MINOR CHILDREN UNBORN CHILDREN PARENTAL OBLIGATIONS ADULT CHILDREN
BLOOD TRANSFUSIONS & MATURE MINORS
___________ SOME AMERICAN COURTS HAVE LEGALLY DESIGNATED JEHOVAH'S WITNESS TEENAGERS AS SO-CALLED
"MATURE MINORS" WHO MAY CHOOSE TO DIE RATHER THAN ACCEPT A BLOOD TRANSFUSION
The law in the United States regarding Jehovah's Witnesses and their refusal to permit blood transfusions is somewhat settled and fairly simple in most cases. Legally competent adults have the constitutional right to refuse to permit a blood transfusion, even if such refusal means they will die. Every year, many Jehovah's Witness adults in the United States exercise their constitutional right to choose death rather than permit a life-saving blood transfusion. Presently, for every account of such death that is reported by the news media, there are numerous cases that go unreported due to tightened HIPAA confidentiality rules that restrain medical and hospital staff from reporting the fact that a death was due to the deceased's (or guardians's) refusal to permit a life-saving blood transfusion.
Recently, a few ignorant and half-witted courts have legally declared a Jehovah's Witness Child who was nearing the age of majority to be a "mature minor", thus granting that child the same legal authority to refuse life-saving blood transfusions that is held by adult Jehovah's Witnesses, so that the child could die as a martyr for the WatchTower Cult. How do those same courts automatically rule that preteen and younger children of Jehovah's Witness Parents are incapable of making their own medical decisions, but then turn around and reason that older Jehovah's Witness Children -- who have been completely brainwashed their entire life with inaccurate anti-transfusion propaganda, PLUS have been taught that consenting to a blood transfusion constitutes automatic "resignation" out of the Jehovah's Witness religion, which in turn requires their entire JW family and the entire JW community to SHUN them -- have the legal competence, or "maturity", to refuse to permit a life-saving blood transfusion.
Granting children the legal authority to countermand the best advice and practices of professional health care providers rarely if ever results in positive outcomes. After all, there have been no court cases where children of Jehovah's Witness Parents have requested to be declared "mature minors" so that they could circumvent their Jehovah's Witness Parents' refusal to consent to blood transfusions. "Mature Minor" judicial legislation essentially grants children reared within the WatchTower Cult the legal authority to commit "backdoor suicide" and become a WatchTower Cult martyr.
The case summaries below deal with this "mature minor doctrine"
issue. Readers interested in the MATURE MINORS ISSUE
, and its legal arguments, should also read the MARTIN
case summary located on our SCHOOL
webpage. In that case, where a 15 year-old JW sued his JW Parents to stop home schooling him, the JWs argued to that Court the exact opposite side of the coin that they argue in blood transfusion cases where their child will die. In the Martin
case, the JWs argued that an intelligent, mature 15 year-old should not be permitted to make his own decision as to whether he should attend home school or regular High School. Seems that JWs consider what school their children attend is more important than whether their children live or die.
IN RE SHEILA W. was a 2012-13 Wisconsin case. In 2012, a 15 year-old Wisconsin Jehovah's Witness female was diagnosed with aplastic anemia, a life-threatening illness in which a person's immune system attacks the person's bone marrow. She was treated at the University of Wisconsin Hospital, in Madison, where her doctor said she would die without blood transfusions. Sheila and her JW Parents refused to consent to the life-saving blood transfusions. Interestingly, the JW Teen told a Dane County circuit judge that a life-saving blood transfusion would be "devastating to me mentally and physically," and was "the equivalent of a rape", which is the standard WATCHTOWER BS LINE that most JWs state during such court hearings. Dane County filed a petition that led to the appointment of a guardian for the girl, who then approved the needed blood transfusions, which were administered in March 2012. In June 2013, the Supreme Court of Wisconsin declined to rule on the issue declaring this particular lawsuit to be moot due to expiration of the guardian appointment.
SAN JOAQUIN COUNTY HUMAN SERVICES AGENCY v. MARCUS W., a Minor was a 2010 California appellate court case. In October 2008, Marcus W., an African-American 16 year old Jehovah's Witness who suffered with sickle cell anemia, was ordered by a California Juvenile Court to undergo periodic blood transfusions for a term of one year to prevent him from suffering a third stroke, and possibly death. Marcus W. and his Jehovah's Witness Parents opposed the transfusions as contrary to his WatchTower beliefs, and appealed the Juvenile Court order. In June 2010, the California Court of Appeals reversed the JC order, despite the fact that it expired in November 2009, explaining:
We conclude the juvenile court lacked jurisdiction to issue the order because the requirements of Welfare and Institutions Code section 369 were not met. (Further section references are to this code unless otherwise specified.) Thus, we need not address the minor's other claims of error.
As we will explain, section 369 provides the juvenile court with jurisdiction to order the performance of necessary medical care for a minor only when (1) the minor has been taken into temporary custody pursuant to section 305, or is a dependent of the court pursuant to section 300, or is named in a petition filed to declare the minor a dependent of the court, (2) a licensed health care professional recommends that the minor needs medical, surgical, dental, or other remedial care, and (3) the minor's parent, guardian, or person standing in loco parentis is unwilling or incapable of authorizing such care.
Here, the minor had not been taken into temporary custody pursuant to section 305, the San Joaquin County Human Services Agency (the Agency) had not filed a section 300 petition to declare the minor a dependent child of the court, and the minor had not already been adjudicated a dependent child of the court. Thus, the juvenile court did not have jurisdiction to order the minor to undergo blood transfusions against his will and over the objection of his parents.
Why did the San Joaquin County Human Services Agency fail to follow proper legal procedure? This court further explained that the Agency and even the local court simply had been kowtowing to the WatchTower Society:
The Agency makes the policy argument that the filing of a section 300, subdivision (b) petition should be excused because such a petition "with its stigma of parental abuse or neglect [has been] found to be offensive to the parents of Jehovah's Witness children and even to the medical professionals seeking the order for the transfusion," and has caused "additional emotional trauma during a time of stress for the family." The Agency states that, in the "early 1990s," the Hospital Liaison Committee for Jehovah's Witnesses in Stockton asked for implementation of a "system by which medical professionals seeking authorization for a court order for blood transfusions could obtain an order without a "300b" petition being filed, but while still providing ... full due process of a hearing before the Judge who would make the order." After "consultation with the Juvenile Court, [such] a system was created" and was later used in this case.
The problem is that, although well intended, the "system" created in San Joaquin County does not comply with the statutory scheme and results in a juvenile court acting without subject matter jurisdiction.
Apparently, this JW Family was encouraged to pursue this belated appeal in order to make yet another attempt to get the California Courts to reconsider their yet-to-date refusal to adopt the "mature minor" doctrine. This appellate court stated:
The minor and his parents filed opposition to the application, requested an evidentiary hearing to determine whether the minor is a "mature minor possessing the competency and the responsibility to make his own medical decisions," and asked the juvenile court to dismiss the application "on the basis that [the minor] is a mature minor with the capacity of giving informed consent."
Counsel for the Agency responded that, while some states have recognized a mature minor doctrine, allowing sufficiently mature minors to make their own medical decisions, such a doctrine "has not been recognized in California." Indeed, argued county counsel, the fact the Legislature has enacted specific statutes allowing certain minors to make their own medical decisions' e.g., emancipated minors (see Fam. Code 7050, subd. (e)) and minors seeking medical care related to sexually transmitted diseases, treatment of drug or alcohol abuse, and mental health care (see Fam. Code, 6926) indicates "the failure to enact a broad `mature minor' statute is not an oversight, but rather an intentional limit on the rights of minors to make their own health care decisions." Accordingly, county counsel asserted, "until such time as [the minor] reaches the age of full and legal discretion, the court [should] exercise its interest as parens patriae, to [e]nsure that [he] gets appropriate treatment."
At the hearing on the application, the minor's attorney conceded "California does not have a mature minor doctrine," but disagreed with county counsel's assessment that the specific statutes allowing certain minors to make their own medical decisions in certain situations indicated the Legislature intended to preclude the courts from straying outside the confines of these provisions in recognition of a broader mature minor doctrine. In the alternative, the minor's attorney argued that the juvenile court should hear from the minor, "as [a] due process measure," to allow him to express his feelings concerning the blood transfusions.
WASHINGTON STATE'S CONSPIRACY OF DEATH
IN THE MATTER OF DENNIS LINDBERG
was a 2007 Washington state trial court decision which involved a 14 year-old newly converted Jehovah's Witness Child named Dennis Lindberg. Dennis Lindberg was first diagnosed with leukemia on November 8
, 2007, at Seattle's Children's Hospital. Lindberg's legal guardian, a Jehovah's Witness Aunt named Dianna Mincin, refused to allow Dennis to have blood transfusions made necessary by chemotherapy. After only two treatments without accompanying blood transfusions, Dennis developed anemia and an enlarged heart, so chemotherapy was stopped.
UNBELIEVABLY, neither doctors nor administrators at Seattle's Children's Hospital attempted to obtain court intervention. In fact, Washington CPS was not contacted by a Children's Hospital social worker until November 21, 2007.
UNBELIEVABLY, Washington CPS determined that Lindberg had a 75% chance of survivability with chemotherapy, but decided that it would NOT intervene, but rather would leave the matter in the hands of Children's Hospital.
On November 26, 2007, the Salvation Army and Lindberg's out-of-state biological father contacted CPS and inquired why CPS was doing nothing. INTERESTINGLY, Washington CPS then got on the ball and filed for court intervention.
On the morning of November 27, 2008, a commissioner's hearing was held, and a full hearing before Superior Court Judge John Meyer was scheduled for that afternoon. Dr. Douglas Hawkins testified that Lindberg still had a 70% survival rate if treatments were re-started immediately, but that without further treatments, Lindberg might not last another day. In fact, Dennis was already unconscious. HOWEVER, Dr. Douglas Hawkins also testified that he and the other doctors at Seattle's Children's Hospital believed that 14 year-old, eight-grader, Dennis Lindberg was a MATURE MINOR, and that they supported Lindberg's right to refuse life-saving blood transfusions.
Despite the obvious urgency of the situation, Judge John Meyer decided to put off his decision until the next day. On the afternoon of November 28, 2007, Judge John Meyer ruled that 14 year-old, eighth grader, Dennis Lindberg was a MATURE MINOR who had the legal right to choose death rather than violate his religious beliefs.
Dennis Lindberg DIED a WATCHTOWER CULT MARTYR only a few hours later that same day.
IN RE BERKLEY ROSS CONNER JR. was a 2006 Oregon appellate court decision. In November 2005, when he was 17 years old, Berkley Ross Conner, Jr. learned that he had lymphoblastic leukemia. His treating physician at the Oregon Health & Science University's Doernbecher Hospital, indicated that, with chemotherapy, Conner had a 75 percent chance of long-term survival, and that Conner might require a blood transfusion in the future to prevent death or serious irreversible harm.
