Re: Is a patient who believes "Jesus would save [me]" competent to refuse life-saving medical treatment?
I hate to say it, but this situation is just like the ancient joke about the pastor and the flood (stop me if you've heard it before): There was a terrible flood coming to a small Midwestern town. A news bulletin on the radio warned all residents to evacuate. Just about everyone did, except the town's pastor, who was confident that if he prayed, God would save him. The rains came, and the waters rose, flooding the streets and rising to windowsill height. The emergency service sent people around in rowboats to evacuate anyone left in town, and one of the rescue workers found the pastor's house with the pastor still in it. "Get into the boat, we'll get you out." The pastor refused: "I know that if I pray, God will save me." The waters kept rising, flooded the first floor, then the second. The pastor had to climb out on the roof. A rescue helicopter came by, and the operator tossed down a rope ladder. "Climb up, we'll get you out of there." But the pastor again refused, saying that if he prayed, God would save him. The pastor drowned. On reaching heaven, he demanded an audience with God. "I prayed and prayed, Lord, but why didn't you save me?" God replied, "What did you want me to do? I sent you a bulletin, I sent you a rowboat, and I sent you a helicopter!" My take is that if medical workers were better trained to deal with religious people (perhaps telling people like J.M. a variant of that story), cases like this would not arise. Her wanting to be saved by God is not a sign of insanity, but she just wasn't seeing the situation from God's point of view. On Thu, Jul 15, 2010 at 5:58 PM, Volokh, Eugene wrote: > From *In re* Matter of J.M. (N.J. Super. > Ct.)<http://www.judiciary.state.nj.us/decisions/BER_P_036_10.pdf>, > http://www.judiciary.state.nj.us/decisions/BER_P_036_10.pdf, just released > earlier this month (for some interesting reader comments, see > http://volokh.com/2010/07/15/is-a-patient-who-believes-jesus-would-save-me-competent-to-refuse-life-saving-medical-treatment/#comments > ): > > A patient has capacity to consent to medical treatment if she can > reasonably understand her condition, the effect of the proposed treatment, > and the risks of both undergoing and refusing the treatment. *In re Conroy > *, 98 N.J. 321, 382 (1985). Of the three psychiatrists who testified, two > of them determined J.M. lacked capacity to refuse dialysis. Dr. Psemar > indicated J.M. does not acknowledge the risk of refusing dialysis. She > demonstrated anxiety, depression, and an inability to problem-solve. Dr. > Dealwis testified J.M. did not believe she would die if not treated, and > therefore, was not making a reasoned decision to choose death over dialysis. > They both believed that because she did not understand the likely > consequences of refusing treatment, she lacked capacity to make decisions > about her health. The dissenting psychiatrist, Dr. Scham, acknowledged that > he is not an expert in competency evaluations and only does five to six of > them every year. He said J.M.’s mental status is clear and she has adequate > judgment, but he also acknowledged her views were inconsistent in that she > accepted blood transfusions and resuscitation, but not dialysis. Dr. Scham > believed that J.M. understood she would die without dialysis, yet he also > testified J.M. stated “God would save her.” When J.M. herself testified, she > asserted that she would not die without dialysis because Jesus would > save her > > A competent patient is able to choose his course of treatment even if his > medical decision may seem irrational or unsupported by medical evidence. > [Footnote: New Jersey courts have ruled that a patient found to be competent > and aware of the consequences of her decision may exercise her right to > refuse treatment for any reason, including when treatment violates the > tenets of her religion. Further, guardians of incompetent patients must > consider the tenets of a patient’s religion when determining the proper > course of treatment. J.M.’s refusal of treatment was not premised upon an > established tenet of her religion precluding certain medical procedures, as > evidenced by her consent to all other medical treatment and her pastor’s > attempt to convince her to undergo dialysis. As a result, her belief that > God would save her does not preclude her from being found incompetent, nor > does the appointed guardian need to act on that professed belief.] If a > patient is unable to understand the consequences of the decision, however, > that patient is unable to give informed consent and is therefore > incapacitated. > > The Court found, by clear and convincing evidence, that J.M. does not have > the capacity to make a decision regarding dialysi
Is a patient who believes "Jesus would save [me]" competent to refuse life-saving medical treatment?
