The ethical dilemma, otherwise called an ethical difficulty, are circumstances in which there is a decision to be made between two alternatives, neither of which settle the circumstance in a morally worthy way. In such cases, societal and personal moral rules can give no acceptable result to the chooser (Your dictionary, 2017).
While delivering an effective healthcare to any person, healthcare professionals face a multitude of ethical dilemmas every day. It may arise from patients, family members, or medical staff, where they at crossroads, choice, and decision-making become difficult in terms of ethics (Loyola University New Orleans, 2017).
According to Kalvemark et al. (2004), the most widely known factors contributing to ethical dilemmas are the lack of resources, including time and staff, rules or guidance, conflict of interest and lack of supporting structures . These may lead to the situation ranging from issues like contraception, confidentiality, abortions, euthanasia, to issues involving religious and cultural beliefs.
Emerson, Mckinney (2010) states, the religion is one of the more frequent specified determinants of the good values that support moral norms. The real world religions have moral lessons and in different ways to show dissatisfaction of unethical activities.
Jehovah’s Witnesses (JW) are some of the biggest examples of religious beliefs causing dilemmas in healthcare settings. Woolley (2005, p.869) states, JW is known to the outsider of refuses blood products even the result of this is their death. JW has a scriptural stand in view of scriptural writing, such as ‘ The life of all flesh is the blood its: whoever eats it shall be cut off’ (Lev. 17:10-16) and ‘abstain from the meats offered to idols and blood’ (Acts 15:28-29).
According to Journal of American Medical Association (JAMA, 1981, pp. 2471-2472),
An individual from this religious group has profound religious feelings against tolerating homologous or autologous entire blood, whole red blood cells, white blood cells, or
platelets. Many will let the utilisation of (non-blood-prime) heart-lung, dialysis, or comparable gear if the extracorporeal dissemination is continuous. They acknowledge non-blood substitution liquid. Autologous pre-donation is not permitted to patients who are JW.
This essay will focus on the capability of an adult and young children of Jehovah’s Witnesses in terms of giving a consent and their ability to make their own decisions, the roles of the court and law to intervene in their decision in a life and death situations.
According to British Medical Association (BMA, 2016), Consent is the legal requirement and informed agreement between healthcare professionals and patients before the treatment or procedure can go ahead. It is a moral obligation to respect patient autonomy.
According to Griffith, Tengnah (2014, p. 101), Patients matured 16 and over are expected in law to be able to settle on choices about their medicinal services and their worry to treatment is required before it can continue. However, the Author states, where the patient lacks decision-making capacity, The Mental Capacity Act 2005 and its guiding principles that their rights and interest are the centres of the decision-making process.
Here are the examples of the decision-making that challenges healthcare professionals and their ethics; According to (Murphy, 2007), “A young Jehovah’s Witness has died just an hours after giving birth to twins. She had signed a form refusing a blood transfusion, and her family would not overrule her. Couldn’t the doctors have intervened?”. If the doctors intervene to transfuse blood to a young JW, they might have been charged with a criminal offence and they cannot defend their case. In the same article (Murphy, 2007), a
young woman in Dublin who lost lots of blood after giving birth to a healthy baby. she is a JW who refused a blood transfusion. In an emergency the hospital has been permitted to carry out the procedure, their argument was the right of the child to have a family. The principal article is the best case of the autonomy while the second article is the best case of basic leadership.
Whereas, when the young children are concerned, the ability to agree or withhold consent agree to treatment for their sake lies with those with parental obligation. Parents consent is vital to do any medical procedure involving children. Legitimately, aside from in a crisis. (Woolley, 2005, p715)
However, in the event that parents declined to give consent to a specific treatment, this choice can be overruled by the courts if the treatment is thought to be in the best interest of the child. If the people with parental duty differ about what’s in the child best interest, the court can settle on a choice.(Griffith, Tengnah, 2014, p.157)
What best to described a child?, according to Office of the
Commission on Human Rights (1989), the child is as everyone under the 18 years of age unless “ under the law applicable to the child, the majority is attained earlier”.
Furthermore, there are different laws across the U.K. that define age limit on contrasting chances. These are child protection, the age of criminal, the age of consent.(NSPCC, 2017)
In the U.K a young person who is 16 or 17 years old can consent for them self, considering they have enough capacity to close on their own medical treatment. Children less than 16 years old can agree to their own particular treatment in the event that they're accepted to have enough insight, skill, and comprehension to completely value what's associated with their treatment.( NHS choices, 2016 )
Additionally, there is a tool that assesses the competency of a child in terms of decision-making and giving a consent for their treatment. The Gillick- competency is used in England and medical law to assess the skill and comprehension of a child who’s seeking medical intervention.(NSPCC, 2017)
Lord Fraser states, “It seems to me verging on the absurd to suggest that a girl or a boy aged 15 could not effectively consent, the consent of the parents should normally be asked, but they may not be immediately available. Provided the patient, whether a boy or a girl, is capable of understanding what is proposed, and of expressing his or her own wishes, I see no good reason for holding that he or she lacks the capacity to express them validly and effectively and to authorise the medical man to make the examination or give the treatment which he advises. After all, a minor under the age of 16 can, within certain limits, enter into a contract.”(E-LAW CASES, n.d.).
However, if the young person declines any treatment or procedure that may lead to their death, the decision can be overruled by the court of protection. The Mental capacity act 2005 is the legal body the oversees the protection. However, the parents of the child who refuse treatment can overrule the child decision but it’s better to go to the court. (NHS choices, 2016)
According to Wheeler (2014), the section 8 of Children Act 1989 that the particular issue was outlined in view of blood transfusion for Jehovah’s Witnesses, at the command of the JW people group, among others. The author states, that this request allows the court to practice its control over the situation on the particular issue of blood transfusion.
The request can be obtained from High Court judge in the matter of 30 mins in an emergency situation. However, a blood transfusion can proceed if there is not enough time for the application to save child’s life, even the refusal of patient and parents. The clinician who saves a life in good faith will never be allowed to be prosecuted by the English Court.(Wheeler, 2014)
It is a matter of life and death in terms of making a decision that tests your faith. Every person has the right to decide for themselves if they have the mental capacity to do so.
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