As Jehovah's Witnesses, Berkley Conner and his 46 year-old father, Berkley R. Conner Sr., and his mother, Callie Conner, had religious objections to receiving transfusions of whole blood products. Conner's father signed a form provided to him by the hospital entitled "Transfusion Blood Refusal", on which he indicated that his son is "one of Jehovah's Witnesses and refuse[s] transfusion of whole blood or any of its primary components", although he would condone acceptance of all available "blood fractions or blood alternatives". Just above his signature on that form, Conner's father crossed out the following preprinted paragraph:
"Refusal of Blood transfusion for a minor. As the parent/guardian of a minor child I understand that the doctor(s) treating my child will make every effort to respect my beliefs regarding the transfusion of blood products as indicated above. However I also recognize that my child's physicians have a legal obligation not to withhold therapy they think is necessary to keep my child alive or to keep him/her from serious harm or permanent injury or disability. I understand therefore that, if the treating physician believes transfusion, after evaluating alternative non-blood medical management, is necessary to save my child's life, or to prevent serious irreversible harm, my child may be transfused although every effort will be made to avoid this."
Below that crossed out paragraph, father hand-wrote the following statement:
"Berkley Ross Conner Jr. is a mature minor. Will not condone blood transfusion but will accept [blood fractions and blood alternatives]. Berkley, at 4 months shy of 18 yrs is able to make his own decisions. This statement by parent /s/ Berkley Conner."
Eight days later, on November 22, 2005, Conner's treating physician, along with other concurring physicians at OHSU, prepared a handwritten letter to the local court requesting an ex parte order authorizing them "to be able to transfuse [Conner] with blood products if necessary, in the future, to prevent death or serious irreversible harm." The court granted that order.
The following day, Conner's parents requested and were afforded a hearing. Present at that hearing were Conner's mother, father, and attorney. Conner testified by speaker phone. During the hearing, Conner's attorney explained that "the only real issue here is [Conner's] capacity to make [health care] decisions under the law." Conner's attorney submitted to the court several cases from other jurisdictions that had applied the common-law "mature minor" doctrine in cases similar to Conner's. He also stated, almost parenthetically and with no supporting argument, that "the matter of due process, equal protection, and fundamental fairness would demand that a child that's that close to being 18 should have an opportunity to be heard." The court heard testimony from Conner's father, mother, and from Conner himself, primarily regarding his capacity to make health care decisions concerning blood transfusions and the sincerity of his faith. Specifically, Conner and his parents testified that he was a senior in high school; he had a 3.5 grade point average; he was interested in chemistry and physics; he has spoken at length to the doctors regarding his diagnosis; and he fully understood the nature of his disease and the consequences of refusing a blood transfusion. They further explained that Conner refused the blood products explicitly on religious grounds that he has held since age 10, and that he himself had chosen to be baptized in the church the previous summer.
The juvenile court declined to create and apply an Oregon version of the "mature minor doctrine", noting that its own "obligation is to enforce the laws of this state, and the law in this state is that somebody under the age of 18 is a minor and therefore does not have the legal capacity to make this kind of a medical decision." The court then issued an order stating: "This Court's 11/22/05 order authorizing transfusions if deemed necessary by the attending physicians to prevent death or serious irreversible harm is hereby continued."
On appeal, the Oregon Court of Appeals refused to overturn the trial court decision, or rule on the "mature minor doctrine" issue (thus leaving such to the Oregon Supreme Court -unknown status), stating in part:
"... petitioner makes a variety of legal arguments supporting his contention that a mature minor exception should be applied in the present case. He explains that the legislature has long afforded minors the ability to make health care decisions on certain issues, such as treatment of venereal disease, ... sterilization, ... and abortion... . He points out that other jurisdictions have allowed mature minors to make health care decisions, including refusal of treatment. See In re E.G.,... (1989) (17-year-old Jehovah's Witness with leukemia allowed to make decision regarding refusal of blood transfusion as a mature minor even though the age of majority in Illinois is 18); In re Swan, ... (1990) (minor's stated desire not to remain on life support adhered to); In re Rena,... (1999) ("It is appropriate for a judge to consider the maturity of the child to make an informed choice.").
"Petitioner argues that the federal and state constitutions provide protections not only for adults, but also for minors, ensuring them free exercise of religion and substantive due process. He notes in particular that the Supreme Court has deemed unconstitutional a flat ban on abortions for minors, requiring instead individualized hearings. See Planned Parenthood of Missouri v. Danforth, ... (1976) ...
"Although petitioner raises complex and interesting issues, we do not have occasion to consider them in the present case. ...
"... The court's order authorizing emergency medical care ceased to have any legal effect on petitioner's eighteenth birthday. The present appeal is therefore moot. Appeal dismissed."
The following is an excerpt from the article, Who decides: You or your patient?", from MEDICAL ECONOMICS, December 2004:
If the patient isn't a consenting adult, however, all bets are off. In the case of a minor, most states require you to notify child protection services if a parent refuses vital therapy on a child's behalf. "Most parents base these decisions on religious beliefs," [Dr. Eric E.] Shore says. "I had that situation once with a teenager who had lost a great deal of blood due to trauma. The parents were Jehovah's Witnesses and, since the boy was obtunded, refused transfusion for him. The hospital obtained a court order to transfuse him. Once awake, the boy told us that he didn't believe the way his parents did, and was glad we transfused him."
IN RE MATTER OF "RENA" was a 1999 Massachusetts appellate court decision. "Rena", a/k/a Alexis Demos, of Lenox, Massachusetts was born on October 10, 1981. At the time in question, Alexis Demos was seventeen years old and a junior in High School. Alexis Demos ALLEGEDLY had been a Jehovah's Witness since she was ten years old. A principal tenet of her WatchTower religion was that the act of receiving blood precludes an individual from resurrection and everlasting life after death. Consistent with this belief, Demos had periodically executed a written medical directive declaring that she would not assent to a blood transfusion and last executed such a directive on January 12, 1999. She understood that her refusal might well result in her death in the event of a life-threatening event.
On January 26, 1999, Alexis Demos lacerated her spleen in a snowboarding accident. Demos was taken to Berkshire Medical Center's emergency room. Upon examination, it was determined that in order to keep her blood count at a stable level a blood transfusion might become necessary to keep Demos alive. Both Demos and her Jehovah's Witnesses parents indicated that they would not consent to a blood transfusion. The hospital then filed a complaint for declaratory relief in the Superior Court seeking authority to administer a blood transfusion if the same became necessary to treat her injury. At a hearing, the hospital presented medical evidence that there was a potential need for this authority in the event a blood clot broke loose from the spleen laceration, which might result in a massive hemorrhage, which in turn might require a blood transfusion to sustain her life. At this hearing, the wishes of the parents and those of Demos through her attorney were made known to the judge. Based on the best interests of Demos and the State's interest in the preservation of life and protection of the welfare of a minor, the judge entered a temporary order allowing Demos' physicians to administer a blood transfusion in the event of a life-threatening, traumatic event. At a subsequent hearing, the judge entered a final order authorizing the hospital "to administer a blood transfusion to [Demos] in the event that a life-threatening, traumatic event occurs during her treatment that requires, in the medical opinion of her treating physicians, the administration of a blood transfusion." On the day after the presentation of oral argument at the appellate level, Demos was discharged from the hospital in good health. On appeal, the appellate court vacated the trial court's final order, stating in part:
"The sole issue in this case is whether the judge erred in concluding that the best interests of an unemancipated minor and the State's interest in the protection of a child's welfare and in the preservation of a child's life mandated judicial authorization for administering a blood transfusion to Rena, if, in the opinion of her physicians, a life-threatening event occurred in the course of her treatment. Rena argues that the judge committed error in failing to consider her maturity to make an informed decision in determining her best interests.
"The law is well settled in this Commonwealth that a competent adult may refuse medical treatment even if the treatment is necessary to save her life. ... The law is also clear that when parents refuse medical treatment necessary for the preservation of an unemancipated child's life, a court may authorize the treatment to be administered after weighing the child's best interests, the parents' interests, and the State's interests. ... The best interests of a child are determined by applying the same criteria applicable in substituted judgment cases, namely (1) the patient's expressed preferences, if any; (2) the patient's religious convictions, if any; (3) the impact on the patient's family; (4) the probability of adverse side effects from the treatment; (5) the prognosis without treatment; and (6) the present and future incompetency of the patient in making that decision. ... In assessing the child's expressed preference, religious convictions, and present and future incompetency, it is appropriate for a judge to consider the maturity of the child to make an informed choice.
"The Illinois Supreme Court has determined that the test that should be applied in circumstances such as this is whether the minor is mature enough to make an informed decision. In Re E.G. ... (1989). This concept has been adopted by our Legislature in allowing a judge to authorize a minor to have an abortion without parental consent if the judge determines that the minor is mature enough to make an informed decision. ...
"We recognize that our laws provide no bright line as to when a minor reaches an age to make certain decisions in life. ... An emancipated minor and a minor who is married, divorced, or widowed may consent to his or her own medical treatment, including abortion and sterilization. ...
"Although the judge did consider Rena's wishes and her religious convictions in this matter, he made no determination as to her maturity to make an informed choice. While recognizing and appreciating the obvious conscientiousness of the judge throughout this proceeding, we think this was error particularly in the circumstances of this case where Rena will soon attain the age of eighteen. In addition, in assessing Rena's preferences and religious convictions, he should not have relied solely on the representations made by her attorney and her parents but should have heard Rena's own testimony on these issues where she apparently had the testimonial capacity to answer questions. Only after evaluating this evidence in light of her maturity could the judge properly determine her best interests.
"Because the Supreme Judicial Court has not decided that the State's interest in preserving a child's life will invariably control in every case where State intervention is sought for life-saving measures, ... we ordinarily would remand this case to the Superior Court for an expedited hearing to determine the best interests of the child in light of this opinion and to reassess the three-part balancing test of Rena's best interests, the rights of her parents, and the interests of the State. The hospital has informed us, however, that on the day after the presentation of oral argument in this case, Rena was discharged from the hospital. Consequently, there no longer appears to be an immediate need for the hospital's authorization or judicial intervention in this matter. We, therefore, vacate the final order, not on the merits, but because it has become moot."
NOVAK v. COBB COUNTY KENNESTONE HOSPITAL was a 1996 Georgia federal Court of Appeals decision. Two WatchTower attorneys, Donald T. Ridley and James M. McCabe, represented the Jehovah's Witness plaintiffs in the appeal of this $19,000.000.00 +++ lawsuit.
In June 1989, sixteen year old Gregory Alan Novak was seriously injured in a single auto accident after he fell asleep at the wheel. He was transported by ambulance to Kennestone Hospital, where it was determined that Novak had sustained numerous injuries, including fractures of both legs and multiple lacerations. Novak informed the ambulance personnel at the scene that he was a Jehovah's Witness and that for medical and religious reasons he did not wish to have a blood transfusion. When he arrived at Kennestone Hospital's emergency room, he repeated his wish to have no blood transfusions. Novak said that he was a Jehovah's Witness and that it was against his religious beliefs to receive blood.
