h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

This story is Irish. Its implications will be felt in Ireland (and also in the Dem. Rep. of Congo). It may yet go before the Eurpean Court of Human Rights, possibly. But, legally, it ends there.

The principles, however, are global.

http://www.timesonline.co.uk/article/0,,2091-2372595_1,00.html

http://www.unison.ie/irish_independent/stories.php3?ca=133&si=1693394&issue_id=14682

TRiG.

Hi Trig

This is an interesting one but could you présis the Irish Indi article as I don't wish to register with the site.



turvy

This parallels the 'no vaccine' stance. Vaccinations are also seen to be the be all and end all. Some countries will not allow children into school or childcare without a full complement of jabs. Students and uni is the same story as well. Many worldwide homeschool for just this reason alone. The worst offending natins are the US and Australia as I understand it. Many third world countries are just as bad, but don't legislate it so well.
W

Personally, I think the courts have rather more right to override someone's wishes when it comes to potentially lifesaving treatment refused on religious grounds than in the case of someone terminally ill not wanting their life prolonged.

Ultimately, there doesn't seem to be any kind of clear-cut dividing line between 'religious objections' and delusional behaviour on the part of the patient.
If someone thought that antibiotics were the work of the Devil, and were made from tiny demons, and refused to let a child with a serious bacterial infection be treated, I'd hope they'd be rightly ignored, if not actually sectioned. The only real issue in my mind would be whether the child should be returned to people like that when it had recovered.
Even if their objections were to their *own* treatment, there comes a point where a court may have to judge whether they really are mentally competent to make that kind of judgement.
The existence of numbers of other people with the same belief doesn't make it any more sane.

Where would you then place the dissension of an adult (presumably sane) with regards to vaccinations whether for themselves or their children?

well, Potholer, the courts are quick enough to take children away from families which aren't abusing them - they have enough powers to just take the child into care and force their treatments on it and then not return it to its birth parents.

In the case of this woman - so what if she's delusional? The baby was healthy. There are, I guess, enough people in Ireland looking to adopt babies - where's the problem if she had died?

Instead resources have been used which could have been used for someone who wants them, and nobody has even begun to consider if there might be some kind of long-term psychological problems for this woman now she is alive when presumably she would have died (as she probably believes her God willed it)

I think it's morally dodgy to restrain someone to shove blood into them.

sorry, I forgot to add: delusional behaviour? Presumably all Jehova's Witnesses are delusional? If they carry a card and make their wishes known - that doesn't sound delusional to me (especially if they're over 21)

It also behooves to remember where this woman comes from. Congo as in DRC, as in previously Zaire, the French colony? The same France that had the HIV contaminated bloodbanks? The same Zaire where HIV erupted first? The same Congo now decimated by AIDS.

I would not want a blood transfusion either. Does that make me delusional?

Pah.

Yes, I think it is fairly clear that the woman was not delusional and made an informed choice about her healthcare that was totally ignored by the hospital and the courts. This is a serious breach of her rights, and I agree the principles being affected here are global.

I'm thinking this is connected to religion in other ways. Would this situation have arisen in a more secular country? The connection is the Catholic anti-abortion stance: Women as baby incubators, now women as childcare facilities.

The central issue seems to be that the judge thought the woman had a responsibility to the child that overrode her self-autonomy. If the woman had not just had a baby she would have been entitled to refuse the transfusion. I can't see why, in a culture that officially sanctions adoption, the court would rule that the basic right to automony over one's body is secondary to the obligations to another human.

There are implications here connected to when pregnant women can be forced into treatment against their will (this happens to the greatest extent in the US). If women can also now be forced into treatment post-partum where does this end?


I also wonder if she had been Irish if this would have happened? Would the judge have seen the state as having more responsibility to taking over care of the child if the child hadn't been the offspring of an immigrant?

>>"Where would you then place the dissension of an adult (presumably sane) with regards to vaccinations whether for themselves or their children?"

It would depend on the evidence on the risks and benefits.

