Every day I find myself surrounded by medical students, medical doctors, residents, and research scientists at the ready to help any patient who passes their way regardless if the care needed is great or small. This is an innate characteristic of doctors in training; the patient does, and always comes first. Regrettably I have also found that medical discourse, training and residency programs rely on the assumption that patients want treatment. This neglects analysis on the exceptionally rare cases of tending to a patient admitted who steadfastly refuses all modern treatment based on religious or personal beliefs. Such a scenario becomes even more complicated if a child is suffering, and it is the parents whose religious or personal beliefs are being exercised and forced upon the suffering child. While this may be a rare occurrence, this case is symbolic of a larger medical ethical issue: how much power should, and could a Dr. have and exercise? Three questions emerge when evaluating such a case. The first I find is the easiest to ask but the most difficult to answer; as a Dr. what would you do? Secondly; what should be done in terms of the patients’ emotional and physical health? And lastly; was this decision the most ethical? An attempt was made by the US Supreme Court to settle such issues, and comes from a 1944 ruling (Prince vs. Massachusetts), which states “The right to practice religion freely does not include the right to expose the community or the child to communicable disease or the latter to ill-health or death...Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

However, even with this court ruling many States have religious exemptions freeing a parent to be charged with neglect for withholding medical treatment. This makes the ability of medical doctors to administer necessary treatment in these rare cases nearly impossible. For example, a mentally disabled 13 year old boy was diagnosed with a treatable form of leukemia. His mother refused continued chemotherapy citing religious beliefs. To further complicate matters Daniel also stated to the court judge that he would resist treatment because he believed it would kill him. After a prolonged legal battle, the court eventually ordered the child to undergo treatment. This case is important because it clearly illustrates the difficulty to provide the best possible care under unusually difficult circumstances.

Speaking only for myself, I can confidently say i would have advocated for immediate treatment even against the child’s will at the risk of losing my job and credibility. However, close friends of mine who do practice medicine would not. They believe there is more to lose such as the credibility of the hospital, potential law suits, and often cite the worst case scenario “what if the child actually does die?” These are concerns which I believe need open discussion for all aspiring physicians; and needs to be grounded on sound ethics.

Maxwell Koobatian is a PhD student at the SUNY Buffalo Medical School. His research interests include the development of artificial blood vessels and their translation into medical practice. He graduated with a B.S in chemistry from UC Merced, and has been published in the journals Langmuir and Philosophical Transactions of the Royal Society Part A. Maxwell is currently a contributing writer for the SUNY Buffalo school newspaper “The Spectrum”.