Dr. Bradley Henderson, concluded that surgery would be needed to repair Novak's fractured right leg. Novak's father, the only family member on the scene at that early stage, consented to the surgery. Although Novak's father was not a Jehovah's Witness, he did so with the understanding that Gregory Novak not be given blood during the procedure. Gregory Novak's mother, June Lowery Novak, was the custodial parent, and as a Jehovah's Witness, the father knew that she, as well as his son, objected to blood transfusions.
Dr. Henderson believed that Novak could withstand the surgical procedure without a blood transfusion. However, Novak lost a considerable amount of blood as a result of his injuries and the subsequent triage and surgery. By the early afternoon of June 19, he had become severely anemic. Novak's blood count and blood pressure were falling at such a rate that Drs. Henderson and John David Tucker, the general surgeon on the case, after consulting Dr. Richard G. Gray, a hematologist, were convinced that, without a blood transfusion, Novak would likely die. The last blood test on June 19, 1989, was taken at 8:42 p.m. and reflected a Hemoglobin reading of 4.7 (normal range 12.5-15 gm/dl), and a Hematocrit reading of 13 (normal range of 36-46%). However, June Novak rejected,and her son continued to reject, the physicians' recommendations for a transfusion.
At that point, Drs. Henderson and Tucker informed the hospital's management of Novak's condition and of June Novak's refusal to allow a transfusion to save her son's life. After consultation with their attorneys, the Hospital petitioned a local court for assignment of temporary guardianship to determine whether administering blood transfusions were in Gregory's best interests. Because the petition presented a matter that needed immediate attention, Judge Hines considered it within minutes, without notice to Novak or his mother. Judge Hines granted the petition and appointed a guardian ad litem for the limited purpose described in the petition.
The following morning, June 20, Judge Hines telephoned Hospital staff and learned that Novak's condition had deteriorated during the night. Hines went on to convene a hearing in the hospital's intensive care unit where Gregory Novak was confined. Judge Hines handled the hearing himself in that he, alone, examined the witnesses: Drs. Henderson and Tucker, Novak's primary treating physicians, and members of the hospital's staff. The hospital's attorneys, Pedrick and Landers, simply stood by. The physicians testified that Novak's condition was continuing to deteriorate and that, without a blood transfusion, he would probably die.
At the conclusion of the hearing, the guardian ad litem asked the court to order a transfusion. In response, the court noted for the record that June Novak had not changed her position - a blood transfusion would offend her and her son's religious beliefs - but held that her wishes could not be imposed on her minor child given the life or death situation at hand. An order authorizing the treating physicians to arrange for the blood transfusion was therefore entered. The transfusion was promptly carried out, with Gregory Novak receiving three units of packed red blood cells. His blood count improved significantly, and he suffered no untoward effects from the procedure.
Gregory Novak was discharged from Kennestone Hospital on August 2, 1989. He was alive and well, and suffered no medical complications or adverse physical reactions as a result of the blood transfusion of June 20, 1989. After a lengthy recovery period, Gregory resumed normal physical activity for a person of his age, although he temporarily suffered from a slight limp due to the injuries he suffered as a result of his own at-fault accident. In due course, he fully recovered from his injuries.
In June 1990, in gratitude for saving his life, Gregory Novak and his mother, June Lowrey Novak, each filed separate lawsuits totalling $19,000,000.00 against (1) Gregory Novak's treating physicians, Drs. Henderson and Tucker, (2) Dr. Gray, the hematologist whom Dr. Henderson consulted on June 19, (3) the governmental authority that operates the hospital, (4) the hospital's Director of Risk Management, Samuel Bishop, (5) the attorneys, Grady Pedrick and Jerry Landers, who petitioned the Cobb County Superior Court for the appointment of a guardian ad litem, and (6) the guardian ad litem, Robert Ingram. Unspecified punitive damages were also requested. The Novaks' amended complaint contained eighteen counts; some alleging federal constitutional violations, with the remainder alleging violations of Georgia constitutional, statutory, or common law rules.
Incredibly, one of the Novak's main arguments was that no actual medical emergency existed which would have necessitated the administering of a blood transfusion. Even more incredible were their assertions that all of the defendants were part of conspiracy to deprive the Novaks of their religious freedoms.
The Novaks also argued that Gregory Novak was a "mature minor" under Georgia state law, and as such he had the legal competence to refuse a life-saving blood transfusion. The federal district court ruled that Georgia law had no such provision, stating in part:
"Plaintiffs have argued that the state of Georgia recognizes a mature minor's right to refuse medical treatment and that such right is protected from arbitrary denial by federal procedural due process requirements. In so arguing, plaintiffs have cited a number of related sections in the Georgia Code which plaintiffs assert support their position. ... Defendants cite to the very same provisions of the Georgia Code in support of their assertion that Georgia has established a scheme of "bright line" tests for deciding who has the power to consent to and refuse medical treatment. Upon a review of the applicable code provisions and cases construing them, the Court concludes that Georgia does not recognize the right of a "mature minor" to refuse unwanted medical care.
"The general rule is that adults have the power to consent to or refuse medical care on behalf of themselves. ... The age of majority in Georgia is eighteen and prior to reaching that age, "all persons are minors." ... Plaintiffs point to various statutory exceptions to the general rules as support for their position. ... These exceptions allow minors who are married, pregnant or have children the power to consent to medical treatment for themselves, their spouses and their children. Rather than supporting plaintiffs' position, however, these exceptions undermine it. If minors, "mature" or otherwise, possessed the power consent to and/or refuse medical treatment, there would be no need for these specific statutory exceptions. [Note in other decisions on this page how several state courts have fell for the WatchTower's argument.] Moreover, with respect to the right to refuse medical treatment, the Georgia Code's protections are expressly limited to the "right of a person 18 years of age or over to refuse to consent to medical and surgical treatment to his own person." ...
"Plaintiffs have argued that the "mature minor" exception is a part of the common law of Georgia and that any statute in derogation of that common law must be read narrowly. However, they have failed to direct this Court's attention to any reported Georgia case recognizing the exception. Thus, contrary to the position urged by plaintiffs, the Court finds that Georgia provides no "mature minor" exception to its general rule that only adults may refuse unwanted medical care."
The federal district court concluded that the Novaks' federal claims were meritless and gave the defendants summary judgment. Having disposed of the Novaks' federal claims in this fashion, the court dismissed their pendent state law claims without prejudice. The Novaks and the WatchTower Society Legal Department then appealed to the federal Court of Appeals, which affirmed the district court's rulings, stating in part:
"In conclusion, we find no cognizable federal constitutional claims in this record and therefore affirm the district court's grant of summary judgment. We also affirm the court's dismissal of the Novaks' pendent state law claims without prejudice. Finally, because we find this appeal to be frivolous with respect to appellants' claims against Dr. Gray and the hospital's attorneys, we award them double costs and reasonable attorney's fees. Those fees shall be determined by the district court following receipt of our mandate."
IN THE MATTER OF TONY R. BRIGGS was an INTERESTING 1996 Pennsylvania court decision. In May 1996, African-American Tony R. Briggs, age 17, of Wapwallopen, Pennsylvania, suffered a severe head injury in an at-fault two-vehicle accident. Air-flighted to Geisinger Medical Center in Danville, Pennsylvania, Tony Brigg's African-American Jehovah's Witness Parents, JW Stepfather, Charles T. Briggs, age 64, and JW Mother, Betty M. Briggs, age 54, refused to give their consent for needed blood transfusions. Tony Briggs also carried in his own wallet a standardized legal document supplied by the WatchTower Society -- an Advance Medical Directive -- stating that he did not wish to receive a blood transfusion under any circumstances.
Apparently, the hospital indicated that they would administer a transfusion if such became necessary to save Tony Brigg's life, probably because Tony Briggs was still a "minor". Charles T. Briggs and Betty Briggs then petitioned a local court to PREVENT the administering of any blood transfusions. Columbia County Judge Gailey Keller apparently ignored Pennsylvania law and sided with the Briggs Family. Judge Gailey Keller ordered that no blood transfusions could be administered by the doctors at Geisinger Medical Center. INTERESTINGLY, the Briggs Family were legally represented by local Attorney and a former Penn State football hero, Harry Hamilton, who just so happened to be Tony Briggs' step-brother from one of Betty Briggs' previous marriages to civil rights activist Stan Hamilton. Another non-JW step-brother, Charles M. Briggs, publicly expressed his "disbelief" at what the Briggs Family had convinced Judge Gailey Keller to do. Medical outcome unknown. Neither were we able to figure out who was the real father of Tony Briggs.
ON APPLICATION OF ST. JOSEPH'S HOSPITAL was a 1995 Florida court decision. In July 1995, the unidentified Jehovah's Witnesses parents of a 15-year-old girl, who was suffering from ovarian cancer that had spread to her liver and abdominal cavity, refused to give their consent to the administering of blood transfusions that would be needed in conjunction with the needed aggressive chemotherapy. St. Joseph's Hospital petitioned the local Hillsborough County court for guardianship and authorization to administer medically required blood transfusions as needed. Reasoning that the hospital's petition was "not an emergency", and apparently reasoning that the 15-year-old girl was a "mature minor", the judge refused the hospital's petition, and and assigned a court appointed guardian to consult with the girl as to "what she wanted". In the meantime, the Jehovah's Witnesses parents "REMOVED" their daughter from St. Joseph's Hospital and admitted her to Tampa General Hospital, which supposedly set up a schedule of chemotherapy that would not require blood transfusions. St. Joseph's Hospital withdrew its petition. Outcome for teenager unknown.
IN THE MATTER OF LENAE MARTINEZ was the 1993 California decision that was NOT MADE BY A COURT! We know about Lenae Martinez's case only because it was reported in the WatchTower Society's magazine, "AWAKE!". The May 22, 1994, issue of AWAKE! is the INFAMOUS issue which displayed the photographs of 26 children on its' front cover, including children who had died in obedience to the WatchTower Society's "no blood" doctrine. The caption on the front cover read: YOUTHS WHO PUT GOD FIRST!
Under the subtitle "Youths Who Have 'Power Beyond What Is Normal'", the AWAKE! tells the WatchTower Society's version of the death of Lenae Martinez.
Accordingly to the article, Martinez had been admitted to Valley Children's Hospital in Fresno, California, "for what appeared to be a kidney infection."
Accordingly to the article, it was not until after Martinez had been admitted to Valley Children's Hospital that tests revealed that Martinez actually was suffering from leukemia.
Accordingly to the article, when Lenae's doctors told her that she would need transfusions of packed red blood cells and platelets, she told her doctors that she wanted no blood or blood products. Although her parents supported her in this stand, "Lenae stressed that it was her decision and it was very important to her." ... ... ... Even though they didn't like my stand, they did say I was a very mature 12-year-old."
