Refusing Treatment for Religious Reasons
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Most of us have heard of Daniel Hauser, the thirteen-year-old boy who (with the support of his parents) has refused conventional chemotherapy to treat his Hodgkin’s lymphoma cancer. The justification for their decision is rooted in their American Indian religion’s belief of natural remedies over the voluntary injection of “poison” (ie, chemo-drugs) into the body. We’re also familiar with the classic example of religion interfering with medical treatment – Jehovah’s witnesses refusing blood transfusions.
Now I’m going to keep my opinion short as I’m eager to read your comments, but I think religion inherently commands us to preserve life above all else. If conventional treatment (chemotherapy and radiation in Daniel’s case) has an 85% or better chance of eliminating the growing tumor (which experts are saying), I would accept that I’m violating my religion in favor of the scientific community… in favor of continuing life.
In the case of Daniel, though he and his family made his “no-treatment” wishes clear, a court order demanded that he receive the chemotherapy. The result? Daniel and his mom have fled to an unknown destination. As Daniel’s tumor continues to grow, he will gradually lose the ability to breath and ultimately suffocate. Was the court right in ordering the chemotherapy, or should the patient and his family have the last call?
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Published: 2 years, 8 months ago
Court order is correct.
If love is stronger than religion, like I think it is, then the ultimate saving of a human life is also greater than the love for religion. There is nothing glorious about dying, nothing beautiful. Religious people who prefer to die instead of receiving adequate medical treatment suffer from flawed mentality. What does death accomplish? Nothing. In my life I have encountered several people that perished due to circumstances beyond their control, and the shattered families and friends they leave behind only take solace that their loved one was “called home by God. That God needed him or her.”
What else can people say? I am the type of individual that would claim that God had nothing to do with it. If God is love, then I imagine God want us to live rich, long, fruitful lives. I doubt God would want us to pursue our own demise. Yet… you see how I write “I doubt”? I am speaking what I believe. I am only a mere man, full of flaws, and my statements cannot be proven, perhaps God does want us to die before our time… but I doubt it.
Religion is fruit for the spirit, medicine is fruit for the human body. We live mostly in the realm of the tangible and physical, and as such we need to take care of our human “shell” with medicine, until we depart from this world. After we depart, we can go sing with whatever deity we worshiped while living.
Published: 2 years, 8 months ago
Great comment, Oscar! You speak my mind, as you always do, lol.
Published: 2 years, 8 months ago
Thanks, buddy.
We have to respect their wishes? Even when they have a death wish, using religion as an excuse to execute their demise? If only it were so simple. Perhaps, for some patients, death is a better option, but if there is an even .01% chance of curing someone and saving them from certain death, physicians must do everything in their power to save that one life. What type of physicians would we become if we were to give up because things look bleak? Are we to give up when patients give up? No. True Spartans, err, I mean doctors never retreat, we never surrender. How many doctors have saved people who have wanted to die, and those patients end up being forever grateful with their second chance? Countless such cases exist, even though it is not shown by the media, it is no American Idol, heaven forbid.
I think we fall in a loop hole when it comes to respecting patients’ wishes. Physicians are not infallible, not by a long shot, but chances are that many KNOW better than what their patients wish (ie, Daniel Hauser). In this case, physicians know better, and the best course of action is chemotherapy, not waiting on a deity to miraculously “save” or “take” him. Call me a maverick or unconventional, as much as I would eventually like to adhere to a patient’s wishes, a line must be drawn, and medicine should be executed accordingly. Even when you are right, you are wrong.
Published: 2 years, 8 months ago
Wow. I’m glad you like to force people to do things. Perhaps you should be pre-law. It will give you more “power” to force people. But oh wait, thats right. Daniel Hauser and his mom STILL made their own decision despite the law, too. What can overcome their mindset now? Nothing really. You can lay out the facts and persuade them, but a person makes their own decisions and has to live with the consequences too.
Forget doctors, we learn that as kids.
Published: 2 years, 8 months ago
Hi, Rizwana!
Pre-Law?! No way! I have a strong dislike of lawyers and don’t really get along with future lawyers, unfortunately. It’s nothing personal, I just don’t find their discussions interesting and the ones I have met are like American Psycho.
Have you or any of your siblings or any kids that you know ever refused to take medicine because it “tastes nasty”? And yet, parents still force you to swallow that Children’s Tylenol! Well, many adults are the same way, they are like big babies that need a firm person to “force” them to take their medicine.
