Does the right to religion override a medical facilities right to cease treatment?
On the first of June, 12 year old Motl Brody was admitted to Children’s National Medical Center in Washington after undergoing brain surgery for his progressive brain tumor. He never regained consciousness. For the past few months, he has been living on a ventilator, his brain activity slowly decreasing and on November 4, was declared legally brain dead by the hospital. His family though, members of a Hasidic sect of the Jewish community, refused to allow the hospital to take Motl off of life support, believing that he was not dead until his heart and lungs stopped functioning. They filed for an injunction to stop the hospital from acting against their wishes and discontinuing treatment. The hospital stated that Motl had ceased all functions- even more so than Terri Schiavo or Karen Ann Quinlan, the two precedents used- and wanted to exercise their right not to treat the boy any longer. The case was scheduled to be heard last Wednesday, but was postponed because of Motl’s deteriorating health which he finally succumbed to on Saturday the 15th.
The hospital, in its original arguments, declared that it had taken several steps to accommodate the family including seeking out a place that could sustain a child on life support until the family was ready and even encouraged the family to take the boy home where he could pass in peace. The parents, however, refused, stating that the movement could be detrimental and was against their religious beliefs it could ultimately bring about their son’s death. The hospital also pressed for more tests to be done on the brain to truly establish that all functions had ceased, but the family would not agree to this either because of their belief in death based on heart and lung function and not brain. It is undisputed that Motl Brody’s heart and lungs were only functioning because of the drugs being pumped through him to maintain blood pressure and the machine breathing into his body.
So, who has the right to decide- the parents or the hospital? Are resources more important than religion?
Parental rights take all to me, and since those are based in religion, religion must be protected. The parents held a belief that they could not morally stop treatment under the eyes of God and told the hospital no. That is essentially all I need to know. It was their child and thus their right to decide when to “pull the plug”. There is a reason for the current process of telling the family there is no hope and leaving it with them to sign or not and if the court is going to override their decision, what is the point in asking at all? From a religious standing alone, this country is based on the respect of beliefs (theoretically), not only when it is convenient or unanimous, but in times such as this where two different communities believe two very different things. It is not within the power of the medical institution to override religious belief. (But I think the larger issue is parental rights)
In regards to the idea of wasting resources (one of the hospital’s motivations for wanting to take the child off life support), someone is going to pay for those services and it is not part of the Hippocratic oath to base your decisions about harm off of monetary standings. If the parents believe their child is alive, you are killing them by removing the tube and that violates what we currently accept as the no harm standard.
Had this case been played out fully, I would hope that the court would rule in favor of the family because this is an overstep of the hospital and a clear instance where the religious freedoms of the nuclear family need to be protected.
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I completely agree with Brittanie P’s assessment of this decision. The family has obviously based their decision on established religious beliefs, and as such those beliefs should be respected. Hasidic Jews live by a unique interpretation of Jewish law, which for them clearly dictates certain courses of action. It was wrong of the hospital to use the Terri Schiavo case as evidence for “pulling the plug” because the Terri Schiavo case was not centered on a religious issue. If the boy’s bed was needed for other patients, the hospital should have tried to arrange for the boy to return home with hospice care or be moved to another wing. In addition, it was undoubtedly obvious to the staff that this boy’s family was Hasidic. They should therefore have checked with the family or a Hasidic rabbi about religious restrictions on medical treatments before they put him on life support. To attempt to coerce the family into taking an action that, according to their religious beliefs, is a form of murder, is absolutely unacceptable.
I understand that parent's rights are very important but I do have a problem with the fact that the hospital made it clear that the boy was brain dead and there was no chance of the child returning. The hospital did try to move the child to they home but the parents said that it was detrimental that he stayed in the hospital. I do not understand what the difference was if he was brain dead. I also question how the child died on Saturday the 15th if his lungs and heart were kept pumping due to medications. Did the doctors start to take him off of medications? If that was the reason the child finally died that is a different issue that needs to be brought up. Yes, religion plays into the parents decision but the child's welfare should be the most important aspect at stake.
This is a very interesting case and I also agree that the hospital should respect the parents' decisions about their son, even if they are religious opinions. However, the situation becomes more complicated if a family wants to keep their child on life support but do not have the resources to. I don't think the state should pay for that, but it definitely puts people in a really difficult position.
While I don't necessarily disagree with Brittanie's conclusion, I would like to address the resources issue she brought up a little more. I think that Kaitlyn brings up a good point regarding payment for services. If the family (or their insurance carrier) is willing to foot the bill to keep their son on life support, then their should be no problem with this. It is a simple exchange of goods and services.
On the other hand, if the state is paying for it, the issue takes on a different nature. In this case the focus shifts from the personal world of the family to the larger view of the hospital. Brittanie claims that monetary decisions should have no impact on medical decisions. This is clearly not the case. As much as physicians try to ignore this, it is very true that hospitals are very much a business, and as such seek to generate profit. Furthermore, profitability aside, I would suggest that deciding how to allocate their (scarce) resources has everything to do with the Hippocratic oath. Using resources for one thing carries with it an opportunity cost--the value of the next best alternative, which in this case is saving others lives. Some may raise objection to the notion of placing a value on human life, but as an economist I am comfortable with this language, as I recognize that we implicitly do just this with a variety of actions. Anyway, from the hospital's point of view, spending $2 million on a hopeless case when that money could have saved two other lives clearly "does harm" from an overall societal point of view.
