A notorious bioethics journal has published a piercing attack on the right of Christians and other religious believers to make crucial end-of-life medical decisions for their own children. The title — “Should Religious Beliefs be Allowed to Stonewall a Secular Approach to Withdrawing and Withholding Treatment in Children?” — reveals the game that is afoot. The article is published in the Journal of Medical Ethics, which also permitted advocacy for “after-birth abortion” in its pages. The article’s authors blame “fundamentalist Christian” parents for causing their children to “suffer unnecessarily” by refusing to remove life support.
The international media was quick to pick up on the blatant religion-bashing. CBS News reported:
British doctors behind a new study say that many cases in which parents insist on continuing treatment even though medical professionals believe the child has no hope of recovery are motivated by religious beliefs and the hope for divine intervention.
A study has raised concerns that religious faith is causing parents to insist on the continuation of aggressive treatment on a child who is unlikely to recover.
Despite overwhelming medical evidence supporting the withdrawal of intensive care in extremely ill children who are unlikely to survive, parents who have deeply held religious beliefs may hold out for a miracle, a small study has found.
In actuality, there was no “study.” Indeed, the “ethics approval” note at the end of the paper states: “Not really a ‘study’ but a review of cases referred, and no identifiable clinical details provided.” In other words, contrary Newsday, we don’t know if there was “overwhelming medical evidence” supporting the withdrawal of life-sustaining treatment, nor whether the cases were “hopeless.” We are only told that the children had been admitted to the pediatric intensive care unit presenting with “serious and burdensome” medical conditions that resulted in disputes between parents and doctors over protracted intensive care.
Not only that, but the only cases the authors reviewed involved religion as a “non-negotiable aspect” of the discussions — meaning situations involving non-religiously-based impasses were not scrutinized. And get this: The headlines about heartless religious parents forcing helpless children to suffer in the name of their faith involved a mere six cases that took place over a three-year period.
Here are the reported statistics:
- Of 203 cases reviewed, all but 17 were resolved by agreement.
- Of these, 11 did not involve “explicit religious claims” as the reason for refusing medical advice.
- That leaves a mere six cases, one of which culminated with a court ordering life support withdrawn.
- Of the remaining five children (all Christians), four died and one survived with “profound residual neurodisability.”)
In other words, the entire fuss concerns a whopping 3% of all the cases reviewed. And yet, from this bare handful of painful situations, the authors weave a policy argument aimed at undermining the rights of religious parents — and only religious parents — to make end-of-life decisions about their children when they disagree with “secular” doctors.
First, the authors argue — citing the famous atheism proselytizer Richard Dawkins — that a child’s religion should not be considered that of their parents:
Children are currently seen as having a religion by virtue of their parents but it could be argued that children have no religious faith until such time as they are deemed mature enough to make decisions around consent. As Dawkins suggests, should we refer to the child of Christian parents rather than a “Christian child”? We suggest it is time to have a default position in that it is presumed that parental religion is not a determining factor in decision-making for the child until the child is [able] to choose to consent to be part of the parent’s religion.
In other words, the religious aspects of the disagreement should be ignored when the child is too young to “consent” to accepting his or her parents’ faith. Yet, their doctors’ — essentially strangers — secular values should prevail in such cases even though the child can’t consent to those beliefs either. Talk about cultural hegemony!
Admitting that their argument amounts to “religion being legislated against,” the authors advocate speeding up the procedures for taking dissenting religious parents — again, only religious parents — before a judge to force withdrawal of life-sustaining treatment over their objections:
… an accelerated process … would simply become the default position in religious disagreements on end-of-life management, as it is [in Jehovah’s Witness cases] for refusing consent for transfusion, which could also result in death. The obvious difference being the former is seeking a default position that will result in death whereas the latter is seeking to preserve life.
That’s a distinction with a humongous difference! Not only are these blood transfusion cases about preserving life, but time is almost always of the essence in those controversies, thereby justifying fast-track litigation. That is rarely true in disputes over removing life support.
In the end, follow the money:
One further argument for such an approach and one we do not shy away from is the resources used in maintaining children in this setting. While we feel the best interests of the child in question are paramount, the interests of society — including other children who might have used this valuable resource — cannot be ignored, especially when non-medically indicated painful and futile therapies are continued on children due to an expectation of a miraculous intervention.
So, children of religious parents cost more to care for than those of refusing non-faithful parents who are not targeted for “special” treatment? Please. And to be clear, when the authors argue that “futile” treatments should be withdrawn, they don’t actually mean care that isn’t working. To the contrary, these disputes usually involve withdrawing treatments that are successfully maintaining life when doctors think the time has come for the child to die.
There are certainly circumstances when maintaining a dying child’s life is so egregiously abusive that parental refusal to finally say “enough” should be overturned by a court. But those are the exceptions, not the rule. In any event, doctors should have the high burden of proof to demonstrate why dead now is better than dead or disabled later. And most certainly, disputes involving religious beliefs should not be treated invidiously or with greater disdain and intolerance than other circumstances in which parents reject a doctor’s end-of-life advice.