With vaccines, there seems likely to be different balance of risks and benefits than with blood transfusions, etc, where there is an immediate, significant and reasonably quantifiable risk to the life of an individual ('If she's lost X pints of blood, her chance of survival without a transfusion is about Y%').

Still, with vaccines, there are complex factors - if enough other people are vaccinated against a particular human-to-human disease, the personal benefit a single individual gains from being vaccinated may be slight, but that may only be the case as long as other people behave differently.
It's not possible from the outside to tell whether someone has objections to vaccination so strong that they would decide precisely the same way if the disease in question regularly swept through the population and killed a goodly percentage, or if they are to some degree implicitly or explicitly relying on other people reducing the risk to a level where they feel comfortable refusing a vaccine.

The *religious* basis of objections to treatment seem largely irrelevant - if someone is refusing to allow a treatment that could save someone else's life (or their own), the rationality of their decision seems best judged on the basis of the best available medical knowledge of the risks and benefits, and I don't see it as the job of the courts to consider someone's personal opinions on the hazard or potential glory to their immortal soul as part of the risks or benefits in the case of likely life-saving treatment.

If I had a secular *or* a religious aversion to needles penetrating my skin, they each seem worthy of the same degree of consideration when it comes to people working out whether they should hold me down while giving me an injection.

>>"In the case of this woman - so what if she's delusional? The baby was healthy. There are, I guess, enough people in Ireland looking to adopt babies - where's the problem if she had died?

Instead resources have been used which could have been used for someone who wants them, and nobody has even begun to consider if there might be some kind of long-term psychological problems for this woman now she is alive when presumably she would have died (as she probably believes her God willed it)

I think it's morally dodgy to restrain someone to shove blood into them."

Maybe it's morally dodgy to pump the stomach of an attempted suicide, but we do it anyway. The way I see it, if someone really is *determined* to be dead, they can always have another go later on.

Personally, if someone actually thinks that through no fault of their own they have failed their God by still being alive, despite their best attempts to be dead, I think that the long-term psychological problems were *probably* already there.

>>"It also behooves to remember where this woman comes from. Congo as in DRC, as in previously Zaire, the French colony? The same France that had the HIV contaminated bloodbanks? The same Zaire where HIV erupted first? The same Congo now decimated by AIDS."

Well, I'd have thought it was the job of the Irish doctors and courts to decide what to do *now*, on the basis of the current knowledge of risks in Ireland. If the woman was truly going to die without that transfusion, then any chance of surviving with a transfusion would seem to be better than nothing.

>>"I would not want a blood transfusion either. Does that make me delusional?"

Personally, I'd rather not be in the situation where I needed one, but if the choice was transfusion or signficant risk of death, it'd be a no-brainer.

>>"Yes, I think it is fairly clear that the woman was not delusional and made an informed choice about her healthcare that was totally ignored by the hospital and the courts. This is a serious breach of her rights, and I agree the principles being affected here are global."

At what point does saying "I believe in an invisible being who wants me dead and my child motherless" become a delusion?
When it's not claimed to be a religious viewpoint?
When it's not shared by enough other people? (How many *is* enough?)

10.

This post has been removed.

Potholer: "Ultimately, there doesn't seem to be any kind of clear-cut dividing line between 'religious objections' and delusional behaviour on the part of the patient."

That's a pretty arrogant statement.

The term 'religious' can apply as much (in my obviously delusional mind) to people of the exclusively scientific 'persuasion'. There is great error on both extremes of polarity (imho, of course).

For my part, I find it just as delusional for people to assert that vaccines prevent disease. They may (note the 'may') prevent the diseases they purport to protect against but they 'cause' others, some even worse... You may like to google "Oman provocation polio" for example - pick out the medical journals you get in the result. This is not the only example, either. You may also choose to look at the phenomenon of disease reporting and the alleged reclassification of symptoms... or the phenomenon of SV40 and other vaccine-related viral diseases. All this from the profession that proudly takes a Hippocratic oath.

Potholer: "With vaccines, there seems likely to be different balance of risks and benefits..."