And medical persuasion is highly effective, check this out:
http://news.bbc.co.uk/2/hi/americas/8069375.stm
Published: 2 years, 8 months ago
How Oscar can compare “taste of Children’s Tylenol” to adverse side effects of chemotherapy are beyond me. Guys, newsflash, chemotherapy is not an elixir. While it targets cancerous cells the side effects are that it can affect some normal cells hence the side effects. But I digress. The son has refused treatment, along with the parents. It does not matter if the cure rate was 100%. It is NOT the doctor’s choice. I don’t even care if the treatment needed was an extra strength Tylenol. A patient (or family if patient is underage) has the right to autonomy and decide medical options and more importantly refuse them. PERIOD.
Published: 2 years, 8 months ago
In practice, I have to agree with Rizwana’s and UTSWStud’s views regarding patient autonomy. It’s a concept drilled into our heads in medical training, and therefore must be followed; however, there’s a tiny splinter in the back of my mind that wishes patients would always attempt to preserve life above all else. I would think that’s common sense, but I’m just letting personal bias cloud the obvious truth – a patient’s decision supersedes that of a doctor. I just don’t understand how we can sit and watch patients like Daniel (and his family) voluntarily commit themselves to a path which, sure, is of their choosing but simultaneously abide by the infamous “do no harm” mantra.
Published: 2 years, 8 months ago
Do I agree with the family’s and Daniel’s decision on this case? Absolutely not. But that is irrelevant. As a doctor, your job is to give treatment options along with risk and benefits (informed consent). You are NOT the decision maker. It doesn’t matter if the treatment is surgery, chemotherapy, biopsy, a chest x-ray, EKG, or a stool softener. At every point in medical care the competent patient (competence is determined by courts not doctors – and even medical mental retardation does not count as lack of competence) has the right to refuse any and all treatment. 9 times out of 10, the patient will follow what you want. 1/10 they will say no. Yes, while it may affect you personally get used to it. TONS of patients won’t care at all to follow what you want. Patient autonomy is what separates the United States from most other countries that actually do “force” the patient to take treatment.
Published: 2 years, 8 months ago
Rishi, I don’t think you understand the “do no harm” mantra. Do no harm means YOU do not cause any ADDITIONAL harm. For example, a patient that is hyponatremia you run NS too correct the sodium too quickly to correct it, resulting in an even bigger problem – central pontine myelinolysis. Then you just created greater harm. A patient refusing treatment does not constitute the doctor doing harm.
Another great example: A doctor gets informed consent and does a laparatomy for suspected diverticulitis. Inside the abdomen/pelvis he finds something else what seems to be consistent with ovarian cancer. What should he do? Get a sample for biopsy and tell the patient afterwards what he found? Or don’t do anything, related to the ovary, only to what you gain informed consent for? The answer is #2. If you go in with the “Well, I’m the doctor, and I’m sure the patient would want me to do this” – you’re in for a whole world of hurt. You would have to close up the patient and then tell the patient what you found and gain informed consent for that as well, then if they let you, then go back in.
Published: 2 years, 8 months ago
I also think court order is correct. For muslims, in the Quran it states that God has made a cure for every ailment/disease. It is upto human to find that cure. So refusing it would be in a way giving up that life which God has blessed us with.
Now, for people like Daniel and Jehovah’s witnesses, if they can point out in the bible or religious text where it says for them not to get chemotherapy or blood transfusions, well than as a future doctor, and as a human we DO have to respect their wishes. Thats just what we are taught. I remember during High School when I would Shadow in the E.R. we had a high risk preg. who died during childbirth. She knew she would, but she chose to have the baby because of religious beliefs she didn’t want to abort, and although the Doc (Dr. Bui) didn’t agree with it, he did have to respect the patients beliefs.
So in conclusion, yes the court should give orders (since it seems to be the last ray of hope in somehow convincing the patient it is for the better) but the patient will ultimately do what they want, and we do have to respect that.
Published: 2 years, 8 months ago
I forgot the part when I compared the taste Children’s Tylenol with Chemotherapy, did you edit that part, Rishi? I can’t find it… I know perfectly well all the adverse toxic effects of chemotherapy, my own mother had chemotherapy treatment for her cancer, for crying out loud. You can go to a med school, and learn about medicine and its application, but not all doctors will turn out the same. If it were up to me, I would rather save lives than respecting someone’s wishes to just let their son die.
Published: 2 years, 8 months ago
Haha, nah, I didn’t edit anything. I think that as doctors, we’ll both have to accept the patient’s wishes (or else we’ll face pretty short careers in medicine); however, I also know that if either of us had a terminal condition, we would totally disregard religion/culture/etc. to do anything we could to preserve our lives. We just can’t project this same mentality on others… no matter how badly we want to.