Accordingly to the article, "... Then two doctors and a lawyer came, told Lenae's parents that they wanted to talk to her alone, and asked the parents to leave, which they did. Through all this discussion, the doctors had been very considerate and kind and were impressed with Lenae's articulate way of speaking and her deep conviction."
Accordingly to the article, the two doctors and the lawyer did their best to change Lenae's mind, but Lenae witnessed to them from the Bible. Lenae refused to change her mind.
Accordingly to the article: "The doctors and the lawyer were visibly impressed. They commended her and went out and told her parents that she thinks and talks like an adult and is able to make her own decisions. They recommended to the ethics committee of the Valley Children's Hospital that Lenae be viewed as a mature minor. This committee, made up of doctors and other health-care professionals, along with a professor of ethics from Fresno State University, made the decision to allow Lenae to make her own decisions with regard to her medical treatment. They considered Lenae a mature minor. No court order was sought."
Lenae Martinez died shortly thereafter, on September 22, 1993. Interestingly, Lenae Martinez was not the first child of Jehovah's Witnesses parents to die at Valley Children's Hospital. Just 22 days earlier, on August 31, 1993, 17 month old ELIANA HERMOSILLO, of Modesto, California, had also died at Fresno's Valley Children's Hospital. Hermosillo's death was reported as caused by complications brought on by her injuries from a August 1992 accident. Hermosillo was initially treated for her August 1992 injuries at a Modesto, California hospital, which had obtained a court order to administer blood transfusions.
Am I the only one who wonders whether Hermosillo died a year later because Valley Children's Hospital had agreed to perform followup surgery without the option of administering blood transfusions?
Am I the only one who wonders whether Valley Children's Hospital had decision-making staff who were Jehovah's Witnesses? Or, if not, whether there was some other connection, agreement, or relationship with the WatchTower organization?
In April 1996, emergency room doctors and administrators at Lowell General Hospital, in Lowell, Massachusetts, allowed 17 year-old Juan Baez to make the decision to die rather than accept a life-saving blood transfusion.
That despite the fact that the boy's Jehovah's Witness Family even stated publicly that Juan Baez was not even an active Jehovah's Witness. And despite the fact that Juan Baez had just committed assault and possibly battery. Juan Baez's Jehovah's Witnesses Family and JW Friends described the 17-year-old as "easy-going", and "not quick to anger". Yet, Juan Baez had just been dragged to the point of death after he confronted another driver in a parking lot during a road-rage incident. When Baez pushed his entire upper torso into the other driver's car, that driver sped off dragging Baez 170 feet before Baez was clotheslined into a parked vehicle.
Juan Baez's Jehovah's Witnesses parents and siblings rushed to the hospital, where they supported him in his decision to refuse consent to blood transfusions. Obviously proud of their family member who up until then had apparently rejected the family's WatchTower beliefs, the Baez's brother, Fernando Baez, boasted that Juan had first refused blood transfusions while in the ambulance on the way to the hospital. Sister, Sylvia Baez, boasted that once arriving at the hospital, Juan refused a blood transfusion that might have saved his life, stating: "Even if I die, ... ." Fernando Baez further stated: "He knew the injuries were bad, and then the doctor said he wasn't going to make it. He told us that he loved us, and we told him that we loved him, too, and would be there for him."
IN RE ANGELICA NIEBLA, IN RE ANGELICA NIEBLA, IN RE ANGELICA NIEBLA, and MARCELINO NIEBLA and MARIA NIEBLA v. COUNTY OF SAN DIEGO were a series of California court cases involving a Jehovah's Witness Family taxing the Califonia court system. Angelica Niebla and her parents, Marcelino and Maria Niebla, were Jehovah's Witnesses. Born in 1974, Angelica had an unspecified medical condition, which on at least two -- probably more --occasions had required local courts to authorize the administering of blood transfusions to save Angelica Niebla's life.
In October 1986, twelve year old Angelica Niebla was hospitalized with a falling blood count. On October 13, following a doctor's request, a social worker from San Diego County obtained an ex parte custody and transfusion order over the telephone from the Juvenile Division of the San Diego County Superior Court. No blood was transfused. The next day, the juvenile court took testimony from Angelica's parents regarding the family's opposition to blood transfusions. The court left the blood order in place and continued the hearing. On October 21, the court withdrew the order because blood had not been transfused and Angelica's condition had improved. On December 10-11, the juvenile court held a trial on the medical neglect petition the county had filed against Angelica's parents. Angelica, her parents and Angelica's attending physician testified. The court dismissed the petition. In the course of that proceeding, Angelica's attorney urged the court to find that twelve year old Angelica was a "mature minor" capable of determining her own medical care in the future. The court refused to make that finding.
In 1989, a similar scenario repeated - county social workers successfully sought emergency, ex parte orders authorizing blood transfusions -- but details are not available.
Thereafter, the entire Niebla clan filed a federal lawsuit against the County of San Diego claiming various violations of their civil rights under both the U.S. and California Constitutions. The federal district court dismissed the federal claims, and remanded the pendant state claims. In 1992, the Court of Appelas affirmed. Outcome of state claims unknown.
Angelica Niebla died of unknown causes on May 15, 1996, at the age of 23. It is unknown whether she finally, as an adult, exercised her right to refuse a life-saving blood transfusion.
IN RE LAKESHIA LEGETTE was a 1991 Florida court decision. In July 1991, unwed 16 year old African-American Lakeshia Legette, of Boynton Beach, Florida, gave birth by cesarean section at Bethesda Memorial Hospital to daughter Brittany LaShond Johnson. Due to excessive blood loss, Lakeshia Legette was in critical condition. Doctors informed Lakeshia Legette, and her mother, Gwen Legette, that Lakeshia would need a blood transfusion to save her life. However, the Legettes informed the hospital that they were Jehovah's Witnesses, and that it was against their Bible beliefs to allow someone else's blood to be put inside their body. The hospital then sought and was granted an emergency court order to administer the life-saving transfusions.
This particular case is extremely interesting given Lakeshia Legette's status as a new mother. This case would have been a good one for WatchTower Legal to appeal to the extremely LIBERAL FLORIDA APPELLATE COURTS on the "mature minor" question. If any sixteen year old could be labeled a "mature minor", would not a sixteen year old "mother" have been an excellent candidate? I wonder why WatchTower Legal did not jump all over this opportunity?
IN THE MATTER OF JOSHUA M. GALLAHER was a 1991 Colorado court decision. In April 1991, Joshua M. Gallaher, a 17 year old Denver teenager, was accidently shot in the stomach at his Denver home, when he and another Jehovah's Witness teenager were playing around with a firearm. When Joshua Gallaher arrived at the hospital, he informed doctors that he and his family were Jehovah's Witnesses, and that he did not want any blood transfusions. Joshua Gallaher's parents later backed his decision. The hospital then proceeded to petition the local court for authorization to administer the needed transfusions. During the three hour hearing, Joshua Gallaher's unidentified parents continued to refuse to consent to the transfusions, and IRONICALLY the Jehovah's Witness Parents raised the argument that Joshua Gallaher was a "mature minor" who was legally competent to make his own health care decisions. The judge disagreed, and granted the hospital's petition.
PHILLIP MALCOLM v. LONG ISLAND JEWISH MEDICAL CENTER was a 1990 New York court decision. In April 1990, Theodore Venable and Joan Venable took their step-son, Phillip Malcolm, to Long Island Jewish Medical Center, where preliminary tests indicated that Phillip Malcolm was suffering from anemia, and that his blood was being broken down and that in all likelihood he would require a blood transfusion. However, Phillip Malcolm and his parents were Jehovah's Witnesses, a religious group whose tenets forbid blood transfusions, and they all three refused to consent to a transfusion if such became medically necessary.
The following morning, April 12th, the hospital petitioned the local court for an order authorizing necessary medical treatment, including blood transfusions. A hearing was held at the hospital that same afternoon. The treating physician, Dr. Ashok Shende, a board-certified pediatric hemotologist-oncologist, reported that at 7:00 A.M., the patient's blood level was 6.3 grams as against 6.4 upon admission, and his hematocrit was 18.3 as against 19.2 upon admission. The doctor testified that CAT scans of the patient showed an extensive mass involving the back part of the abdomen with fluid on both sides of the chest and that a bone marrow analysis revealed there were malignant cells in the bone marrow. The results of a needle biopsy of the mass were not then available but the patient appeared to be suffering from a pediatric cancer of the tissue that is to become muscle. The recommended course of treatment would be chemotherapy and radiation and, in the doctor's opinion, the survival factor, with treatment, was from 20 to 25%. However, the chemotherapy would further suppress the production of red blood cells and could not be undertaken without authorization for blood transfusions.
Theodore Venable, the patient's stepfather, testified that his religion prohibited blood transfusions and that he believed Phillip would die or be unable to live a normal life, regardless of what was done. He stated that he was unalterably opposed to Phillip receiving any blood transfusions.Joan Venable, Phillip's natural mother, testified that her religious beliefs would not allow her to consent to blood transfusions for her son. Phillip also stated that he would not accept blood transfusions because of the teachings of his religion. Realizing that this was the first time the patient and his parents had heard that Phillip was suffering from widespread cancer, the court deemed it advisable to allow them time to reflect and to reconsider their decision regarding blood transfusions. Accordingly, the hearing was adjourned to the following day.
The first witness was Dr. Philip Lanzkowsky, chief of staff of pediatrics and chief of pediatric hemotology and oncology at Long Island Jewish Medical Center, who was supervising the treatment of Phillip Malcolm at the hospital. He stated that Phillip had disseminated malignant disease. There was a large mass infiltrating the abdominal cavity, with spread to the vertebrae and the area of the right buttock. The cancer had metastasized to the bone marrow and there was also pulmonary effusion in both lungs. Because of the dropping hemoglobin and low blood pressure, blood transfusions would have to be administered before chemotherapy treatment could be undertaken and, during chemotherapy, further transfusions would be necessary. According to Dr. Lanzkowsky, the pediatric cancer from which Phillip was suffering, although widespread, responds to treatment, with 75% of the patients going into remission for a period from several months to years and a cure rate among these patients of 25 to 30%. Without treatment, the patient was certain to die, probably within a month, during which time he would have a great deal of pain. The doctor said there was a need for immediate action. He stated that an unmanageable emergency could arise at any moment and that any delay was harmful to the patient.
In addition to Phillip and his parents, an attorney from WatchTower Society headquarters, plus three Jehovah's Witness Elders, were present at this second hearing. Theodore Venable remained adamant in his refusal to consent to blood transfusions as part of Phillip's treatment. Joan Venable claimed that she did not know the whereabouts of her son's natural father, and stated that she wanted "alternative blood management" for her son, and that she would not consent to transfusions.
