Refusal of Consent to Treatment – Health System Example

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"Refusal of Consent to Treatment" is an outstanding example of a paper on the health system. Unprecedented advances in medical science have raised the life expectancy throughout the developed world. Whatever be the nature of a disease, suitable lines of treatment do exist that can sometimes save a patient from imminent death or could considerably raise the quality of life of a patient undergoing treatment. So far as the choice of treatment is concerned, most of the time patients agree and consent to the opinion of the competent medical authorities or doctors.

In a majority of cases involving disease or distress, one rarely does come across patients who offer voluntary resistance to the line of treatment selected by the medical experts. Still there exist exceptions to such a trend. Many times, doctors and the nursing staff in modern medical facilities do come across patients who refuse to consent to a particular kind of treatment. Such patients may choose to do so owing to religious or some other reasons. Such a scenario raises a plethora of ethical and legal questions for the medical fraternity and also for society in general.

Does a patient have the right to refuse to consent to a particular kind of treatment, the denial of which may seriously jeopardize one's chances of survival or recovery? Such questions become even more disturbing when the patient involved happens to be a minor child (Shield, 1994). Do the parents or guardians of a minor patient have the right to refuse to consent to a treatment that may save his/her life? In the contemporary technology-driven world, society more than often comes across such medical dilemmas. More than often, people misunderstand the issue of refusal of consent to treatment for a plea for euthanasia.

However, the issue under consideration is very different from euthanasia. By euthanasia, we mean the termination of a patient’ s life either by a specific act as giving a lethal injection or by withholding or withdrawing the life support systems. However, the patients who refuse to consent to treatment do not necessarily wish to end their life. Refusing a particular kind of treatment is not the same as refusing all treatment in order to hasten death.

Such patients do expect the doctors to save their lives or the lives of their loved ones by some alternate medical procedures, rather than by following the line of treatment objected to by them (Kee, 1995). Their objection relates to the choice of treatment and not to the overall refusal of treatment. An analysis of the instances of refusal by Jehovah's Witnesses to administer blood or blood-derived products to their ailing minor children could provide meaningful insight into the issue under consideration (Morton, 1959). The situation becomes really confusing in the instances when parents who adhere to Jehovah's Witnesses sect refuse the administration of blood or blood products to their progeny on the grounds of their faith or religion.

In Australian law there exist specific legislation pertaining to the treatment for minor children without parental consent. Such legislations were enacted not only to protect the lives of minor children but also to safeguard the parents from being liable to refusing the treatment of their children on religious and moral grounds. Such legislations authorize the doctors to intervene in the treatment of a minor child against parental wishes when necessary. In Western Australia, Australian Capital Territory, Victoria, Tasmania, and Queensland, the medical staff may give blood transfusions to an ailing minor against parental wishes, provided the child is expected to die without such treatment (Health Care Directives Act).

In the Australian Capital Territory, Victoria and Tasmania, blood transfusions could be given to a minor child against parental wishes only if at least two doctors agree that it is not practical or wise to delay such transfusions. As per the law of Northern Territory, doctors are authorized to perform an emergency surgical procedure on a minor child without obtaining parental consent if at least two doctors hold that the child could die or could suffer irreparable medical losses due to the lack of such a treatment.

The same stands true as per the law of South Australia. In New South Wales also, doctors are allowed to conduct an emergency surgical procedure involving blood transfusions on a minor child without the consent of the parents if they consider that the child will severely suffer without such treatment. However, the existing laws have to some extent failed to allay the fears and doubts of medical practitioners pertaining to the refusal of a patient or a guardian to consent to treatment (Jerome, 2004).

In the case of Dalton v Skuthorpe (New South Wales), the concerned doctor was unable to decide if he was legally authorized to intervene in the treatment of a minor child. The doctor failed to decide whether the existing medical condition of a child legally permitted him to give a blood transfusion to a minor patient.

Such instances are indicative of the complexity of the issue at hand. Is the opinion of the medical professionals enough to deal with a refusal to consent to a treatment or should the courts actively interpret the law before such a treatment is administered? Should the treatment of the patients be delayed or can be delayed till the courts get the time to constructively intervene in the scheme of things? To what extent can society and the law permit a dependent patient to suffer due to religious or personal beliefs and aspirations (Deakin, 1999)?

The law pertaining to the issue under consideration, in the case of minor children is motivated by the intention to protect the rights of a minor child under medical duress or distress. However, the legal position gets more complex in the case of teenagers. In the recent case of a 16-year-old boy suffering from leukemia who strongly shared the religious affiliations of his parents, the court withheld his right to refuse to consent to a treatment on the grounds that the child lacked sufficient intelligence and maturity to make decisions about his well being.

Doctors were authorized to give a blood transfusion to this boy against his wishes. In such instances, the law is primarily guided by the seriousness of the condition of a patient, lack of viable alternatives to the treatment being avoided, and the patient's prospects of recovery. However, in the case of adult patients, the Australian law seems to be more willing to recognize the supremacy of a patient’ s right over one’ s body and is not swayed by the risks of refusal.

The law clearly states that in the case of adult patients refusing to consent to treatment, the principles of self-determination and autonomy stand supreme. Thus a patient has the complete right to determine what could be done to one’ s body and doctors could not administer him/her a particular treatment against his/her wishes. In an adult scenario, the patient's consent stands supreme. However, there exists a twist to this doctrine that doctors are required to respect the wishes of a patient only if he/she is in a fit condition to make them plain or has indicated them in advance, well before the treatment began (Cameron, 1995).

In case the doctors have valid grounds to doubt the ability of a patient to give an authentic refusal, they can proceed with the treatment of their choice. The ground reality is that the law and society need to strike a delicate balance between personal convictions and medical necessities. The issue under consideration is still open to much debate and deliberation.

References

Cameron, 1995, ‘Mandatory Consent to Treatment’, ERIC, Viewed 22 May 2008,

‘Consent to Treatment’, viewed 22 May 2008,

‘Consent to Treatment for Children’, Deakin Law Review, Viewed 22 May 2008,

‘Health Care Directives Act’, viewed 22 May 2008,

Kee, P. 1995, ‘Refusal of Parental Consent to Treatment’, E-Law viewed 22 May 2008,

Shield, J.P.H 1994, ‘Children’s Consent to Treatment’, British Medical Journal, viewed 22 May 2008,

Martin, A 1959, ‘Refusal of Parental Consent to Treatment’, Bmj.com, viewed 22 May 2008,

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