As for court orders – I still think there’s an appropriate time for them, but drawing the line is incredibly difficult.
Published: 2 years, 8 months ago
Of course. We all think differently and have a set mentality, and as you say, this bias cannot be projected to others. All doctors will, inexorably, give in to a patient’s wishes. I have never said that I will never respect a patient’s wish, we have to, but there are limits. It is because of these limits that I would rather transfer such a patient to another physician, one who wouldn’t mind just sitting down and respecting a patient’s desire for their demise, since it is “their body”. My most sincere apologies to UTSWStud and Rizwana if they find my view distasteful. I just do not like the way some things are, nor do I believe that just because they teach you somethings in med school, they will forever be true. Science and medicine is always changing. If all doctors were of the same view, medicine would be lame, really lame.
Published: 2 years, 8 months ago
Yes, science and medicine and the technologies, treatment modalities, and diagnostic modalities, are always changing. The hospital took it to court for “CYA” protocol. But patient autonomy in the United States will NEVER CHANGE NO MATTER WHAT (with minors it is taken to court).
Published: 2 years, 8 months ago
The example you use to justify forcing a patient to undergo treatment was the Tylenol example. I did not say you said that Chemotx adverse effects and Tylenol taste were one in the same. It’s your comparison as if they have anything to do with eachother, hence your scale of degree, however, is ridiculously off.
“Have you or any of your siblings or any kids that you know ever refused to take medicine because it “tastes nasty”? And yet, parents still force you to swallow that Children’s Tylenol!”
By the way after your first malpractice lawsuit, try not to say inane things like these – which would not only result in the plaintiff winning, but more importantly in having your medical license revoked, leaving you unable to practice medicine.
“I think we fall in a loophole when it comes to respecting patients’ wishes.” No, it’s not a loophole. It’s pretty clear both from a legal standpoint AND a medical ethics standpoint.
“Physicians are not infallible, not by a long shot, but chances are that many KNOW better than what their patients wish (ie, Daniel Hauser).” – once again patients have many more reasons to refuse a treatment based on more than just morbidity/mortality ratios that doctors look at. It is not up to you decide which reason is “valid” or “invalid”. I don’t care if they are of the Flying Spaghetti Monster religion. Asian third world countries, esp. have this concept of follow everything the doctor says, even if the patient doesn’t want it.
“Well, many adults are the same way, they are like big babies that need a firm person to ‘force’ them to take their medicine.” — Wrong again. They are called ADULTS for a reason – they make their OWN decisions. You can counsel and be completely straightforward about all the risks, but you can not “force” them. That’s why there is a thing when patients leave a hospital on their own, it’s called Leaving AMA, where they sign a form. If you don’t let them leave – holding a competent patient against their will is a felony against the law. Not to mention, giving them treatment against their will IS considered “assault” under the law.
“Call me a maverick or unconventional, as much as I would eventually like to adhere to a patient’s wishes, a line must be drawn, and medicine should be EXECUTED (my emphasis) accordingly. Even when you are right, you are wrong.” —- Stalin and Pol Pot would have loved you. You are no maverick, that’s for sure. The fact that you will become a doctor is even more scary.
Published: 2 years, 8 months ago
Thank you for your well-constructed criticism. Again, there was no COMPARISON, how you added them together was of your own device. The point was that people needed persuasion to accept treatment, not comparing Children’s Tylenol and chemotherapy as similar. Thing is, I am not under the cover your ass mentality taught to medical students. You write more like an attorney than a medical student, employing the words: plaintiff, legal, lawsuits, law and such. Yes, I reckon taking CYA classes is part of the curriculum. It is this precise fear of malpractice lawsuits and fear of losing your medical license that have medicine at a plateau and demands ALL physicians to CYA. Though it is highly necessary, of course, I still cannot help but see medicine stagnated, leaving little room for improvement. I am not implying we should do radical and unethical medical practice, that is totally not the case here. I am just stating my view as someone outside of medical school. Do not suffer from other people’s way of thinking, or care what they think. Just because I do not agree with a patient does not mean I will not act accordingly and do the right thing. The “real” learning is not even in medical school, it is in residency and beyond. My nature is to question everything, not accepting everything as it is or what doctors teach me in the classroom, but to find out first hand and look for fallacies. In the end, all I want is to save lives.
