Should you "protect" a patient from his own convictions?
This week's JAMA includes an interesting article by Dr. Bruce Campbell, a surgeon in Milwaukee. He writes about his apprehension in removing a tumor from a Jehovah's Witness. The procedure itself was relatively ordinary, but it carried the real risk of bleeding -- and the patient had, in accordance with his beliefs, forbidden Campbell from delivering a transfusion. (The article isn't open access, but NYT's Well blog helpfully clips many of the interesting sections.)
The patient ends up being fine, but Campbell was left with uncertainty about the situation:
For my part, I had spent two weeks becoming increasingly anxious that I might suddenly be called upon to “protect” this man from his own convictions. What emergency course of action might I have recommended if he had experienced a massive hemorrhage during the operation? Would I have tried to force his family to consider a lifesaving transfusion? I was still not certain.
If the patient had needed a transfusion, what should Campbell have done?
-Greg Dahlmann
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When I first read the original article, I was surprised that Dr. Campbell was not certain at the end of the ordeal. He listened to his patient and allowed him to have his goals within the context of appropriate medical treatment. But then when I read it a second time, I saw the uncertainty as a good thing. Difficult situations like this are best resolved when there is a certain amount of uncertainty. The pause gives us a chance to reflect on what is important rather than dogma.
For those of you who have not been to his blog, Dr. Campbell continues some of his great writing over at his blog Reflections in a Head Mirror.
- by Christian Sinclair on Feb 28, 2008 at 1:34 AM | link
He should respect his patent and "do not harm" and not force his beliefs on his patent. He should read more here:
http://www.watchtower.org/e/hb/index.htm?article=article_07.htm
To understand his patent.
- by online reader on Feb 28, 2008 at 8:19 AM | link
If he wasn't confident that he'd be able to let that man die, then he should not have agreed to operate. Of course it'd be different if the patient were a minor, or not of sound mind, but it doesn't sound like that was the case.
- by Eli on Feb 29, 2008 at 9:07 AM | link
If the patient is a fully informed, competent adult, his or her wishes in this matter should be respected. The difficulty for me arises when the patient is a child and denied such an ordinary, potentially life-saving procedure based on the beliefs of another. Any right to life, liberty, and the pursuit of happiness the child might have now or in the future is eradicated. In other words, I would argue it to be a violation of the child's rights to not intervene. I would be interested in anyone's thoughts on this matter.
- by T. D. Williams on Feb 29, 2008 at 10:02 PM | link
My thoughts are that if a child denies possibly life-saving medical treatment based on religious beliefs, or for any other reason, an individual assessment needs to be done to determine whether the child is competent to make that decision. Abraham Cherrix's case comes to mind. Some people have mature reasoning by age 12. Some people never grow up.
- by Laura(southernxyl) on Mar 2, 2008 at 8:33 PM | link
The difficulty is that the physician's code is based on not doing harm, and even unintended risks of surgery are 'done' by the surgeon. I don't think the dilemma should be seen as easily resolved.
- by emily on Mar 3, 2008 at 9:56 AM | link