by Marvin Shilmer 12 Replies latest jw friends
Doctors – What is the liability?
Today I added a new article to my blog addressing a recent legal development in England affecting risk for hospitals and doctors treating patients who are Jehovah’s Witnesses and choose to abide by Watchtower’s blood doctrine.
My article is titled Doctors – What is the liability? and is available at: http://marvinshilmer.blogspot.com/2012/03/doctors-what-is-liability.html
Marvin Shilmer
Shocking to read. Doctors do not let people bleed even if they are going to accept blood. If the doctor followed protocol and they did, then there is no wrong done. If we could locate haemorrhage early we would, if we could stop it early we would. Blood is a risky treatment, just as antibiotics is, or paracetemol. We give it as a last resort. It is wrong to say the patient may have lived had they treated her differently as a JW. As they themselves say nobody knows the possible outcome of not following protocol. Protocol is based on priority... usually airways being clear, breathing then circulation.... if the haemorrhage was known about then there must have been a higher priority OR the haemorrhage gave no signs until it was too late.
To refuse life saving treatment, then the family hold an investigation, then imply the doctors were less than capable & then take money from the service for other people being treated in my opinion is wrong.
If the doctor followed protocol and they did, then there is no wrong done.
In this case the hospital had a protocol it had adopted to help save Witness patients who refuse blood. This policy was not followed to the letter.
Unfortunately the consulting doctor took more than an hour to get to the scene which meant the process of finding and stopping the hemorrhage was delayed. Ordinarily this would not have posed a mortal threat. But in this case because the patient refused transfusion of blood product she ended up dying.
The take-away is that doctors cannot treat Witness patients with the standard-of-care afforded everyone else. Doctors have an added duty due to the patient’s religious preference.
Marvin Shilmer
Ok sorry, I read it in a hurry.
Hmmm...
If a patient arrives and has low volume due to bleeding in a non-obvious place, i.e. cant clamp/halt the bleeding, then they are given fluids, preferably blood. This has to be quick,we are talking seconds on arriving if possible, because you need to get the fluids in quick to restore volume and prevent death. They will pour the fluids in and send them for surgery to halt the bleeding.
if a patient refuses blood.... now you change protocol and go hunting for the bleed first instead of giving blood, then ok fair enough, alternate fluids can be used temporarily for volume (maintain blood pressure and cardiac output), but as they are just for volume and cant carry oxygen, depending on how much blood remained... within minutes the patient can suffer irrepairable damage. A risk of the patients own choice. That i understand as being ethical and legal, though I obviously think it is mistaken and foolish decision for the patient, possibly under duress from the religion etc.
Getting priority over other patient I have an issue with...
If you have to prioritise your time, between Patient A who comes in very sick and needs blood, and then patient B who arrives more stable but needing blood and refuses it, how can it be ok to give priority to patient B?
Patient B even though they may have lost less blood, will now get priority/attention/expertise due to the time required to find a bleed anywhere in the body. That just seems like an issue that needs serious debate and legal attention.
Should religious preference that seriously endangers ones life by choice be given priority over other very sick patients ?
I assume he was prioritising his time according to need. Consultants arent really on a Golf Course at 11am, they are marching around wards at 100mph with a face that says "dont talk to me", because they are calculating the risk of life and death of a ward full of patients. You can spot a consultant from the burden he carries as he walks down a corridor. Now we have to prioritise not on clinical need but preferance of treatment? Hmmmmmm.....
Marvin,
Is that what the courts/legislature imposed a heightened standard of care? Did the consulting md realize the patient was a Witness refusing blood? Causation is not easy to prove. I would place liability on the patient who made a conscious decision to incur the risk. I don't know English law. Are you saying the doctor was morally wrong or negligent. This discussion appears complex.
I see that fewer and fewer professionals will voluntarily treat Witnesses. What was the reason for the delay? Extremes are easy to discuss but the middle/the balance is much harder.
The patient should bear the burden. Of course, if someone maliciously lingered, another story is present.
Band on the Run,
Is that what the courts/legislature imposed a heightened standard of care? Did the consulting md realize the patient was a Witness refusing blood? Causation is not easy to prove. I would place liability on the patient who made a conscious decision to incur the risk. I don't know English law. Are you saying the doctor was morally wrong or negligent. This discussion appears complex.
You’re correct saying the discussion is complex.
The NHS has a written protocol for treating Witness patients who refuse some blood products (but not all blood products). This is tacit admission that this patient population presents a special complication which happens to be religious in nature. Essentially, the court finding holds that doctors must treat this religious complication just as they treat medical complications.
Doctors are well trained to manage and accept responsibility for medical complications they find themselves confronted with. They engage years of academic and clinical training to gain this expertise. More importantly they have chosen this training, which is scientific in nature and as a preference they immerse themselves in the field.
Doctors are not well trained to manage and accept responsibility for religious complications. They do not engage years of academic and clinical training to become experts in religious complications. This is a field they have not chosen hence they have not immersed themselves in it.
Despite the disparity between religious and medical complications the court found that doctors have a duty to bear responsibility for the religious complications arising from patient preference.
What makes all this even more complicated is that 1) not all Jehovah’s Witnesses agree with Watchtower’s blood doctrine so that they hold to it, and 2) Witnesses that do hold to Watchtower’s blood doctrine are not uniform in the religious complications presented in clinic because Watchtower’s blood doctrine is static in some areas and fluid in others. (I.e., some procedures/products are forbidden and others procedures/products are accepted or rejected on an individual basis.)
