Death case backs religious freedom

The Daily Telegraph, Australia/August 6, 2009

A critically ill patient has been allowed by a court to refuse medical treatment in hospital because of his religious beliefs, even though his decision will "hasten his death."

The patient, identified only as Mr A, signed an Advanced Care Directive last year stating that he refused to have a blood transfusion "even if health-care providers believe that such (is) necessary to preserve my life or even if any of my family, my relatives, or my friends, disagrees with my considered and non-negotiable decision."

Mr A, who has appointed two fellow Jehovah's Witnesses to act as his guardians, was admitted to the emergency department of a hospital in the Hunter region on July 1, suffering from septic shock and respiratory failure.

He needed dialysis after his kidneys shut down, however his guardians produced the Advanced Care Directive and asked doctors to cease cleaning the toxins from his blood via dialysis.

After keeping him alive for two weeks by mechanical ventilation and dialysis, the Hunter and New England Health Service requested the Supreme Court on July 14 to make a ruling on whether it was justified in complying with Mr A's wishes according to the Advanced Care Directive.

In upholding the patient's request, Justice Robert McDougall emphasised that the court was in no way recognising Mr A's "right to die."

Justice McDougall found that Mr A was competent when he signed the directive, drawn up by a solicitor who had drafted many such documents for other Jehovah's Witness clients.

The solicitor, Mr N, admitted he did not explain the risk of refusing dialysis to Mr A, because "it was unclear whether, according to the beliefs held by Jehovah's Witnesses, there was any biblical proscription of this form of treatment."

However, in addition to the directive, Mr A's guardians produced two Jehovah's Witness "worksheets" indicating his attitude to various forms of medical treatment, written by him in August last year, but unsigned.

On Mr A's second worksheet, under an explanation of dialysis, he stated that he would refuse the treatment.

In his reasons, Justice McDougall said any competent adult is entitled to refuse medical treatment on moral, social or religious grounds in the form of an Advanced Care Directive.

"If (it) is made by a capable adult, and is clear and unambiguous, and extends to the situation at hand, it must be respected," he said.

"On the basis of medical evidence, I accept that the result of withdrawal of dialysis will be to hasten Mr A's death. That is a consequence of the decision that he made, as signified in Worksheet 2."

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