The Venable family, which included four children who were younger than Phillip, joined the Jehovah's Witnesses in 1987. Phillip Malcolm testified that he began studying the teaching of the WatchTower Society with his family, and then lost interest for a while, but then returned to religious study about a year ago. He did not know the books of the Bible, which are an important part of the study of Jehovah's Witnesses, but he did appear to understand the basic tenet of the religion's prohibition regarding blood transfusions. He believed that if he followed the teachings of the Jehovah Witnesses that he would have everlasting life, but that if he consented to a transfusion, which is forbidden, he would not have everlasting life. Phillip stated several times, that if the court ordered the transfusion, it would not be his responsibility or sin.
Phillip was in his last year at the High School of Art and Design, where he is studying industrial design. He has never been away from home and has never dated a girl. He consults his parents before making decisions and when asked whether he considered himself an adult or a child, he responded "child" [at which the WatchTower attorney cringed for not having prepared his witness.] There was no evidence that Phillip had been urged by his parents to make his own decision regarding blood transfusions.
At the request of the WatchTower attorney, the hearing was continued until April 16, 1990, to afford them an opportunity to arrange for acceptable alternative medical treatment for Phillip. When the hearing reconvened on April 16th, the patient's hemoglobin had dropped to 4.9 and his hematocrit to 15.0. A biopsy confirmed that Phillip had rhabdomyosarcoma, a form of pediatric cancer of the tissue that is to become muscle. Dr. Lanzkowsky stated that the use of erythropoietin, which had been suggested by the WatchTower Society as an alternative to blood transfusions, was not feasible. This drug stimulates red cell production and it would not be effective in Phillip's case since his bone marrow, which produces the red blood cells, was contaminated with malignant cells. [This is not the only case in which alternatives recommended by the JWs turned out to be inappropriate, and disclosing total ignorance of the patient's medical condition.] The WatchTower attorney did not have a doctor present to testify to alternative medical treatment that did not involve the use of blood transfusions. However, he informed the court that a Dr. Edwin Fondo and a Dr. Stephen Malamud could have the patient transferred to Beth Israel Hospital for such treatment. In attempting to confirm the transfer, the Hospital's attorney learned that Dr. Fondo had been suspended from Beth Israel Hospital. Dr. Stephen Malamud who, upon being PROPERLY informed of the patient's condition, stated that he could not treat him without a blood transfusion.
Having given the Jehovah's Witnesses full opportunity to expose their competence in such a situation, the court authorized an immediate transfusion of 1,000 cc. for Phillip, and entered an order to that effect. The transfusion of the 1,000 cc. of blood ordered by the court on April 16, 1990 was performed in several stages and completed by the following day. On April 18, 1990 the court was notified that Malcolm's hemoglobin count was 10.6 and his hematocrit was 32. Nevertheless, chemotherapy had not commenced because neither Dr. Lanzkowsky at Long Island Jewish Medical Center, nor Dr. Malamud at Beth Israel Hospital would agree to treat the patient with chemotherapy without authorization from the court for blood transfusions if they become "medically necessary" during the course of the chemo treatment.
As a last resort, the WatchTower attorney argued that since Phillip Malcolm would turn 18 on May 30, that this trial court should rule contrary to existing New York law for Malcolm to be a "mature minor", who was legally competent to make his own decisions regarding his medical care. However, the trial judge had no such option, and stated in part:
"It is well-settled law in this, and most other jurisdictions, that a competent adult has a common-law right to refuse medical treatment. ... However, when the patient is a minor, the court must act parens patriae (in place of the parents); because parents may throw their own lives away, if they wish, but they cannot make martyrs of their children.
"Counsel for the patient and his parents posed the following legal question. Does an intelligent, articulate young man, just weeks shy of his 18th birthday, have due process right to demonstrate his capacity to make medical decisions for himself consistent with his values and convictions before he loses the right to control what is done to his body? This concept has been recently adopted by the highest court in Illinois. The Supreme Court of Illinois said, 'If the evidence is clear and convincing that the minor is mature enough to appreciate the consequences of her actions, and that the minor is mature enough to exercise the judgment of an adult, then the mature minor doctrine affords her the common law right to consent to or refuse medical treatment.' Tennessee has also accepted the 'mature minor' doctrine. The Supreme Court of Tennessee noted that the mature minor doctrine is not a recent development in Tennessee law. It stated, 'recognition that minors achieve varying degrees of maturity and responsibility (capacity) has been part of the common law for well over a century.'
"Should one equate the right to consent to medical treatment with the right to refuse medical treatment? If so, there are numerous instances in our State's statutory law that permit minors to consent to treatment for out-patient mental health services; treatment for substance abuse; and treatment for sexually transmitted diseases. In addition, minors over the age of 16 can consent to in-patient mental health treatment. Pregnant minors and minors who are parents are treated like adults for decision-making capacity for their own and their children's health care. ...
"While this court believes there is much merit to the "mature minor" doctrine, I find that Phillip Malcolm is not a mature minor. Therefore, his refusal to consent to blood transfusions is not based upon a mature understanding of his own religious beliefs or of the fatal consequences to himself. It is recommended that the Legislature or the appellate courts take a hard look at the "mature minor" doctrine and make it either statutory or decisional law in New York State."
O. G. v. BAUM was a 1990 Texas appellate court decision which involved a 16 year-old Jehovah's Witness male, identified only as "O. G.", and his JW parents, "P. G." and "M. G.". Details are limited, but apparently, the boy's right arm was severely injured in some type of accident involving a train. Blood transfusions were needed if surgery was to be performed in order to save the child's arm, but both the child and their parents refused to consent based on the family's WatchTower beliefs. Trial Judge Robert Baum appointed Harris County Child Protective Services as temporary managing conservator of the minor, including the authority to consent to a blood transfusion. The JW Parents and Child appealed, but the Texas Court of Appeals noted that Texas had not accepted the "mature minor doctrine", and refused to reverse Baum's decision. Outcome of surgery unknown.
In February, 1990, a 19-year-old Jehovah's Witnesses high school student, named Patricia Knight, died at Drew Medical Center in Los Angeles, Calilfornia, after she refused to consent to a blood transfusion. Patricia Knight had ignored flashing signal lights at a Hawthorne railroad crossing and drove in front of a train. The collision killed Knight's passenger. Suffering from severe internal injuries, doctors told Knight that she would survive if she allowed them to give her a transfusion. Knight refused, citing her beliefs as a Jehovah's Witness. Since the 19-year-old Morningside High School student was legally considered an adult, the hospital allowed her to die. It is unknown if the hospital made any effort to contact a judge in this emergency situation.
IN RE ERNESTINE GREGORY a/k/a IN RE E.G. was a 1989 Illinois Supreme Court decision. WatchTower attorney, Donald T. Ridley, Brooklyn, submitted an amicus curiae brief on behalf of the Watchtower Bible and Tract Society of New York, Inc. Evidently, this case was "set up" to establish the "mature minor doctrine" in the state of Illinois. The trial judge had no choice but rule against E.G. given existing Illinois law, but it appears that that judge got into the trial record everything the Supreme Court needed to overrule his decision and establish the "mature minor doctrine" in Illinois.The trial judge concluded his ruling by encouraging E.G. to appeal.
In February 1987, E.G, a 17 year old child, was diagnosed as having acute nonlymphatic leukemia, a malignant disease of the white blood cells. When E.G. and her mother, Rosie Denton, were informed that treatment of the disease would involve blood transfusions, they refused to consent to this medical procedure on the basis of their religious beliefs. As Jehovah's Witnesses, both E.G. and her mother desired to observe their religion's prohibition against the "eating" of blood. Mrs. Denton did authorize any other treatment and signed a waiver absolving the medical providers of liability for failure to administer transfusions.
As a result of Rosie Denton's and E.G.'s refusal to assent to blood transfusions, the State filed a neglect petition in Cook County juvenile court. At the initial hearing on February 25, 1987, Dr. Stanley Yachnin testified that E.G. had approximately one-fifth to one-sixth the normal oxygen-carrying capacity of her blood, and consequently was excessively fatigued and incoherent. He stated that without blood transfusions, E.G. would likely die within a month. Dr. Yachnin testified that the transfusions, along with chemotherapy, achieve remission of the disease in about 80% of all patients so afflicted. Continued treatment, according to Dr. Yachnin, would involve the utilization of drugs and more transfusions. The long-term prognosis is not optimistic, as the survival rate for patients such as E.G. is 20 to 25%. Dr. Yachnin stated that he discussed the proposed course of treatment with E.G. He testified that E.G. was competent to understand the consequences of accepting or rejecting treatment, and he was impressed with her maturity and the sincerity of her beliefs. Dr. Yachnin's observations regarding E.G.'s competency were corroborated by the testimony of Jane McAtee, the associate general counsel for the University of Chicago Hospital. At the conclusion of this hearing, the trial judge entered an order appointing McAtee temporary guardian, and authorizing her to consent to transfusions on E.G.'s behalf.
On April 8, 1987, further hearings were held on this matter. E.G., having received several blood transfusions, was strong enough to take the stand. She testified that the decision to refuse blood transfusions was her own and that she fully understood the nature of her disease and the consequences of her decision. She indicated that her decision was not based on any wish to die, but instead was grounded in her religious convictions. E.G. further stated that when informed that she would undergo transfusions, she asked to be sedated prior to the administration of the blood. She testified that the court's decision upset her, and said: "It seems as if everything that I wanted or believe in was just being disregarded."
Several other witnesses gave their opinions extolling E.G.'s maturity and the sincerity of her religious beliefs. One witness was Dr. Littner, a psychiatrist [handpicked by WatchTower's Legal Dept???] who has special expertise in evaluating the maturity and competency of minors. Based on interviews with E.G. and her family, Dr. Littner expressed his opinion that E.G. had the maturity level of an 18 to 21 year old. He further concluded that E.G. had the competency to make an informed decision to refuse the blood transfusions, even if this choice was fatal.
On May 18, 1987, the trial court ruled that E.G. was medically neglected, and appointed a guardian to consent to medical treatment. The court felt this was in E.G.'s best interests. The court did state, however, that E.G. was "a mature 17-year-old individual," that E.G. reached her decision on an independent basis, and that she was "fully aware that death [was] assured absent treatment." The court noted that it considered E.G.'s maturity and the religion of her and her parents, and that it gave great weight to the wishes of E.G. Nevertheless, the court felt that the State's interest in this case was greater than the interest E.G. and her mother had in refusing to consent to treatment. The court concluded its ruling by encouraging E.G. to appeal.
On appeal, the order of the trial court pertaining to E.G.'s right to refuse treatment was vacated in part and modified in part. The appellate court observed that this court, in In re Estate of Brooks (1965), held that an adult Jehovah's Witness had a first amendment right to refuse blood transfusions. The appellate court then extended the holding in Brooks to include "mature minors,"deriving this extension from cases in which the United States Supreme Court allowed "mature minors" to consent to abortions without parental approval through the exercise of constitutional privacy rights. Although the United States Supreme Court has not broadened this constitutional right of minors beyond abortion cases, the appellate court found such an extension "inevitable." Relying on our Emancipation of Mature Minors Act, the court held that a mature minor may exercise a constitutional right to refuse medical treatment.