Neither medicine, science, nor the courts are anywhere near infallible - check out the Cambridge study that shows a vegetative state patient responding to instruction in the 'identical' way as a conscious person. So who would I trust to make that judgement about risks and benefits? I have enough anecdotal evidence of doctors and scientists getting things totally wrong: a child left unilaterally deaf for over a year while seeing a consultant (who performed surgery on her) every 4 weeks... myself having a homebirth VBAC despite being threatened with legal action by my doctors; my very much alive father being told he would die within 18 months (in 1990) if he did not follow instructions. Why do they get it wrong? I believe it is because they do not look at the big picture, do not allow any hint of personal dictum and maintain a tunnel vision based on their own narrow field of expertise. These do not make for quality decisions.

My opinion? My life, my child, my responsibility, my decision.

Potholer: "It's not possible from the outside to tell whether someone has objections to vaccination so strong that they would decide precisely the same way if the disease in question regularly swept through the population and killed a goodly percentage, or if they are to some degree implicitly or explicitly relying on other people reducing the risk to a level where they feel comfortable refusing a vaccine."

You again ignore the larger picture. They do not vaccinate because their children have had negative repercussions from vaccines. This is usually the first case scenario, child number one has a post vaccine episode which the doctors usually pooh-pooh.

except now there is a formalised method of reporting *all* post vaccine events - because parents like these have made so much noise for so long the evidence could no longer be ignored. Note though that you have to ask for these forms, noone will voluntarily tell you about them.

So, vaccination is halted by the parents and subsequent children not vaccinated - and *nursed* through their childhood illnesses - not sent to school with fevers (as advised by my GP on several occasions, with the requisite antibiotic and Nurofen prescription)..

I grew up in North Central Ghana. I lived in an area where polio and measles especially were rife. The kids and adults with scars and limps or who died were all (without fail) either 1) poor or 2) already ill with something else. We had a mad English doctor by the name of Boseman who decided to dose with vitamin A and vitamin C as a first course of action. Mortality and morbidity sank like a stone. I was fortunate that this happened when I was a child - 35 years ago. I (and many many others) have pushed and vocalised and protested and spent a lot of time yapping on about the underlying cause of disease, and specifically the use of vit A and C in communicable diseases for years now.

This summer, in my home country (Lebanon), I was gratified to see that the WHO was sending intravenous vitamins A and C as part of the programme against communicable diseases.

'Truth' and 'scientific' truth in particular are relative to time and evolution of thought, with all my respect to all of us who have studied science and believe in it.

The minute anyone believes anything is the whole truth and nothing but the truth, they have lost the plot, and become religious, imho.



Wilma

<> (Potholer)

At what point was that ever said? That the women thought her god wanted her dead and her child motherless?

If there had been a need for a transfusion *before* the birth that would have affected the life of the baby about to be born (who clearly had no religious affiliations) then the hospital probably would have been within its rights to step in. But as the transfusion was only necessary after the birth (and the baby was born well and healthy) it does sound like a breach of personal rights to me.

My mother refused to have chemo after having a breast removed three years ago - against the advice of her doctor - which was clearly her choice to make. She was not forced to have chemo (she opted for radiotherapy instead and is still alive and, if not kicking, at least still happy with her choice). It affected nobody but herself.

Likewise, if this woman had died after giving birth without the blood transplant, that would have been her choice. Yes, her child would have been left motherless, but probably not for long.

What I cannot agree with, however, is when parents make this choice for young children needing a life saving intervention such as a blood transfusion because of *their* particular religious beliefs. In the case of minors, I do think it's right that the state steps in and provides them with the exact emergency life-saving medical care they need, as these children are not able to make this sort of decision on their own and should not be subjected to their parent's decision based on a religious belief that they may not end up holding themselves later on in life.

az

Wilma and az

I'd also add that contemporary, historical and prehistorical evidence shows that the number of aspiritual humans is very low. So who's got the delusion?



