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Religious beliefs versus benefits of medical treatment

by Simon Longstaff

History records many cases in which people have been willing to die for their beliefs. We are all familiar with the stories of people who have endured death rather than deny what faith or reason led them to hold as an important truth. In nearly every case such people are held up as worthy exemplars. They are venerated as saints; they are celebrated as heroes.

So, what are we to make of those amongst us whose faith requires them to deny forms of medical assistance that would, in all probability, save their lives. And who should have a say in whether those faced by this choice should live or die?

This is the situation that faced one woman, a devout member of the Jehovah's Witnesses, when complications set in after the birth of her first child during the course of this year. Although unconscious, the woman had previously left absolutely clear instructions that she should not be administered a transfusion under any circumstances – even if a physician should deem it necessary to preserve her life. Despite this, her husband obtained a court order allowing him to instruct the doctor to perform the transfusion. This was done and the woman lived – only to take legal action to overturn the principle that saw her beliefs set aside in favour of another determined to preserve her life.

In a case such as this, we are asked to consider whether or not the decision to accept an avoidable death should be solely in the hands of the individual whose life is at stake. Or, should those who will be most immediately affected by the death also have a right to determine what happens? For example, in the case of the young mother, do the interests of the child, in having the love and care of its natural mother and of the father, be with the woman he loves and with whom he might share the burden of raising their child, count for more than the religious beliefs of the woman?

It would be ridiculous to deny that other people have legitimate interests in the issue of whether someone that they are connected to lives or dies. However, even if we recognise a multiplicity of interests, we are still left with the fundamental question of who should ultimately decide.

In the field of medical ethics, it is a widely accepted principle that a competent, adult patient can refuse treatment – even if to do so might endanger the patient's life. All that is required is that the person makes an informed decision based on a correct understanding of the risks that they face.

As can be seen, this is a fundamentally individualistic approach. Responsibility for the final decision is left to the person concerned. Whether or not the interests of others such as loved ones, or the community as a whole, should be considered is entirely at the discretion of the patient. It's not that the individual cannot take into account the interests of others, it's just that no other can make them do so, or override their decision if they fail to do so.

This focus on the individual's right and responsibility is, in part, the result of support for a relatively modern (but deep-seated) belief in the individual's moral right (duty) to act according to a well-informed conscience. In some traditions (such as the Catholic Church) conscience reigns supreme; trumping even the pronouncements of a figure as authoritative as the Pope (a position that he openly recognises).

Thus, respect for a person's conscience becomes an absolute principle that cannot be violated for any reason – including the good of others. This is consistent with the claim, made by those who believe in an absolute conception of right and wrong, that there is no set of consequences so good as to justify some fundamental wrong. The classic case of this is that the deliberate sacrifice of one innocent life can never be justified by the good it does – even if it saves the lives of a million.

This position is rejected by those who look to good consequences as the standard for judgement. On this view of the issue, the transfusion should be provided if, when all things are considered, to do so would be for the greatest good of the greatest number.

This issue touches the deepest beliefs held by some of our fellow citizens. It involves questions that are difficult to address in a predominantly secular society in which there is a widespread and uncritical acceptance of the proposition that everything is 'relative'; that no truth or principle is absolute.

Against this background, there will be some who find it barely conceivable that a person might make the supreme sacrifice for the sake of their soul.

Beyond the arguments of religion and philosophy we need to remember the human dimension in all of this. It is rarely the case (if ever) that people act in bad faith when it comes to such matters. The desperate need to save a loved one might overpower all other considerations. We might think this selfish – even wrong. But surely, we must understand and empathise with those who are not made to be saints.

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