The appellate court noted that E.G., at the time of trial, was only six months shy of her eighteenth birthday, and that the trial court believed E.G. to be a mature individual. Based on these facts, the appellate court declared that E.G. was partially emancipated and therefore had the right to refuse transfusions. The court, however, affirmed the finding of neglect against Rosie Denton, E.G.'s mother [thereby giving grounds for appeal to the Supreme Court to E.G., since the state people in this case weren't going to contest the "mature minor" ruling.]
To the surprise of absolutely noone who recognized "that the fix was in", the Illinois Supreme Court affirmed the establishment of the "mature minor doctrine", and reversed and remanded the "neglect" ruling. First, with regard to the "neglect" ruling, the SC stated:
"... If the trial judge had ruled that E.G. was a mature minor, then no finding of neglect would be proper. Although the trial judge was impressed with E.G.'s maturity and sincerity, the judge did not explicitly hold that E.G. was a mature minor. The trial judge, guided only by the law as it existed prior to this opinion, rightly felt that he must protect the minor's health and well-being. This case is one of first impression with this court. Therefore, the trial judge had no precedent upon which to base a mature minor finding. Because E.G. is no longer a minor, nothing would be gained by remanding this case back to the trial court for an explicit determination of E.G.'s maturity. Nevertheless, since the trial judge did not have any clear guidance on the mature minor doctrine, we believe that the finding of neglect should not stand. Accordingly, we affirm the appellate court in part and reverse in part, and remand this case to the circuit court of Cook County for the sole purpose of expunging the finding of neglect against Denton."
With regard to the "mature minor" ruling, the SC stated:
"The paramount issue raised by this appeal is whether a minor like E.G. has a right to refuse medical treatment. In Illinois, an adult has a common law right to refuse medical treatment, even if it is of a life-sustaining nature. ... This court has also held that an adult may refuse life-saving blood transfusions on first amendment free exercise of religion grounds. (In re Estate of Brooks (1965), ... ) An infant child, however, can be compelled to accept life-saving [blood transfusions] over the objections of her parents. (Wallace v. Labrenz (1952). In the matter before us, E.G. was a minor, but one who was just months shy of her eighteenth birthday, and an individual that the record indicates was mature for her age. Although the age of majority in Illinois is 18, that age is not an impenetrable barrier that magically precludes a minor from possessing and exercising certain rights normally associated with adulthood. Numerous exceptions are found in this jurisdiction and others which treat minors as adults under specific circumstances.
"In Illinois, our legislature enacted ... the (Consent by Minors to Medical Operations Act), which grants minors the legal capacity to consent to medical treatment in certain situations. ... For example, a minor 12 years or older may seek medical attention on her own if she believes she has venereal disease or is an alcoholic or drug addict. ... Similarly, an individual under 18 who is married or pregnant may validly consent to treatment. ... Thus, if E.G. would have been married she could have consented to or, presumably, refused treatment. Also, a minor 16 or older may be declared emancipated under the Emancipation of Mature Minors Act ..., and thereby control his or her own health care decisions. These two acts, when read together in a complementary fashion, indicate that the legislature did not intend that there be an absolute 18-year-old age barrier prohibiting minors from consenting to medical treatment.
"In an analogous area of law, no 'bright line' age restriction of 18 exists either. Under the Juvenile Court Act, individuals much younger than 18 may be prosecuted under the Criminal Code, if circumstances dictate. ... Furthermore, to be convicted of many of the offenses in the Criminal Code, a trier of fact would have to find that a minor had a certain mental state at the time the alleged crime was committed. Implied in finding this mental state would be an acknowledgment that a minor was mature enough to have formulated this mens rea. Consequently, the Juvenile Court Act presupposes a 'sliding scale of maturity' in which young minors can be deemed mature enough to possess certain mental states and be tried and convicted as adults. This act reflects the common law, which allowed infancy to be a defense to criminal acts. The infancy defense at common law was 'based upon an unwillingness to punish those thought to be incapable of forming criminal intent and not of an age where the threat of punishment could serve as a deterrent.' ... When a minor is mature enough to have the capacity to formulate criminal intent, both the common law and our Juvenile Court Act treat the minor as an adult.
"Another area of the law where minors are treated as adults is constitutional law, including the constitutional right of abortion. The United States Supreme Court has adopted a mature minor doctrine, which allows women under the age of majority to undergo abortions without parental consent. ... In the abortion rights context, the Court has noted: 'Constitutional rights do not mature and come into being magically only when one attains the state-defined age of majority. Minors, as well as adults, are protected by the Constitution and possess constitutional rights.' ... Moreover, children enjoy the protection of other constitutional rights, including the right of privacy ..., freedom of expression ..., freedom from unreasonable searches and seizures ..., and procedural due process ... . Nevertheless, the Supreme Court has not held that a constitutionally based right to refuse medical treatment exists, either for adults or minors. While we find the language from the cases cited above instructive, we do not feel, as the appellate court did, that an extension of the constitutional mature minor doctrine to the case at bar is 'inevitable'. These cases do show, however, that no 'bright line' age restriction of 18 is tenable in restricting the rights of mature minors, whether the rights be based on constitutional or other grounds. Accordingly, we hold that in addition to these constitutionally based rights expressly delineated by the Supreme Court, mature minors may possess and exercise rights regarding medical care that are rooted in this State's common law.
"The common law right to control one's health care was also the basis for the right of an incompetent patient to refuse life-sustaining treatment through a surrogate in In re Estate of Longeway (1989), ... While the issue before us in this case is not exactly the same as in Longeway, the foundation of the common law right here and in Longeway is the same. We see no reason why this right of dominion over one's own person should not extend to mature minors. Furthermore, we find support for this conclusion in a decision of one of our sister States. In Cardwell v. Bechtol ... the Tennessee Supreme Court held that a mature minor had the capacity to consent to medical procedures based on the common law of that State[spinal manipulations performed by an osteopath -- thus equating consenting to getting your back "popped" to refusing to have a life-saving blood transfusion]. The court noted that the mature minor doctrine is not a recent development in the law: 'Recognition that minors achieve varying degrees of maturity and responsibility (capacity) has been part of the common law for well over a century.' ...
"In Cardwell, the Tennessee court held that a minor 17 years, 7 months old was mature enough to consent to medical treatment. We note that in other jurisdictions, courts have ordered health care for minors over the objections of the minors' parents. These cases, however, involve minors who were younger than E.G. or the minor in Cardwell. ... Moreover, the issue in the above cases was not whether a minor could assert a right to control medical treatment decisions, but whether the minor's parents could refuse treatment on behalf of their child. Here, E.G. contends she was mature enough to have controlled her own health care. We find that she may have done so if indeed she would have been adjudged mature.
"The trial judge must determine whether a minor is mature enough to make health care choices on her own. An exception to this, of course, is if the legislature has provided otherwise, as in the Consent by Minors to Medical Operations Act ... . We feel the intervention of a judge is appropriate for two reasons.
"First, ... When a minor's health and life are at stake, this policy becomes a critical consideration. A minor may have a long and fruitful life ahead that an immature, foolish decision could jeopardize. Consequently, when the trial judge weighs the evidence in making a determination of whether a minor is mature enough to handle a health care decision, he must find proof of this maturity by clear and convincing evidence.
"Second, the State has a parens patriae power to protect those incompetent to protect themselves. ... The State's parens patriae power pertaining to minors is strongest when the minor is immature and thus incompetent (lacking in capacity) to make these decisions on her own. The parens patriae authority fades, however, as the minor gets older and disappears upon her reaching adulthood. The State interest in protecting a mature minor in these situations will vary depending upon the nature of the medical treatment involved. Where the health care issues are potentially life threatening, the State's parens patriae interest is greater than if the health care matter is less consequential.
"Therefore, the trial judge must weigh these two principles against the evidence he receives of a minor's maturity. If the evidence is clear and convincing that the minor is mature enough to appreciate the consequences of her actions, and that the minor is mature enough to exercise the judgment of an adult, then the mature minor doctrine affords her the common law right to consent to or refuse medical treatment. As we stated in Longeway however, this common law right is not absolute. The right must be balanced against four State interests: (1) the preservation of life; (2) protecting the interests of third parties; (3) prevention of suicide; and (4) maintaining the ethical integrity of the medical profession. ... Of these four concerns, protecting the interests of third parties is clearly the most significant here. The principal third parties in these cases would be parents, guardians, adult siblings, and other relatives. If a parent or guardian opposes an unemancipated mature minor's refusal to consent to treatment for a life-threatening health problem, this opposition would weigh heavily against the minor's right to refuse. In this case, for example, had E.G. refused the transfusions against the wishes of her mother, then the court would have given serious consideration to her mother's desires. [Think long and hard on the logic, if any, and why it was so stated.]
"Nevertheless, in this case both E.G. and her mother agreed that E.G. should turn down the blood transfusions. They based this refusal primarily on religious grounds, contending that the first amendment free exercise clause entitles a mature minor to decline medical care when it contravenes sincerely held religious beliefs. Because we find that a mature minor may exercise a common law right to consent to or refuse medical care, we decline to address the constitutional issue.
In June/July 1989, an unidentified 20 year-old Jehovah's Witness female died after refusing to consent to blood transfusions made necessary by her aplastic anemia -- a particularly severe blood disorder that requires intensive treatment, including blood transfusions. The young JW still lived at home with her JW Parents, who apparently agreed with her choice to die. Doctors described the 20 year-old red-headed, blue-eyed, female as having a nearly "translucent" fair complexion. The JW had taken canthaxanthin "tanning pills" until such had turned her skin a bright orange. During the four months that followed, she developed aplastic anemia, which had symptoms including headaches, fatigue, easy bruising, and weight loss. After finally seeking medical treatment, she was transported from her home "in the Midwest" to Vanderbilt University Hospital, where doctors did all they could, but could not save her life without blood transfusions. She and her parents checked out, and she returned home to die, which happened soon thereafter.
IN RE CHRISTOPHER LAVENDER was a series of 1987-88 California court decisions. This case arose when the Los Angeles County Department of Children's Services sought to have Christopher Lavender declared a dependent of the court after his Jehovah's Witness Parents refused to permit blood transfusions.
Lavender suffered from leukemia, and his doctors were recommending a lengthy three-year course of chemotherapy which would require blood transfusions. Chris Lavender's attending physician testified that without transfusions he could die, but that with transfusions and other treatment there was a 90% chance of remission of the disease, and a 50% chance of a cure.
Under a temporary court order, Lavender received one transfusion, but Superior Court Judge Michael Pirosh, after hearing testimony from Lavender, ruled that the minor was mature enough to legally refuse treatment. Chris Lavender told the court that he had studied the Bible regularly since he was 8 years old and believed that he should follow a command of God to "abstain from blood."
