The authors respond;
Mr Bodnaruk misunderstands how paediatricians approach teenagers in providing care. When a teenager with Roman Catholic parents seeks reproductive advice, a paediatrician will discuss all medical options with the patient alone and without asking a priest to give advice on medical management.
Our cases dealt with life-saving medical treatment; transfusion was court-ordered. The judge in case 1 specifically found that, because of ‘undue influence put upon her’, the patient did not have adequate information and voluntariness to make decisions (1). We recommend that Jehovah Witnesses parents and their children have full information, both official Watchtower Society and alternative information (2), and should be free to choose medical treatment without sanction.
We welcome Mr Bodnaruk’s assurance that parents who disagree for religious reasons about their child’s medical treatment can still live amicably together. A judge in case 1 cited the parents’ disagreement about transfusion as the reason for marital breakdown (3).
In the papers Mr Bodnaruk cites, authors describe variations in neonatal management, including the timing and volume of blood transfusion, but not the option of no transfusion (4,5). One referenced author specifically cites the dangers of under-transfusion with perioperative hemoglobin less than 10 g/dL (6). In case 1, physicians recommended transfusion when the hemoglobin was 4.5 g/dL and oxygen saturation was 82% (7).
Mr How suggests that it was inappropriate for the patient in case 1 to receive 38 transfusions given her ultimate death. The high mortality of her condition was always made clear in court (8,9). A 50% success rate is not a reason for withholding medical treatment.
Mr How states that the case 1 father’s lawsuit against the Watchtower Society lawyers has failed. On the contrary, the case is proceeding (10).
Paediatricians must look for all elements of consent: competence, information and voluntariness. Most difficulties among physicians, parents and adolescents are resolved amicably. We support this. In some situations, reporting to child welfare is a statutory duty and legal help is required.
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