>>
The *religious* basis of objections to treatment seem largely irrelevant - if someone is refusing to allow a treatment that could save someone else's life (or their own), the rationality of their decision seems best judged on the basis of the best available medical knowledge of the risks and benefits, and I don't see it as the job of the courts to consider someone's personal opinions on the hazard or potential glory to their immortal soul as part of the risks or benefits in the case of likely life-saving treatment.<< (Potholer)

I think you are missing several important points. The main one is that the issue here isn't a medical one, it's an ethical one. Medical opinion is important, but it's not the crucial determining factor in the decision.

Also there is a huge difference between making a decision about one's own life compare to making decisions about another's. Generally people have the right to refuse treatment for themselves as long as they are legally sane. They don't actually have to have a socially acceptable reason, as long as they are considered competent to make the decision.

Which brings us to the second point. You seem to be thinking that the best person to determine the value of life is a medical person. This is not true, and it's not that the courts should be considering someone's beliefs, it's that they shouldn't be involved AT ALL unless there is a good reason to consider the adult incompetent i.e people are free to die as long as they are making an informed choice.

People often make decisions about their health for a wide range of reasons of which medical opinion is only one. This is not only because of the kinds of reasons Wilma raises (medical science is fallible, political, has its own biases), but also because we are not primarily medical beings, and we are more than solely the mechanical beings that medical science looks at. Issues of emotion, spirituality, social and cultural mores etc are all very important to people.



>>
Maybe it's morally dodgy to pump the stomach of an attempted suicide, but we do it anyway. The way I see it, if someone really is *determined* to be dead, they can always have another go later on.<<

In that kind of situation the person is either unconcious and therefore unable to make a decision, or they are considered mentally ill and considered incompetent to make the decision. I think in countries where suicide is no illegal, then a concious, sane person could in fact refuse to have their stomach pumped (off course they would have to convince a psychiatrist that they were sane and competent, which is not always easy to do but that is another kettle of fish).



>>
Well, I'd have thought it was the job of the Irish doctors and courts to decide what to do *now*, on the basis of the current knowledge of risks in Ireland. If the woman was truly going to die without that transfusion, then any chance of surviving with a transfusion would seem to be better than nothing.
<<

From what I can tell from the one article I read, the decision wasn't made on medical grounds, it was made on social ones ie the woman was kept alive because there was no-one else to care for her baby.


<<
>>"Yes, I think it is fairly clear that the woman was not delusional and made an informed choice about her healthcare that was totally ignored by the hospital and the courts. This is a serious breach of her rights, and I agree the principles being affected here are global."

At what point does saying "I believe in an invisible being who wants me dead and my child motherless" become a delusion?
When it's not claimed to be a religious viewpoint?
When it's not shared by enough other people? (How many *is* enough?)
>>

This is beyond arrogant. What you are saying here is that you, on the basis of your anti-religious prejudice, should determine someone's mental competence. Mental competence is a highly valued concept, and the people that lose the legal right to their own competence are hugely disenfranchised. You seem to treat this very lightly, but legal loss of mental competence is a terrible thing. If you can't understand the women in question, try imagining something abhorrant being done to your body against your will.

I actually find it pretty offensive that you think you have the right to determine this woman as delusional. Psychiatrists, those trained specifically in the medical science you worship, get this wrong surprisingly often. What makes you think your common view is useful or valid?

It's also offensive to the many people who have been deemed delusional incorrectly. The fact that you twist the woman's beliefs to fit your own prejudices shows the worst kind of prejudice which is why we generally have pretty hefty individual rights legislation (to protect people from others who think their own views are only valid ones).

az: In the case of minors, I do think it's right that the state steps in and provides them with the exact emergency life-saving medical care they need, as these children are not able to make this sort of decision on their own and should not be subjected to their parent's decision based on a religious belief that they may not end up holding themselves later on in life.


That's the real sticking point, isn't it? It is a very tough one. Personally, having had to go through the trauma of a very ill child, I cannot imagine having the 'faith' to refuse anything that might remotely help. In retrospect, unfortunately for my child, I made the wrong decision with regard to her health.

