Obligation to Give Blood Transfusion / Stop Suicide? (Thought Experiment)

[An_N]

Scenario 1:
You are a physician, and you happen upon a man dying on the side of the road. You can perform a blood transfusion on him and save his life. However, he adamantly rejects the blood transfusion, because of religious convictions (he is a Jehovah’s Witness). He has full mental capacities and is fully informed that he will die if he refuses the transfusion.

Are you, as a Catholic, obligated to save his life? Or are you obligated to respect his autonomy?

Scenario 2:
You are walking across a bridge and encounter a man who expresses his intention to commit suicide. He, also, has full mental capacities, is not insane, etc.

Are you, as a Catholic, obligated to save his life? Or are you obligated to respect his autonomy?

Scenario 3:
You are a pregnant woman, who will die unless an abortion is performed on you (there are no alternatives – this is a thought experiment, after all). You are Catholic, so you would rather die than have an abortion. The secular doctors around you think that you are mistaken in your belief that a fetus is a human being.

Are they, as your secular doctors, obligated to save your life by performing an abortion against your will? Or are they obligated to respect your autonomy?

I’m currently taking a biomedical ethics course, and the first two scenarios were brought up during lecture.

I read this article: catholicnewsagency.com/news/bishop_explains_catholic_position_in_response_to_death_of_chilean_woman_who_refused_blood_transfusion/

…which indicates that the bishop believes “respecting the conscience of each person” does not override the duty “to safeguard respect for life.”

So obviously, he believes that as a Catholic you should override the person’s autonomy (even if it concerns religious beliefs) in order to safeguard the person’s life.

I understand that his statements do not equate to Magisterial teaching, so I am looking for either official Catholic teachings or other Catholics’ thoughts on the matter.

Thanks.

 

[cjmclark]

Scenario 2:
You are walking across a bridge and encounter a man who expresses his intention to commit suicide. He, also, has full mental capacities, is not insane, etc.

Are you, as a Catholic, obligated to save his life? Or are you obligated to respect his autonomy?

I would argue that anyone who is seriously contemplating/intending suicide does not, by definition, have “full mental capacities” (I have personal experience with this). Self-harm is intrinsically disordered.

And yes, I would stop him.

 

[minkymurph]

I would argue that yes, you are obliged to save life. How you go about it is another matter.

Scenario 1 - The law tells doctors what to do in this situation, and you cannot break the law. If someone refuses medical treatment, you cannot force them to have it. Therefore, while your are obliged to save life it is not within your power to save them by administering a blood transfusion if they refuse it.

Scenario 2 - I agree with the other poster. Someone who is contemplating suicide is not in full control of their mental faculties, so intervention can be justified.

Scenario 3 - If it is certain either mother or baby will die, doctors are obliged to respect the wishes of the patient - as with the blood transfusion. They cannot administer medical treatment against the patient’s wishes.

 

[kmuestwin]

The answer is the same in all three scenarios. You inform the patient of their problem and then they either decide to accept treatment or they choose not too.

The only difference is the second one because if that you are obligated to stop them because it is assumed that they are not in the mental faculties to make the decision for themselves.

 

[St_Francis]

Extraordinary medical treatment can morally be refused if it would impose grave difficulties.

So, for the JW, he can refuse the blood transfusion; it is not “ordinary care,” and it would impose a grave difficulty on him.

What measures are you thinking of to save the suicidal man’s life? I imagine that anyone would have an obligation to do what they safely could to stop him.

The pregnant woman’s wishes should of course be respected, in fact, ideally the question would never come up. You don’t kill one person to save the life of another. Doctors would never think of killing a man with Alzheimer’s to get his heart to save someone else’s life, would they?

You should see if you canget a Catholic medical ethics book–i know one was put out by Georgetown University Press about 15 or so years ago.

 

[St_Francis]

Here is a link to the book, which seems to have been updated since I read it all those years ago.

press.georgetown.edu/book/georgetown/ethics-health-care

You might be able to get it through interlibrary loan, either through your university library or maybe the public library. When I read it, it was not a textbook, but it was very readable and clear and it had good footnotes referencing Church documents, and I imagine other sources (I was recently returned to the Church and only paid attention to the wealth of Catholic sources!)

 

[An_N]

I would argue that anyone who is seriously contemplating/intending suicide does not, by definition, have “full mental capacities” (I have personal experience with this). Self-harm is intrinsically disordered.

And yes, I would stop him.

Well, this is a thought experiment. (Not supposed to be a projection of every suicide scenario in real life.) So you shouldn’t assume that he is inflicting self-harm because he is mentally disordered (or else that defeats the purpose of the premise). He might be inflicting self-harm because he believes it to be morally correct, or something. You just don’t know.

You simply know that the person has full mental capacities, i.e., full awareness of his actions and its consequences. His intentions for doing so might be disagreeable; for example, maybe he is part of a pagan cult that requires suicide as a part of salvation (just an example), BUT that does NOT negate the fact that he has full mental capacities.

The point is that you have to assume that he is fully aware of his action and its consequences, and that he is not impeded by any external conditions, mental disorders, etc., because that is the point of the premise to begin with.