As a general matter, it's always seemed to me that determinations of mental competence with respect to a specific judgment should not be based solely on the "rationality" of that specific judgment, but should look instead to the entirety of a person's mental state. Even putting that view to one side, though, the crucial question in this case, I think, is not whether J.M. believes in miracles, even to a degree that the rest of us would find over-optimistic, but whether she understands, as a matter of pure fact, that a miracle would be necessary to save her life. I'm also bothered by the focus on the "inconsistency" and unorthodoxy of her views. If the case is viewed through the lens of religious liberty, it should be clear that protected religious commitments need be neither consistent nor orthodox. And if the case is simply viewed under the rubric of patient autonomy, it seems odd that "irrational" decisions "unsupported by medical evidence" would be protected, but confidence in miracles (however unreasonable, inconsistent, or unorthodox that confidence is) would not be. Finally, as to consistency: Even a non-religious person with no faith in miracles might well distinguish between blood transfusions and resuscitation, which are one-time life-saving procedures, and dialysis, which involves an indefinite course of often enervating, dispiriting, treatment. The point in that non-religious case would not be that the person wanted to die, but that he or she was willing to undergo some procedures but not others, in order to live. In the case of J.M., it might be that she thinks that God wants her to look to doctors to save her life through transfusions, resuscitation, etc., but would intervene miraculously to avoid her having to suffer the torment of dialysis. This is not a judgment I would make, but I'm not J.M. Take care. Perry From: "Volokh, Eugene" Date: Thu, 15 Jul 2010 14:58:50 -0700 From In re Matter of J.M. (N.J. Super. Ct.), http://www.judiciary.state.nj.us/decisions/BER_P_036_10.pdf, just released earlier this month (for some interesting reader comments, see http://volokh.com/2010/07/15/is-a-patient-who-believes-jesus-would-save-me-competent-to-refuse-life-saving-medical-treatment/#comments): A patient has capacity to consent to medical treatment if she can reasonably understand her condition, the effect of the proposed treatment, and the risks of both undergoing and refusing the treatment. In re Conroy, 98 N.J. 321, 382 (1985). Of the three psychiatrists who testified, two of them determined J.M. lacked capacity to refuse dialysis. Dr. Psemar indicated J.M. does not acknowledge the risk of refusing dialysis. She demonstrated anxiety, depression, and an inability to problem-solve. Dr. Dealwis testified J.M. did not believe she would die if not treated, and therefore, was not making a reasoned decision to choose death over dialysis. They both believed that because she did not understand the likely consequences of refusing treatment, she lacked capacity to make decisions about her health. The dissenting psychiatrist, Dr. Scham, acknowledged that he is not an expert in competency evaluations and only does five to six of them every year. He said J.M.s mental status is clear and she has adequate judgment, but he also acknowledged her views were inconsistent in that she accepted blood transfusions and resuscitation, but not dialysis. Dr. Scham believed that J.M. understood she would die without dialysis, yet he also testified J.M. stated God would save her. When J.M. herself testified, she asserted that she would not die without dialysis because Jesus would save her A competent patient is able to choose his course of treatment even if his medical decision may seem irrational or unsupported by medical evidence. [Footnote: New Jersey courts have ruled that a patient found to be competent and aware of the consequences of her decision may exercise her right to refuse treatment for any reason, including when treatment violates the tenets of her religion. Further, guardians of incompetent patients must consider the tenets of a patients religion when determining the proper course of treatment. J.M.s refusal of treatment was not premised upon an established tenet of her religion precluding certain medical procedures, as evidenced by her consent to all other medical treatment and her pastors attempt to convince her to undergo dialysis. As a result, her belief that God would save her does not preclude her from being found incompetent, nor does the appointed guardian need to act on that professed belief.] If a patient is unable to understand the consequences of the decision, however, that patient is unable to give informed consent and is therefore incapacitated. The Court found, by clear and convincing evidence, that J.M. does not ha
Is a patient who believes "Jesus would save [me]" competent to refuse life-saving medical treatment?
>From In re Matter of J.M. (N.J. Super. >Ct.)<http://www.judiciary.state.nj.us/decisions/BER_P_036_10.pdf>, >http://www.judiciary.state.nj.us/decisions/BER_P_036_10.pdf, just released >earlier this month (for some interesting reader comments, see >http://volokh.com/2010/07/15/is-a-patient-who-believes-jesus-would-save-me-competent-to-refuse-life-saving-medical-treatment/#comments): A patient has capacity to consent to medical treatment if she can reasonably understand her condition, the effect of the proposed treatment, and the risks of both undergoing and refusing the treatment. In re Conroy, 98 N.J. 321, 382 (1985). Of the three psychiatrists who testified, two of them determined J.M. lacked capacity to refuse dialysis. Dr. Psemar indicated J.M. does not acknowledge the risk of refusing dialysis. She demonstrated anxiety, depression, and an inability to problem-solve. Dr. Dealwis testified J.M. did not believe she would die if not treated, and therefore, was not making a reasoned decision to choose death over dialysis. They both believed that because she did not understand the likely consequences of refusing treatment, she lacked capacity to make decisions about her health. The dissenting psychiatrist, Dr. Scham, acknowledged that he is not an expert in competency evaluations and only does five to six of them every year. He said J.M.'s mental status is clear and she has adequate judgment, but he also acknowledged her views were inconsistent in that she accepted blood transfusions and resuscitation, but not dialysis. Dr. Scham believed that J.M. understood she would die without dialysis, yet he also testified J.M. stated "God would save her." When J.M. herself testified, she asserted that she would not die without dialysis because Jesus would save her A competent patient is able to choose his course of treatment even if his medical decision may seem irrational or unsupported by medical evidence. [Footnote: New Jersey courts have ruled that a patient found to be competent and aware of the consequences of her decision may exercise her right to refuse treatment for any reason, including when treatment violates the tenets of her religion. Further, guardians of incompetent patients must consider the tenets of a patient's religion when determining the proper course of treatment. J.M.'s refusal of treatment was not premised upon an established tenet of her religion precluding certain medical procedures, as evidenced by her consent to all other medical treatment and her pastor's attempt to convince her to undergo dialysis. As a result, her belief that God would save her does not preclude her from being found incompetent, nor does the appointed guardian need to act on that professed belief.] If a patient is unable to understand the consequences of the decision, however, that patient is unable to give informed consent and is therefore incapacitated. The Court found, by clear and convincing evidence, that J.M. does not have the capacity to make a decision regarding dialysis. She had no long-lasting psychiatric disability, but rather demonstrated a lack of understanding of the high risk of death without dialysis. She refused to acknowledge the risk inherent in her refusal of treatment and through her other medical choices had demonstrated an unequivocal desire to live. ___ To post, send message to Religionlaw@lists.ucla.edu To subscribe, unsubscribe, change options, or get password, see http://lists.ucla.edu/cgi-bin/mailman/listinfo/religionlaw Please note that messages sent to this large list cannot be viewed as private. Anyone can subscribe to the list and read messages that are posted; people can read the Web archives; and list members can (rightly or wrongly) forward the messages to others.
