What is your obligation when confronted with parents who are unwilling to accept medical advice in the best interest of their child because of their religious convictions?
The January death of John Travolta's 16-year-old son raises significant questions for physicians faced with families who refuse necessary medical treatment for their children.
Reports-albeit denied by the family-suggest that the Travoltas refused to accept a diagnosis of autism for their child because their religion, Scientology, does not recognize autism as a medical condition. As a result, according to the same reports (again, denied), the Travoltas may not have accepted the medical treatment necessary to protect their child's life.
For a physician who might face a similar scenario, the question is: What is your obligation when confronted with parents who are unwilling to accept medical advice in the best interest of their child because of their religious convictions?
A more difficult case arises when the need for treatment is not so clear. What is the physician's obligation when death or serious injury cannot be predicted, but one course of treatment simply provides a statistically better likelihood of success than another treatment-or no treatment whatsoever? In these cases, it is hard to argue that a parent's decision to decline one course of treatment in favor of another (or none) constitutes abuse or neglect. After all, physicians don't ordinarily substitute their own opinion for that of the parents.
Where multiple recognized treatment options exist, the physician is best served by carefully explaining the risks and benefits of each, scrupulously documenting the advice, and allowing the family to make the decision. Once the decision is made, be sure to have the family provide written informed consent that details the advice provided.
However, where treatment options are limited, and the consequences of avoiding them may be grave, the prudent approach would be to obtain another opinion. A second opinion, agreeing that the decision should be left to the family, would certainly provide some cover.
If, however, the second opinion believes that the recommended treatment is mandatory, then few options remain. One is for the physician to ask the hospital to convene its ethics committee to provide guidance, and then follow that advice.
Alternatively, if the hospital is unwilling to become involved-and it may well seek to avoid getting involved-reporting the case to the appropriate state authorities may prove to be the most prudent course.
One final caveat: In cases where the minor's age or the nature of the condition being treated could fall under a state's laws governing medical decision-making by "emancipated minors" or "mature minors," a physician should consider the maturity of the patient and, where appropriate, include the minor in the discussion and decision-making process.
The author is a health law attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, New Jersey; Lake Success, New York; and Philadelphia. He can be reached at firstname.lastname@example.org
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