However, an appellate court panel found that while Lavender may be a "thoughtful, mature, devout and sincere 17-year-old," Judge Pirosh's order must be overturned in view of the physician's testimony about the threat to the boy's life. Judge Pirosh responded by ordering that blood transfusions could only be administered with his permission, or without in only a life-threatening situation.
In a petition for review to the state Supreme Court, attorneys for Lavender and his parents contended that both the boy and his parents could exercise their rights to religious freedom and privacy to reject the transfusions. Lavender's parents also claimed that they could rightfully prevent the transfusions based on their fear of the risk of the boy's infection from hepatitis B, AIDS and other diseases. The youth's physician had testified that all blood products at the hospital where he was being treated had been screened for the AIDS virus. The boy's attorney noted that under other laws, some minors--such as married minors or minors in the armed services--are legally able to give give consent for hospital, medical or surgical care without parental permission.
The Supreme Court of California set aside the decision by the Court of Appeal in July 1987 upholding a bid by county officials to place Lavender under juvenile court supervision to ensure proper medical treatment. The Supreme Court scheduled a hearing for early 1988, but we have yet to locate any indication that a hearing was held, much less a decision regarding such. We suspect that Christopher Lavender died, and the case was deflected as moot.
IN RE KIMBERLY DIXON was a 1979 Illinois appellate court decision which involved a 16 year-old female Jehovah's Witness named Kimberly Dixon, then of Champaign, Illinois. Kim Dixon had had two faulty heart valves replaced when she was 12 year-old, and when those valves deteriorated she underwent another operation in February 1979 to replace them. Both operations were performed without transfusions. In September 1979, open heart surgery had to be scheduled to replace one of the artificial heart valves which had begun to leak. While Billings Hospital, in Chicago, had agreed that they would not give Dixon a transfusion unless absolutely necessary, they wanted consent to do so if it became necessary to administer a blood transfusion to save her life. Both Kim Dixon and her Jehovah's Witness Parents refused. Billings Hospital then sought court intervention.
In August 1979, some unidentified FOOL impersonating a Chicago juvenile court judge appointed a hospital official as Dixon's temporary custodian, and authorized that custodian "to consent to any and all necessary emergency medical and surgical treatments and procedures, including ... blood transfusions." However, the court order further stated that any medical treatments "must not be inconsistent with the wishes of ... Kimberly [Dixon]." Billings Hospital was forced to quickly apply to the Illinois Court of Appeals to straighten out that lower court FOOL's mess, which the Illinois appellate court did by deleting from the lower court's order the phrase that permitted the Minor to veto a medical necessary blood transfusion. Thankfully, for all parties involved, doctors at Billings Hospital were able to perform the surgery without need for a blood transfusion.
ON APPLICATION OF DELAWARE VALLEY HOSPITAL and IN RE PATTI JO WILLIAMS were two related 1976 Pennsylvania court decisions, which involved the 17 year-old daughter of Karl Williams and Trudy Williams, of Levittown , Pennsylvania. Karl Williams identified himself as a recent convert to the Jehovah's Witnesses, while Trudy Williams stated that she was not yet a member, but agreed with Karl's and Patti's decisions. Readers should keep in mind that the WatchTower Society had started predicting back in 1966 that Armageddon would occur on or about October 1975, or soon thereafter. During that period of time, the WatchTower religion doubled in size. The Williams family was likely part of that frenzy of converts. In December 1976, many Jehovah's Witnesses were still awaiting the "delayed" arrival of the apocalypse.
In mid 1975, it was discovered that Patti Jo Williams suffered from a treatable form of Hodgkin's disease, which required surgery and use of blood transfusions. Williams was initially treated at Delaware Valley Hospital, in Bristol, Pennsylvania. Apparently, when the family refused to consent to blood transfusions, that hospital initiated legal proceeding to obtain court authorization. Although unclear, Patti may have had one or more surgeries at Delaware Valley Hospital.
Whatever happened at Delaware Valley Hospital, in the Fall of 1976, Patti Jo Williams ended up being admitted to Pennsylvania Hospital, in Philadelphia. There, a guard was posted outside her hospital room, and the parents were described as "camping outside" such. Pennsylvania Hospital also initiated legal proceeding to obtain court authorization to treat Patti Jo with all necessary medical care needed to save her life, including transfusions. Such was granted. However, William's doctor, John Durocher, apparently did not agree with the Hospital's efforts, but rather was in sympathy with the "mature minor", and her JW Parents, which probably explains why he was picked to replace the doctor in Bristol. Pennsylvania Hospital was likely nothing more than the hospital where Durocher had privileges. Dr. John Durocher testified at the hearing that if the Judge authorized blood transfusions that such would be futile, because Patti Jo would simply pull out the tubes. Despite obtaining the court authorization, the Hospital's hands were evidently tied by Durocher's support of the decision to allow Patti to die, which happened shortly thereafter, in December 1976.
A local JW Elder, named Stan Fox, made some interesting comments regarding this case. Stan Fox told a reporter that Jehovah's Witnesses believe in strict interpretation of the Scriptures. They have no church tradition or laws, except the Bible. They have no minister who delivers his interpretation of the Bible. Fox said that Patti Jo l did not agonize over her decision to refuse blood, she made her choice logically and without emotion."Patty was very reasonable. ... It was her personal decision based on the Scriptures. Her parents agreed. There was nothing emotional about it. ... People have this image of Jehovah's Witnesses as religious fanatics. They'll probably think we just let our children die. That's not the case, of course." Fox said that Patti Jo's decision is not as unusual as it sounds to persons outside the JWs. He said there have been cases where five-year-old children have made the same decision. Stan Fox stated that he knew of no case where the member died after refusing blood, but he emphasized Patti Jo probably would have died eventually even if she allowed the transfusion. "She might have lingered a little longer but she still would have suffered with the disease. Patti didn't die just from lack of blood."
ON APPLICATION OF CHILDREN'S HOSPITAL was a 1973 Wisconsin court decision which involved an unidentified African-American family of Jehovah's Witnesses. At that time, the JW Parents had four children: Twin boys, age 11; and two daughters, ages 13 and 14. This court case involved the 14 year-old daughter, who suffered from sickle cell anemia, and who had been treated with blood transfusions until she was five years-old, which was when the family converted to the WatchTower religion. Milwaukee's Children's Hospital sought a court order to administer the needed blood transfusions.
During the hearing, one or more JW Elders made the argument that the 14 year-old was sufficiently mature to make this decision for herself; in addition to making the same Biblical misinterpretations which WatchTower Legal directs them to make knowing full well that such have no legal validity, but make good PR quotes to be cited by reporters. The child testified that if she were given a blood transfusion that she not be resurrected, but would be "destroyed". Outcome unknown.
IN RE RICKY RICARDO GREEN was a 1972 Pennsylvania Supreme Court decision. Ricky Ricardo Green was born in September 1955, to Nathaniel Green and Ruth Green. Nathaniel Green and Ruth Green were separated. Ricky lived with his mother. Nathaniel Green payed child support pursuant to a court order.
Ricky has had two attacks of poliomyelitis, which had generated problems with severe obesity and paralytic scoliosis. Due to the 94% curvature of his spine, Ricky was unable to stand or ambulate due to the collapse of his spine. He was only able to sit up in bed. If nothing was done, Ricky would likely become a complete invalid. A spinal fusion was recommended in 1968 by Dr. Donald A. Negel, then chief of the spine service at the State Hospital for Crippled Children at Elizabethtown, Pennsylvania. Spinal fusion involved moving bone from Ricky's pelvis to his spine. Spinal fusion was inherently dangerous. Yet, Ruth Green had consented to the surgery - conditionally. As one of Jehovah's Witnesses, Ruth Green refused to consent to any blood transfusions. However, doctors would not perform this surgery without having the option to administer a blood transfusion in the event such became necessary to save Ricky's life.
So, in December 1970, Dr. Robert W. Sanderson, Director of the State Hospital for Crippled Children at Elizabethtown, Pennsylvania, filed a petition in local court, which sought a judicial declaration that Ricky Ricardo Green was a "neglected child"; the appointment of a guardian; and authorization to administer blood transfusions, if such became necessary to save Ricky's life. Sanderson and Oscar Corn, M.D., acting head of the Division of Orthopedic Surgery at Hahnemann Medical College and Hospital, and spine consultant to the State Hospital, both recommended that spinal fusion surgery be performed. They testified that if Ricky's present condition was not remedied by surgery, the effect would be further deterioration, so that eventually Ricky would not be able to sit up, and Ricky would become a complete invalid. Their testimony further indicated that the proposed operation was necessary for Ricky's physical well-being, and was the only way to preserve for him some chance of a normal life. Dr. Corn testified that permission for a blood transfusion was a necessity. He stated that any major surgery necessarily involved some danger, and that blood transfusions in and of themselves entailed some danger. However, Dr. Corn further indicated that all precautions are taken to minimize the medically acceptable risks, and that the State Hospital had had great success with surgery of this type. Despite that testimony, the petition was denied.
Dr. Sanderson appealed. The central question was "whether the State's interest in the health and welfare of this child is sufficient to overcome the religious objections of the parents, where no immediate threat to life exists." Relying heavily on the recent Sampsoncase, the Superior Court reversed the lower court decision, declaring Rick neglected for the purposes of obtaining medical treatment for him. Ruth Green appealed. The Supreme Court of Pennsylvania, in a close four to three vote, reversed the Superior Court decision, and came close to establishing a "mature minor" ruling, stating in part:
"Initially, we must recognize that, while the operation would be beneficial, there is no evidence that Ricky's life is in danger or that the operation must be performed immediately. Accordingly, we are faced with the situation of a parent who will not consent to a dangerous operation on her minor son requiring blood transfusions solely because of her religious beliefs.... ...
"Unlike Yoder and Sampson, our inquiry does not end at this point, since we believe the wishes of the sixteen year-old boy should be ascertained; the ultimate question, in our view, is whether a parent's religious beliefs are paramount to the possibly adverse decision of the child. While the records before us gives us no indication of the child's thinking, it is the child rather than the parent in this appeal who is directly involved which thereby distinguishes Yoder's decision not to discuss the beliefs of the parents vis-a-vis the children. In Sampson the Family Court judge decided not to 'evade the responsibility for a decision now by the simple expedient of foisting upon this boy the responsibility for making a decision as some later date ... .' While we are cognizant of the realistic problem of this approach ... we believe that the child should be heard.... ...
"... as between a parent and the state, the state does not have an interest of sufficient magnitude outweighing a parent's religious beliefs when the child's life is not immediately imperiled by his physical condition."