Published: 2 years, 8 months ago
What you learn in medical school is NOT CYA protocol. If you read what I had written clearly, you would see I said that the hospital took it to court for CYA protocol. This is bc they wouldn’t want to be sued later by the family for doing nothing, if the boy happens to die. Also since the boy is a minor, the hospital does have the option to go to court as well. If he was a legal adult, the hospital would not even be allowed to file – as medical ETHICS (not legalese, ETHICS) is very clear on this issue.
While you are stating as someone “stating [your] view as someone outside of medical school” (hence why you have such a simplistic, knight in shining armor, the ends justifies the means mentality), I am stating my view as someone who has FINISHED medical school. I am not suffering from “other people’s thinking” and “not examining things critically” for myself. This is medical ethics at the most basic level: putting my patient FIRST (patient autonomy is how I want MY healthcare to be if I was the patient). Being a doctor, does not in any circumstance, no matter what the diagnosis is, give you any upper-hand over the patient in deciding care. In fact, when you start pulling that card, that’s when your patients lose trust in you as a doctor. Patients who are in a hospital know already they are not in control, with respect to their surroundings. Reassuring the patient that AT ALL TIMES, the patient is in control of their medical decisions makes you a better doctor, not a worse one. There is no CYA protocol there.
Also, regardless of what you believe, patient autonomy is not CYA protocol. Never has been, never will be. You only seem to think that it is CYA bc you wouldn’t agree with the patient’s decision. It would be no different if this was a severe hemorrhage case, instead of cancer, and the boy refused transfusions on religious grounds. The only difference is this is much more prolonged, while hemorrhage is more acute.
You would be the typical trigger happy resident that would want to do countless CODE Blues on a patient no matter how many ribs you break on an 80 yr. old with an EF of 25%, bc you BELIEVE that that is the best treatment bc after all it revives them right? (after all we should just TRUST you bc you are the doctor and you “know better”). Respecting a patient’s wishes is not a loophole. It is THEIR care.
As you know patients can choose to be DNR (Do Not Resuscitate) and DNI (Do Not Intubate), which were made to specifically protect patients against those like you, who would hammer out treatments bc Harrison’s Textbook of Internal Medicine tells you so in your “quest” to save lives.
I brought up malpractice and losing a medical license (the latter doesn’t happen in court by the way, it’s with a committee of DOCTORS), bc it’s your type of views and those who would ACT on those views that are dangerous to patients on your quest to “save lives”.
Rizwana and I put the patient FIRST in healthcare. Whether you believe it or not, your view, actually puts the patient second in your quest to “save lives”.
Published: 2 years, 8 months ago
There is MUCH MUCH more to the story. Apparently, HE DID do one course of chemotherapy for Hodgkin’s Lymphoma before deciding not to continue (he did not refuse from the beginning). Also another part of the story not mentioned in this blog post (no fault of Rishi – as that wasn’t the main point of the debated question), is that Daniel Hauser has a learning disability which would thus GREATLY affect his ability to truly give informed consent (on top of which he is only 13 as well) which consists of having ALL 4 of these, or it’s not informed consent: To have given informed consent, a patient should know the following:
1. The patient’s diagnosis.
2. The purpose of the proposed treatment.
3. The risks and benefits of the proposed treatment.
4. The alternatives to this treatment, and the consequences of the alternatives.
5. The risks of NOT having the proposed treatment.
He now has COME BACK to the hospital for further chemotherapy treatment: http://scienceblogs.com/insolence/2009/05/good_news_for_daniel_hauser.php
Oscar’s type of view would result in the Pamela Hamilton case: http://www.cnn.com/2009/HEALTH/05/27/parents.medical.custody/index.html
Published: 2 years, 8 months ago
UTSW…Wow, you’re my guru! I agreed with every word you said, completely. Even if you look at Daniel’s case, they eventually agreed on a mix of chemo. with native american methods as well as medicines which counter the side affects of chemo. Like UTSW said, you have to put the patient first.
On that same note, Oscar. I didn’t find your view distasteful. Who knows, after medical school when we are in the position to take these decisions, you might be the one putting the patient first, and I might be the one trying to save lives. As of right now, this is our opinion, one which honestly we don’t have enough experience and/or knowledge to back up.
What I do, often times find distasteful is your method of rebuttal. Sometimes, it can be demeaning. It seems as if what you say is fact, and anyone who doesn’t agree is wrong. I mean, yes tone cannot be assumed over the internet but sometimes, not matter how your read a sentence, the sentence sounds rude. Lol.
But I think we established this way back around september in a few of Rishi’s other topic posts, and we now have a rude/rebuttal “relationship” which I honestly learn alot out of.
But none the less. I loved this healthy debate and UTSW you rock!