Otherwise, in scenario 3, the secular doctors also can jump to the conclusion that the mother who does not wish to preserve her life (at the expense of a fetus, whom they do not believe to be a human being) does not have full mental capacities either, because according to their reasoning, “self-harm is intrinsically disordered.” Not that I agree with this – it’s just to emphasize that the assumption of “full mental capacities” itself is important, and must be applied across the board for consistency.

We are discussing, after all, the obligation to preserve another’s life vs. respecting his or her autonomy. (Not whether external conditions destroy the foundation of our discussion.)

 

[An_N]

Since I feel many here are appealing to legality, I wanted to make another note:

You should not unquestionably accept secular laws regulating medicine that are currently in place (because a point of ethics is to question whether the existing laws are in themselves moral or immoral, not to appeal to them as an unquestioning moral standard whenever an ethical dilemma arises).

For example: under the current secular law, one can destroy a blastocyst to derive human embryonic stem cells. But according to Catholic teaching, this is murder and thus immoral. So legality does not automatically equate to morality.

 

[An_N]

Extraordinary medical treatment can morally be refused if it would impose grave difficulties.

So, for the JW, he can refuse the blood transfusion; it is not “ordinary care,” and it would impose a grave difficulty on him.

What measures are you thinking of to save the suicidal man’s life? I imagine that anyone would have an obligation to do what they safely could to stop him.

The pregnant woman’s wishes should of course be respected, in fact, ideally the question would never come up. You don’t kill one person to save the life of another. Doctors would never think of killing a man with Alzheimer’s to get his heart to save someone else’s life, would they?

You should see if you canget a Catholic medical ethics book–i know one was put out by Georgetown University Press about 15 or so years ago.

Thank you for the book suggestion. I’m actually quite informed on the Church’s teaching regarding abortion, euthanasia, the various types of stem cell research, human cloning, IVF, etc.

It’s just scenarios like these that really do not have quite a precise answer. How do we balance the respect for autonomy (which undoubtedly includes within it religious liberty) with the obligation to protect life?

(BTW, just some background information: I attend a very liberal university; I am the only one in my class of 120 students who rejects IVF…just to give you some perspective about how liberal the atmosphere is. So I wanted to make sure that the opinions I give during class conform to Catholic moral teaching.)

But to answer your question: I guess the methods of saving the suicidal man’s life is irrelevant. You simply are forcing him against his will to live (he might have religious motives for wanting to kill himself, you just don’t know).

I guess I should have worded it a bit differently.

During my lecture, the point of Scenario 2 was to equate it to Scenario 1, because in both scenarios, someone wants to die (for whatever reason, religious or not, it is irrelevant), and either you can respect the person’s autonomy (as his actions would only be harming himself) or force him to live against his will (because you have an obligation to protect human life).

 

[jilly4ski]

I would suggest there is a difference between forcing someone to accept a treatment they have rejected and allowing someone to self harm. There is a difference in not treating a someone who is dying (think triage situations) and letting (or in a sense helping) a healthy person harm themselves.

In the first and third scenarios, the patient did not put themselves in these positions, in fact they would probably prefer to not be in them. If you were not there, the natural progression would be that they would die, regardless of what decisions they make, it is an inevitable conclusion in the absence of extraordinary measures. They are indeed rejecting a medical treatment option.

But in the second scenario, the fact that the person will die is not the inevitable end to a natural process. If you don’t show up they could change their mind and decide not to die, (which is something the people in the other two scenarios don’t have the option of deciding). Stopping someone from self harming is not a medical “treatment.”

 

[Rence]

Scenario 1:
You are a physician, and you happen upon a man dying on the side of the road. You can perform a blood transfusion on him and save his life. However, he adamantly rejects the blood transfusion, because of religious convictions (he is a Jehovah’s Witness). He has full mental capacities and is fully informed that he will die if he refuses the transfusion.

Are you, as a Catholic, obligated to save his life? Or are you obligated to respect his autonomy?

The physician (Catholic or not) is obligated to respect the patient’s right to consent or refuse treatment, and yes, respect his autonomy.

Scenario 2:
You are walking across a bridge and encounter a man who expresses his intention to commit suicide. He, also, has full mental capacities, is not insane, etc.

Are you, as a Catholic, obligated to save his life? Or are you obligated to respect his autonomy?

No, he does not have full mental capacities. Suicidal tendencies are not normal. You should try to intervene or call for help.

Scenario 3:
You are a pregnant woman, who will die unless an abortion is performed on you (there are no alternatives – this is a thought experiment, after all). You are Catholic, so you would rather die than have an abortion. The secular doctors around you think that you are mistaken in your belief that a fetus is a human being.

Are they, as your secular doctors, obligated to save your life by performing an abortion against your will? Or are they obligated to respect your autonomy?

They are obligated to respect the patient’s autonomy. The patient has the right to refuse or consent to treatment and has the right to direct their medical treatments.

So obviously, he believes that as a Catholic you should override the person’s autonomy (even if it concerns religious beliefs) in order to safeguard the person’s life.

No, those are not the obvious and correct answers. A person’s autonomy should not be overridden just because a health care provider doesn’t agree with the patient’s choice. If the person is competent (suicidal patients are not competent) they have the right to refuse any treatment, and they have the right to consent to treatment.