Justice Eagen dissented. He argued that the decisions relied on by the majority did not limit themselves to life and death situations, but addressed the overall health and welfare of a child. With regard to the majority's decision to send the case back in order to hear from Ricky, he wrote: "To now presume that he could make an independent decision as to what is best for his welfare and health is not reasonable. ... Moreover, the mandate of the Court presents this youth with a most painful choice between the wishes of his parents and their religious convictions on the one hand, and his chance for a normal, healthy life on the other hand. We should not confront him with this dilemma."
In fact, at the evidentiary hearing, Ricky refused to consent to a life-saving blood transfusion based on WatchTower teachings. He further downplayed the possibility that further surgery might improve his life. Having granted Ricky "mature minor" status de facto, if not de jure, the Pennsylvania Supreme Court reversed the Superior Court's reversal. Ricky would not have to undergo surgery.
IN RE LAWRENCE TURNER was a 1961 New Jersey court decision. In December 1961, an African-American 19 year-old Jehovah's Witness, named Lawrence Turner Jr., of Philadelphia, Pennsylvania, was admitted to Atlantic City Hospital, in critical condition, in need of a blood transfusion due to his sickle cell anemia disease. When Lawrence Turner Sr. refused to consent to the needed transfusion, the hospital sought and obtained court intervention. However, Turner Junior died two days later.
MATURE MINORS DOCTRINE
Much critical analysis of the issue of forced treatment of decisionally competent adolescents focuses exclusively on competence and questions why mature minors may not decide for themselves. ... a focus on decision-making competence alone is too narrow. Before one may legally give or refuse consent to medical treatment, three conditions must be met: competence, adequate information, and lack of coercion. ... in addition to fulfilling existing statutory duties to report a child in need of protection, health care professionals caring for acute patients of JW families should actively look for evidence that the patient has accurate medical information and is acting without coercion. Coercion by actual or threatened shunning and excommunication can occur, and these factors may affect adolescent decision-making. In this context, a court order authorizing medical treatment can, therefore, be seen as enhancing patient freedom.
Lack of information on which to base decision-making.
Critics of the orthodox WTS blood dogma, ... claim that the WTS inaccurately finds justification for its blood ban in Biblical passages ... concerning rules governing meat preparation, which have nothing to do with blood transfusion. Critics state that it is illogical for the WTS to claim that a blood transfusion is an "eating" of blood, because a transfusion is more akin to a cellular organ transplant than the administration of nutrition.
[Critics] claim it is also illogical to permit some blood parts but not others when the Bible itself does not distinguish among blood components. ... the WTS claims that the Bible prohibits transfusions of whole blood, packed red blood cells and plasma, as well as white blood cells and platelet administration. The WTS asserts that these Biblical passages do permit adherents to use components such as albumin, immune globulins and hemophiliac preparations, and to receive organ transplants.
Critics particularly condemn the inconsistancy of medical bans generally and of the blood ban in particular. They note that the WTS used to ban vaccinations and organ transplantations but has reversed these positions, and that the WTS has altered the blood dogma itself over time. According to neurologist Muramoto, "Official church publications show that the use of serum was prohibited by the church from 1964 to 1973, the use of clotting factors by hemophiliacs was prohibited until 1978, and the use of albumin was forbidden until 1981". The anesthesiologist Doyle states that the WTS reversed its position on the acceptability of the use of hemoglobin-based blood substitutes in two years (1998 to 2000). ...
According to Kerry Louderback-Wood, the official WTS pamphlet describing the blood policy "How Can Blood Save Your Life?" misrepesents secular facts, historians' writings, the current medical risk of accepting a blood transfusion, the necessity for blood in certain medical situations, the safety and efficacy of medical alternatives to blood transfusion, and the organization's policy in 2005 as to the scope of allowed products.
Lack of voluntariness in decision-making.
Concerns about voluntariness have also been raised. Quoting the official WTS publication, The Watchtower, Muramoto claims that JWs are warned in harsh language against reflecting upon the WTS Biblical interpretations:
"Avoid independent thinking. From the very outset of his rebellion, Satan called into question God's way of doing things. He promoted independent thinking. 'You can decide for yourself what is good and bad,' Satan told Eve. 'You don't have to listen to God.' How is such independent thinking manifested? A common way is by questioning the counsel that is provided by God's visible organization [ie, The Watchtower Society] ... ."
This WTS's discouragement of the independent gathering and sharing of information is the general background against which a number of specific autonomy-limiting practices are said to take place. ... these practices include:
-- the completion of advance directives during group Bible study sessions, without the provision or encouragement of private, independent legal advice;
-- the official church suggestion that it is ethically appropriate for hospital personnel to breach patient medical confidentiality and to report the religiously unauthorized medical treatment of a JW to religious leaders;
-- the requirement that orthodox JWs disassociate themselves from and actively shun members who have accepted religiously unauthorized medical treatment;
-- and the excommunication of JW members who accept religiously unauthorized medical treatment.
These practices of shunning and excommunication have been known to cause severe emotional distress to estranged JWs, occasionally even leading to their suicides. Indeed, one individual described the loss of family and friends through shunning and excommunication as a fate "worse than death".
RELEVANCE OF CONCERNS TO PEDIATRIC PRACTICE
Before one may legally give or refuse consent to medical treatment, three conditions must be met: competence, information and voluntariness. Cases involving adolescents in [Jehovah's Witnesses] families can be confusing because they may focus attention solely on the first condition: competence. Yet, competence alone is not a sufficient condition for valid consent. Even if conscious and alert, and with sufficient cognitive function and maturity to comprehend and appreciate information, a patient may still be unable legally to give or refuse consent. If a patient does not understand and appreciate the risks and benefits of a proposed procedure or a course of treatment, the patient is not in a position to accept or reject the proposal. Patients need reliable information.
They also need the third element of consent: voluntariness. It may be difficult to accept a treatment option if that particular choice will lead to the loss of important relationships. To give or refuse consent to medical treatment, the law requires not just decision-making competence but also accurate information and lack of coercion. ...
Lack of information.
In [three court cases involving three Jehovah's Witness teenagers needing blood transfusions,] the judges in two of those cases determined that the [Jehovah's Witness leaders and other members surrounding the teenage patient] contradicted the statements made by medical personnel. In [one of those cases], the judge ruled that: "Because of incorrect information, and the behaviour of some around her, [JWTeen] now believes that she will not die if she does not have the transfusions ... .[T]he undue influence put upon her in the last few weeks has taken away her ability to make an informed choice."
In [a second] case, the court specifically admonished the [Jehovah's Witness] lawyer for attempting to give false information: "Counsel, you're spinning. You're saying something the doctor has not said". The JW lawyer was attempting to argue that osteogenic sarcoma is not serious when clearly it is.
In addition to being offered misinformation regarding the medical situation, patients and their families can be presented with problems if they seek independently to evaluate the alleged Biblical basis of the blood ban.
Lack of voluntariness.
Coercion can be a great concern in pediatric cases involving [Jehovah's Witness] families. Breach of medical confidentiality can permit coercive practices to begin. Even though the fact that a person is in hospital is a private matter, the confidential medical information of children of JW families can become nationally and even internationally broadcast, ... The public attention from the news broadcasts can place the patient in a difficult and potentially coercive situation by becoming the focus not just of the patient's own congregation, but of [Jehovah's Witnesses] congregations internationally.
With media involvement, discussions and positions may become more rigid. The patient may feel the pressure of being the focus of such attention, in addition to the pressure of threats of shunning and excommunication. The religious advice may be positioned as if it were as accurate as the medical advice.
The power of all these pressures should not be underestimated. For example, the father who rejected [WatchTower Society] teaching by agreeing to a blood transfusion for his daughter, (when his daughter's hemoglobin was at 45 g/L), sat alone on one side of the courtroom (during appeal hearings); while his wife, healthy daughters, and former JW friends sat on the other.
SUGGESTIONS FOR MEDICAL MANAGEMENT
Possibly compromised information.
In such a charged atmosphere, it is especially important to maintain mutual respect among families and health care professionals. It is often possible both for agreement to be reached on a treatment plan, and for the child's life to be safeguarded. But a pediatrician cannot ignore the possibility of contradictory medical information, and the reality of sanctions for those who do not follow official [WatchTower Society] rules. The physicians should verify with the patient alone, and with her family, on an ongoing basis, that they individually, and as a group, understand the physician's assessment of the patient's medical condition, the risks of blood transfusion, and the risks of foregoing blood transfusion when it is urgently recommended.
Communication of medical information may be the source of the greatest difficulty. If the patient and/or parents consistently request that [Jehovah's Witness "Elders"] be present, the pediatrician should direct his or her comments and information to the patient and family, notwithstanding the presence of others. The pediatrician needs to recognize that because of the threat of sanctions, it would be unwise to ask the patient when [Jehovah's Witnesses] are in the room, whether the patient will accept blood or blood products. ...
We agree that, in general, patients are more likely to be better served by too much information rather than too little. While we do not suggest that pediatricians engage in theological disputation, questioning that attempts to elucidate the patient's belief [IS] within the scope of a physician's duty. ...
Possibility of coercion.
A patient may want to accept blood or blood products but refuse because of fear of social and religious effects of such a choice. Physicians should speak to decisional-competent pediatric patients when they are alone, and also with their families, and explain that blood [CAN] be administered in the absence of visitors. Physicians and hospital administrators should ensure that a patient's medical information is kept strictly confidential and should preface any discussion with "What we are about to discuss is confidential ... ."
Physicians should also consider it [PROBABLE] that the [Jehovah's Witness family and] patient [would] welcome the intervention of the legal system. ... the [WatchTower Society] does not require [Jehovah's Witnesses] to shun members who have received a transfusion under court order. By taking the apparent choice out of the [Jehovah's Witness family and] patient's hands, the law can remove the young person from an impossible social position.
Triggering the intervention of the state may be difficult for health care professionals in these situations. But, physicians and all other adult members of [civilized] society (irrespective of their occupations) have a legal obligation to report that the child is in need of intervention or protection when the child's life is in danger. If, after a hearing, the court transfers custody to the Director of Child Welfare, the Director will consult with the physicians regarding the appropriate medical treatment. It is not a question of physicians forcing a transfusion, but the state ensuring that minors receive essential medical treatment. ...
A teenager's ability to consent must be assessed by looking for all its constituent parts: competence, information and freedom from coercion. Such assessment may reveal that patients in [Jehovah's Witnesses] families, even though competent, can be in the unusual position of not having two of the three legal elements necessary for consent to, or refusal of, blood transfusion. -- Medical Emergencies in Children of ... Jehovah's Witness Families, Juliet Guichon and Ian Mitchell, Paediatrics & Child Health, December 2006. Excerpted/edited.
Wifely Subjection: Mental Health Issues in Jehovah's Witness Women
Blood Transfusions: A History and Evaluation of the Religious, Biblical, and Medical Objections (Jehovah's Witnesses perspective)
Blood, Medicine, and the Jehovah's Witnesses: The Hidden History of the Watchtower's Position on the Blood Issue
Jehovah's Witnesses and the Problem of Mental Illness
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