I say this to suggest that this issue is more nuanced than it was originally made out to be. Monetary decisions cannot simply be divorced from medical ones.
The parents or whoever has power of attorney are the only people who should decide when a patient should be taken off life support. It only furthers the issue that the family had a religious reasoning behind it. If they believed they could not give up until Motl's heart stopped beating, then neither should the hospital. I agree that it would probably be best for everyone if the child was moved home instead of remaining in the hospital. Like the Brody's, if a family chooses to keep a child on life support, many options need to be discussed. This becomes an economic issue to me; because the Brody's used religious reasoning, as well as the negative prognosis, the family should shoulder the cost of the continued hospitalization. The individual with the power of attorney, or through the wishes of the patient, should be the only one to decide how to determine this issue. It seems more humane to me to end the fight instead of relying on machines. The posts seem to make this more into a religious issue than it really was represented by the original article.
This Washington Post article is a little more revealing. In fact, the hospital DID try to arrange for the boy to be moved to hospice, but his parents said that it was too close to Yom Kippur; no other hospitals in the area would take him as a transfer, either. Attorneys for the hospital claimed that the parents had not visited the boy since late July, but I’ll give the parents the benefit of the doubt on that one.
I think that Andrew makes a profoundly insightful point regarding opportunity cost and the Hippocratic oath, but he cheapens the moral issue here by giving it a monetary façade. Other articles make it clear that the parents are paying, but one hospital attorney “said the past few weeks had been difficult for staff members, who are already stretched caring for other children in intensive care.” Along the lines of Andrew’s thinking, the distribution of paid staff hours could have been more effectively distributed if treatment ultimately was not “saving” Brody’s life. I agree that, if we place monetary value on human life, and doctors had devalued Brody by declaring him dead, treating him is then a very poor investment of resources. At the same time, if the goal is to maximize the number of lives saved, why assign life monetary value when it has intrinsic value? A patient who dies during a risky procedure earns the hospital no less money than one who lives through the same procedure (barring a malpractice suit); yet the surgeon is always going to prefer that his patient survives.
I have a problem saying that parents should always, without fail, be the sole decisionmakers in withdrawal of life support. Obviously parents have a huge personal stake in the well-being and survival of their children; sometimes this may appear to go too far, and the Brodys clearly have difficulty in letting go. When possible, religious beliefs—but more fundamentally, the wishes of the parents/family—should absolutely be respected and accommodated. However, if the lives of other children were being put at risk by keeping Brody on life support (which may be the case), what about the rights of the other children’s parents? The physician is the clear intermediary, and hospitals have an obligation (and a right, I think) to manage their resources responsibly.
It is very disturbing, however, to see how the hospital handled the situation, and I will leave it to others to interpret as they see fit: Kenneth Rosenau, an attorney for the hospital, said Brody had "ceased to exist. What we have left is not a human being."
I dont quite know where to stand on this issue. On one hand, I think the parents absolutely have the right to life of their child. The state also handles cases of children differently than adults though. The child's welfare is being taken into consideration here because he's not capable of making legal decisions on his own. I did a post earlier in the semester dealing with parents refusing to give their child medical treatment and he ended up dying and the parents were charged. It was their religious belief that he not receive treatment even though he may die. Is there a parallel? I think so. Does the court have to make decisions as to what's best for children in the case of religion cases where treatment may be denied or the right to life may be actually the worst thing for that practically dead child to "experience". ??
I think it is the parent’s right to keep their child on life support for as long as they want. Nonetheless, it is important to note that a person can be kept “alive” on life support for a rather long time. Giving medication and having a feeding tube can easily enable the body to keep “functioning.”
In this case, I think it is unfair to the child to keep him on life support. There is no chance for the child to make a recovery according to the doctors. I think the parents really are just having a hard time letting the child go, which is understandable because they are parents.
Most commenters and the original poster seem to agree that the parents should have the final say. I disagree for two reasons:
(1) The hospital was complaining about a shortage of resources, which seems to imply an abundance of patients. Why should the hospital be keeping "alive" a dead boy, versus some other patient who actually has a chance of surviving? This is what I have the biggest issue with. Even if the parents are paying, they might be harming some other patient's health or life.
(2) This is a conflict between a religious definition of death and a clinical one, and I'm not sure I believe their interpretation of death. What did the Hasidic Jews do before there were these machines to keep people alive? Surely they didn't have brain-dead children whose hearts beat for days or weeks. Why should it be any different today, if we know the kid is never coming back?
While I agree with Brittanie that this is more of a parent decision I disagree with the general tone of most of the responses.
Is no one concerned about parents - religious or not - telling doctors what is best for a patient? Hospitals have a job - to help the hurt. This boy is brain dead and he would never recover. To force the hospital to make room and use equipment, drugs, blood and personnel to artifically keep his heart pumping is drainning all those resources from a living person who needs help.
If a parent does not want his child to receive a heart transplant that would save the child's life, the doctor should not have to get the approval of a parent to treat a critically wounded child. On the opposite side, a parent should not be able to force a doctor to expend resources 'treating' a brain dead child.
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