Ethical Dilemmas In Children

Ethical Paper
The ethical dilemma of an adult refusing care for a child based upon religious beliefs is at the forefront of religious freedom versus patient rights. The issue becomes if and when the government may intervene on behalf of the child in life-saving situations when a parent or guardian cites religious or other beliefs against such action. This paper will detail the ethical dilemma of others refusing care for a child based upon religious beliefs and discuss the pros and cons of both views. The paper will then describe the potential impact to care involved in a practice setting. Finally, the paper will cite two professional journal articles related to the ethical problem and summarize the discussion content.
Freedom of religion
to many means allowing individuals the right to choose any course of treatment for their children. Without that right, some believe it would be an infringement on their First Amendment right to freedom of religion and the Fourteenth Amendment right to privacy. To some, the value and meaning of life are shaped by someone’s religious foundation, which may directly impact health care decision making. Many religions also believe in physical healing through God, prayer and divine intervention. In fact, there have been many cases where prayer is said to be the causative factor in a child being healed. Groups such as the Christian Science, Jehovah’s Witness, and The Followers of Christ are but a few of the religious institutions railing against some or most forms of medical care (Child, Inc. 2016).
“America was founded as a safe haven for religious beliefs that weren't tolerated elsewhere, unfortunately America’s public instinctive tolerance for religion often exceeds reason (Fox 2015).” In 2011, the State of Oregon passed a law that eliminates religious exemptions to criminal charges for parents and guardians of children who were injured or who died as a result of not receiving medical attention. The law was the result of one of the worst incidents of purposeful withholding of medical attention for children when 83 children of people belonging to the Followers of Christ Church had died, some of them from documented treatable conditions such as diabetes and one from an agonizing hernia (Fox 2015). Since the enactment of the law, there have been no deaths linked to the Oregon faction of Followers of Christ Church. The government has a moral obligation in protecting the child who cannot choose for himself. These decisions provide safety and security for those who are otherwise unable to make those decisions. Parents and guardians do not have the sole right to impose their faith on children, who are too young to understand the impact between someone’s beliefs and receiving potentially life-saving medical intervention
Growing up in a household where both parents actively practiced Christian Science resulted in my brothers and I not receiving modern medical attention. Although we never required emergent care, there were many occasions when visiting a doctor was unacceptable and forbidden. As a student nurse performing clinical rotation at Banner Thunderbird Hospital, I was given an opportunity to observe the administration of critical care practices to many sick children. In the event medical care was halted due to religious objection, all avenues to protect the child would be taken. These safeguards would include immediate notification to the charge nurse and appropriate team members. Notifications should also include notifying the hospital ethics committee, legal counsel and Department of Children’s Services. Nurses are patient advocates, and in the case of a child needing medical treatment, act as his/her voice especially when they cannot do so for themselves.
The American Academy of Pediatrics published an article titled “Conflicts Between Religious or Spiritual Beliefs and Pediatric Care: Informed Refusal, Exemptions, and Public Funding,” which details the ethical dilemma of medicine and religious objection. The article states religious or spiritual beliefs, in cases in which treatment is likely to prevent death or serious disability or relieve severe pain, children’s health and future autonomy should be protected. Because religious exemptions to child abuse and neglect laws do not equally protect all children and may harm some children by causing confusion about the duty to provide medical treatment, these exemptions should be repealed.
The article acknowledges the key role religion plays in people’s lives, but notes health care professionals and specialists should respect families and their religious or spiritual beliefs and collaborate with them to develop treatment plans to promote the child’s health.
The article points out that “Most states have religious exemptions to child abuse and neglect laws with those exemptions in response to the Child Abuse Prevention and Treatment Act of 1974. The act stated a parent or guardian legitimately practicing his religious beliefs who thereby does not provide specified medical treatment for a child, for that reason alone shall not be considered a negligent parent or guardian. Finally, the article suggest medical professionals report suspected cases of medical neglect to state provided child services agencies and that the American Academy of Pediatrics work to repel religious exemptions to child abuse and neglects laws and also to prevent money from being paid for religious or spiritual healing practices (Antommaria, Weiss
2013).
The American Medical Association published an article titled, “Limiting Parents’ Rights in Medical Decision Making.” The article details religious and secular issues concerning parental decision when seeking medical treatment for a child. The article relates the law must evaluate a parent’s competence to provide medical care for their child. The review does not end at assessing their mental ability to do so, it also looks at the willingness to make the appropriate medical decisions for the child. In determining religious objections to providing medical care the Supreme Court “Has long upheld the right of parents to make decisions for their children based on religious grounds” (Black 2006). The Supreme Court also states there is a balancing act in ensuring the duty to protect the citizen does not infringe on the rights granted under the First Amendment.
The article also details two court cases, each resulting in different outcomes. The first case involved a child whose parents were Christian Scientists. The parents objected to medical care for their child who was to receive chemotherapy treatment for lymphoma. The court ruled in favor of the parents stating they were within rights to forgo treatment because the child’s physician proposed the child had only a 40% chance of success from the treatments. More recently, another case from the Court of Appeals of Oklahoma ruled in favor of the medical professionals. The case involved a child who was experiencing seizures whose parents discontinued therapy. As a result, the child suffered more severe seizures to which the state intervened, alleging “medical neglect by the parents because the child’s condition was potentially life threatening.” It should be noted, the article points out the provision of medical treatment depends on the type of objection, religious or secular, and whether the treatment has a prognosis for survival with or without the treatment. Religious objection to medical therapy, more often than not, are valid and legal, particularly when the treatment is more likely to fail.
The ethical dilemma of a parent or guardian refusing care for a child based upon religious beliefs is an issue the medical community continues to address.
While the right to decline medical treatment is generally seen as a fundamental right, requests to refuse treatment is not always honored, especially when children are involved. In life-threatening situations or when a parent or guardian are unable to effectively communicate decisions, providers generally proceed with administering medical interventions. Legal competence to make medical decisions for children is not just about physical or mental capacity, it is also about making appropriate best interest decisions (Black 2006). There is a wonderful quote made by Thomas Szasz who said, “Formerly, when religion was strong and science weak, men mistook magic for medicine, now, when science is strong and religion weak, men mistake medicine for magic” (21st Century Quotations, p.69). In a world where values are distorted, the safety and security of children must always remain
strong.