of transfusion against the expected benefit. This concept is not new but has become more pressing, since one can no longer assure an anxious patient that he or she will not get AIDS from transfusion.”

Doctors did not discuss that risk with the Onedas in 1978; it was not then recognized. But we know of it now. Should not such knowledge of the greater risks of transfusions make the Onedas’ decision less subject to criticism?

Parents Must Weigh Risks and Benefits

As an adult you have the right to weigh the risks and benefits of blood transfusions or any therapy. “Every competent adult is considered to be the master of his own body. He may treat it wisely or foolishly. He may even refuse life-saving treatment, and it’s nobody else’s business. Certainly not the state’s.” (Willard Gaylin, M.D., president of The Hastings Center) But who will weigh risks and benefits for a child?

Loving parents is the answer shown by general experience. For example, what if your child had problems with his tonsils and surgery was suggested. Would you not want to know about the advantages and risks of a tonsillectomy? Next, you might compare that with risk/​benefit information about antibiotic therapy. Then you could reach an informed conclusion, as so many parents have.

Look at a more serious situation. Doctors bring you the sad news that your dear child has a virtually incurable form of cancer. They say that chemotherapy could be used, but the chemicals would make your child very, very ill, and the chances of arresting the disease at this stage would be almost nil. Would you not have the right to make the final decision?

Yes is the answer that you would draw from an article by Dr. Terrence F. Ackerman.a He admitted that many court orders have been obtained on the claim that the state must protect minors. Yet, in a number of cases the famed M.D. Anderson Hospital and Tumor Institute followed ‘the policy of not seeking court-ordered transfusions.’ Why? Partly because “each of these children had a potentially fatal disease, and we could not predict a successful outcome.” Was that not true also of Isabella?

Ackerman stressed the value of “respect for the authority of parents to raise their children in a manner that they consider appropriate.” He reasoned: “It is axiomatic in pediatric practice that the physician has a moral duty to support the parents and family. The diagnosis of a potentially fatal illness in their child places enormous stress upon parents. If parents must contend, in addition, with what they believe to be a transgression of God’s law, their ability to function might be further impaired. Moreover, the well-being of the family directly affects the well-being of the sick child.”

Alternative Methods

To avoid the many risks of transfusion, researchers have developed surgical techniques that limit the need for blood. In fact, the Witnesses’ stand on blood has encouraged this research. In late 1983, newspapers in the United States told of a report to a convention of the American Heart Association: No blood was used in heart surgery on 48 children, ages three months to eight years. The patient’s body temperature was lowered and the blood diluted with water containing minerals and nutrients. But no blood was given! Initially, this technique was used only on children of Jehovah’s Witnesses. When the surgeons noticed that Witness children survived these operations much better than those where conventional methods were used, they decided to extend this technique to all their patients.

Understandably, there are cases in which doctors consider a blood transfusion indispensable. It can, however, be objectively held that: (1) Even many doctors admit that cases where they are convinced that transfusions are truly vital are very rare; (2) there is a long-standing harmful habit of administering blood unnecessarily; (3) the grave risks of transfusions make it impossible to be dogmatic as to the risk/​benefit ratio for them. Hence, some hospitals report that even many who are not Jehovah’s Witnesses are demanding that blood not be given them.

Hope for the Future

Happily, more and more attention is being focused on the rights and dignity of the individual. Enlightened countries, such as Italy, are putting forth effort to ensure the widest possible freedom, including the freedom to make informed medical decisions. A booklet produced by the American Medical Association explains: “The patient must be the final arbiter as to whether he will take his chances with the treatment or operation recommended by the doctor or risk living without it. Such is the natural right of the individual, which the law recognizes.”

This applies, too, in the case of minors. If you are a parent, you should take an active part in making medical decisions affecting your children. A council of judges in the United States wrote in “Guides to the Judge in Medical Orders Affecting Children”:

“If there is a choice of procedures​—if, for example, the doctor recommends a procedure which has an 80 per cent chance of success but which the parents disapprove, and the parents have no objection to a procedure which has only a 40 per cent chance of success—​the doctor must take the medically riskier but parentally unobjectionable course.”

Such advice can be most meaningful if you recognize your right​—yes, your obligation—​to obtain accurate medical information. Often it is wise to get a second opinion. Inquire as to the various ways in which a medical problem can be treated, and the potential risks and benefits of each therapy. Then, knowing the risk/​benefit ratio, you can make the informed medical decision. The law establishes that you have that right. God and your conscience say that you have that obligation.

[Footnotes]