I see that fewer and fewer professionals will voluntarily treat Witnesses. What was the reason for the delay? Extremes are easy to discuss but the middle/the balance is much harder.
The NHS admitted that its protocol was not followed to the tee by not notifying the treating physician within the specified time-frame for the patient presentation. Why the consulting doctor took an hour to get in theater is not specified. Typically the doctor would have been with another patient or patients.
Marvin Shilmer
Had the protocol been followed, the young lady would have had surgery much earlier, maybe a blood transfusion would have beeen given, and maybe she would have survived.
As you say Marvin, the whole thing is complicated by the WT trying to reverse out of the corner they have painted themselves in to with the blood policy. However, the protocol also makes it plain that issues regarding fractions etc should have been covered and forms signed at an early stage.
As you rightly say (again) this court ruling puts the responsibility to act faster in the case of a refuser of blood, than in the case of a normal patient who will accept blood, upon the doctors and surgeon involved.
The other point you make about Medics (and this would apply to lawyers too ) not being equipped to deal with the religious aspect of the objection to treatment is valid, and why should they ?
I think that there would be room, here in the U.K, within the Mental Capacity Act 2005 to argue that JW's do not have relevant information available to them to make this decision, which is a religious decision, though impacting on their healthcare.
If they had been given say, JWfacts.com's excellent article on the WT Blood doctrine, they then have more information on which to base their religious decision, but it can hardly be called a fully qualified, conscientious decision if such information has been witheld from them.
I therefore maintain they do not have capacity to make the decision.
The problem is that a NHS Trust is not going to go down this untried route and risk expensive Court cases when there is no need, they already, in emergency situations have the power to overide the patients wishes.
It is all such an unecessary mess. The WT's murderous and callous hanging on to their doctrine just to save face is to blame.
More uninformed JW's who have been denied the tools to make a proper decision, by the WT, will die.
The Court found the defendants should have acted sooner to locate and stop Ms. Maher’s hemorrhage because of her religious preference. Put another way, the Court decided that because defendants knew the patient’s religious preference against accepting blood product then it should have acted sooner than the standard duty of care dictated under the same circumstances had the patient held a different religious preference.
^This bothers me.
Perhaps it is just a matter of poor wording. If you know a patient will not permit a transfusion then you should take that into account in planning care and contingencies. But you should always take as much care as possible to avoid blood loss in all patients.
This "dubs get more careful medical care because they refuse blood" plays directly into one of the most irksome, pervasive jw myths that support their blood ban.
This "dubs get more careful medical care because they refuse blood" plays directly into one of the most irksome, pervasive jw myths that support their blood ban.
It's hardwired into our brains to save children, for most people anyway. When children die entire staff's need therapy. There are whole charities devoted to getting trained psychologists to these types of events. From what I have experienced and learned it's not surprising to me that certain groups are more scrupulous with JW's as a group. Medical ethics are extremely important to the doctors of today and that's encouraging as a whole. To the doctors the Witnesses are never going to change so they may not mind enabling the ban to help lower the mortality rate. The Witnesses historically and even today are widely known for putting people in a moral catch 22. Then when you ask how they can be so heartless they just smile back and say, "We are just doing what Jesus told us to do."
Smiling in the Face of Death
A few weeks later, I was called up for “work service” but soon learned that the main
activity was military training. I explained that I would not fight in the war. When I
refused to sing Nazi fighting songs, the officers became furious.
The next morning I appeared in civilian clothes rather than in the army uniform we
had been issued. The officer in charge said he had no alternative but to put me in the
dungeon. There I subsisted on bread and water. Later I was told that there would be
a flag-saluting ceremony. The officer warned that I would be shot if I didn’t participate.
On the training grounds were 300 recruits as well as military officers. I was commanded
to walk by the officers and the swastika flag and give the Hitler salute. Drawing
spiritual strength from the Bible account of the three Hebrews in the days of Daniel,
I simply said “Guten Tag” (Good day) as I passed. I was ordered to march past again.
This time I didn’t say anything but only smiled.
When four officers led me back to the dungeon, they told me they were trembling
because they expected that I would be shot. “How is it possible,” they asked, “that
you were smiling and we were so nervous?” They said that they wished they had my
courage.
A few days later, Dr. Almendinger, a high-ranking officer from Hitler’s headquarters
in Berlin, arrived in the camp. I was called before him. He explained that the laws
had become much tougher. “You are not aware at all of what you are in for,” he said.
“Oh, yes, I am,” I replied. “My father was beheaded for the same reason only a few
weeks ago.” He was stunned and fell silent.
Later another high-ranking official from Berlin arrived, and he also tried to make me
change my mind. After hearing why I would not break God’s laws, he took my hand
and, with tears streaming down his face, said: “I want to save your life!” The guards
led me back to the dungeon where I spent 33 days altogether.
-Sab
The point is dear rebel8 that in a situation where a severe bleed has started, and the patient is a refuser, it is imperative that action to clamp the vessels or similar is taken quicker than in the case where a blood transfusion and maybe clotting agents can be administered.
That this will be interpreted by ignorant JW's as "better care" is probably inevitable. The reality is that in the case of a normal patient invasive surgery may be avoided, possibly. In the case of the JW patient it has to be done straight away, minutes are important, or organ failure and brain damage may ensue.
To not follow the protocol on this was reprehensible, as the court found, even if perhaps there were mitigating circumstances.
The patient who is willing to accept a blood transfusion is going to get the better care in reality in a case such as this, the JW's position is fraught with danger.
