The Canadian Press
CALGARY – Several medical ethicists are urging Canada’s top court to reconsider the case of a Calgary teenager who was forced to undergo blood transfusions even though she was deemed mature enough to make her own medical decisions.
If the Supreme Court refuses, doctors fear it will create confusion in physicians and anguish in their young patients, especially when they deal with sensitive issues such as contraception and abortion.
“This will likely result in uncertainty, confusion and inconsistent practice in Canada for health-care practitioners and educators,” said Dr. Christine Harrison, director of bioethics at Toronto’s Hospital for Sick Children.
“Health-care practitioners in Canada would benefit greatly if we got some clarity from the Supreme Court,” said Harrison, who also chairs the bioethics committee of the Canadian Paediatric Society.
Bethany Hughes died of leukemia last month at 17. But before she did, she asked her lawyers to continue her legal battle for the rights of teenagers to determine their own treatment.
“She held a very strong conviction that she did not want another young person capable of making their own health-care choices to experience what she had experienced,” lawyer David Day said from St. John’s.
Her lawyers have now filed a motion asking the Supreme Court a second time to hear an appeal of the Alberta court decisions that ruled Bethany was mature but didn’t have an informed opinion because she was greatly influenced by her fellow Jehovah’s Witnesses. The Witnesses oppose transfusions on religious grounds.
Bethany became a ward of the province and eventually received 38 blood transfusions as part of her treatment.
That was despite the fact that five doctors at the Alberta Children’s Hospital – pediatricians and psychiatrists – interviewed her and found her to be mature enough to decide her own medical treatment.
Last month, the Supreme Court refused to hear the Hughes case and as usual gave no reasons. But medical ethicists want the top court to reconsider.
Dr. Paul Byrne, who teaches pediatrics and ethics at the University of Alberta’s faculty of medicine in Edmonton, filed an affidavit urging the Supreme Court to hear the case because of its potentially widespread ramifications.
“In my experience, the recent refusal by this honourable court to hear the appeal in the above case introduces uncertainty into the relationship between a doctor and a competent patient under the age of majority,” Byrne wrote.
“I am personally aware that the decision of this honourable court has generated widespread confusion among our profession.”
Dr. Austin Cooper, chairman of pediatrics in the faculty of medicine at Memorial University of Newfoundland, agrees.
“This rejection could have profound ramifications for health-care professionals, hospitals and families of mature minors,” he said.
“This, in my opinion, will change the way we practise medicine.”
Over the last few decades, physicians have switched from a paternalistic model of care for teenagers to one that allows them to have a greater say in their medical treatment.
Common practice now is that if a doctor decides a young patient is a mature minor who understands the medical procedure and its ramifications, then the patient can refuse or accept the suggested medical treatment. Most times the teenager’s parents are not consulted.
Doctors say it’s important that teenagers trust their physicians to keep their confidences, particularly in matters such as abortion, birth control, impotence and pregnancy.
“Mature minors in our country have the freedom to seek medical advice and treatment from a physician that may cause considerable distress and hostility in the family,” said Cooper, a pediatrician for more than 30 years.
“A decision by a Canadian court that no longer recognizes the right of a mature minor to refuse therapy on religious grounds may be interpreted by the public, the medical and legal profession as the beginning of a process to reverse our current thinking.”
Dr. Ian Mitchell, a pediatrician who teaches bioethics at the University of Calgary, called the Hughes court decisions baffling.
“Those of us who are teaching ethics to doctors are now confused as to what we should be teaching.”