In our case, it was classic mistreatment from the outset. She had a very high fever for several days, was seen by three different sets of doctors: GP, casualty and home visit doctors. All of whom got it wrong. She was diagnosed with tonsillitis, food poisoning and meningitis. She screamed and vomited for two weeks, all told, in absolute agony, with fever, losing a third of her body weight. Our GP told us to give her Nurofen and send her to school. The NHS Direct said to alternate with 7 doses a day of Nurofen and Calpol.

The day I saw her face drop (Bell's palsy) we rushed her to a private hospital because we had run out of options and were pretty much panicking. Before taking blood, she was pumped full of antibiotics and two days later she was operated on to insert a grommet. For a year she was seen every month by this consultant - privately - and we can ill afford it, as you can imagine.

A year later, we had an odd episode where she got something up her nose that needed removing - her doctor was so horrible to her when she was too frightened to let him near her with a fully and visibly brandished foot long sharp instrument (she was 6), telling her she would need another operation then, that it took me and her father days to calm her down. In the end, it was a local nurse at a minor injuries unit who got it out - told her one day she would sneeze and shoot someone by mistake

During this time she was having such an awful time at school, and failing rather miserably so we moved her to a new school. Within days her teacher called me in and said there was something very wrong. We had ed.psych assessments done - including occupational therapy and speech therapy, eye test and a hearing test (the advice was to go to a different doctor).

Our little girl was fine - except she had profound sensorineural deafness in one ear but apparently that was OK too because she had taught herself to lipread

Because so much time has passed, we have no idea what caused it. The theory is that it was shingles in the ear: Ramsay Hunt Syndrome, but the doctors are arguing about this because a key set of symptoms were absent.

So, she was pumped full of antibiotics when she had a viral condition. She was operated on unnecessarily. Noone picked up on the fact the child had become partly deaf. We have a year's worth of bills for (specifically) audiology reports. A year, 12 tests. Noone noticed. How does that happen in Britain today?



So, no thanks, I will never again blindly follow a doctor's advice, I don't think.

And unfortunately cases such as yours are not rare Wilma

I don't understand why, given what we know about disease and antibiotics (the problems of overprescribing, side effects, resistance etc), that antibiotics are still routinely prescribed before a definitive diagnosis is reached.

Most people would be shocked by the rates of iatrogenesis too.

I don't mean to hound, and I am sorry I am having such a violent reaction to this thread - despite the fact that I am throughly enjoying it - cathartic...


>> Wilma: "It also behooves to remember where this woman comes from. Congo as in DRC, as in previously Zaire, the French colony? The same France that had the HIV contaminated bloodbanks? The same Zaire where HIV erupted first? The same Congo now decimated by AIDS."

Potholer: Well, I'd have thought it was the job of the Irish doctors and courts to decide what to do *now*, on the basis of the current knowledge of risks in Ireland. If the woman was truly going to die without that transfusion, then any chance of surviving with a transfusion would seem to be better than nothing.

Again, with respect, potholer, that doesn't work.

1. Hundreds of French haemophiliacs became HIV positive during the 80s.

2. There is an alleged/disputed timeline for the HIV virus. HIV is a simian virus, much like the SV40. Now, worldwide, it has been admitted that the cancer-causing (in humans) SV40 was distributed into he human population through the polio vaccine in the 50s (the culture was grown on monkey cells). In the time time, there was a huge polio vaccine drive in Africa - to eradicate the killer polio... The Rotary backed this to the hilt. HIV first broke out in Zaire, where there were many Haitian expats living. For political reasons they were thrown out (like the Asians in Uganda etc) and ended up in: France, Haiti and California (the largest Haitian community is in San Francisco). A big long sequence of coincidences? Many people who are collating figures and trends of the exponential growth of HIV duing the 80s dispute that most vigorously.

It is a question of trusting that your public health worker has the pertinent information to hand - and care enough. My priority is not to live along life, it is to live a functioning and productive and dignified life. I have every right to this aspiration. No docotr, court or public health policy maker has the right to override my choice for myself.

Nor do they have the right to choose to end a life when it is not yet conclusive when life begins or ends. It has to be a personal choice.m Be it abortion or euthanasia or pulling out the feeding tubes. Everyone should have a living will, imo.