Name: Mehar Mahajan

Student ID: 40189036

Course: PHIL 235

Treatment for Jehovah’s Witnesses: Adults and Children

Contemporary medical practice is an amalgamation of wielding autonomy by the patients and the

physician’s outlook for a patient’s best interest, often known as the principle of beneficence.

The Jehovah’s Witness cases of Georgette Malette (57-year-old) and a 14-year-old Manitoban girl,

epitomize the contradiction between the aforementioned attributes.

Dr Shulman, the attending physician of the Georgette Malette case decided to go full-length with

Malette’s blood transfusion post being acquainted with her identification as Jehovah’s Witness

through an identification card. He disregarded Malette’s advanced directive as not being an

“informed refusal” and worked towards his supposed best-interest judgement. Post being sued by

Malette, Dr Shulman was found guilty of battery.1 In hindsight, this aspect raises a plethora of

morally relevant facts, namely, beneficence and non-maleficence underlined via the

consequentialist theory, utilized to justify the physician’s dilemma of judgement. The Kantian

ethics of autonomy corresponding to deontological theory also become pertinent because they

protect the dignity of the patient.

By the same token, the case of a 14-year-old Manitoban girl wherein, she was forced to undergo a

blood transfusion despite refusal owing to her cultural beliefs, illustrates how autonomy gets

compromised with the facet of age and coarse understanding of competence.

1
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 94–95). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

1
With the multitudinous ethical and moral considerations of the cases identified above, a sense of

complexity can be observed in a day-to-day regimen of a medical setting. These complexities set

a tone to develop the most integral nuances of decision-making; To what extent can the right to

exercise autonomy trump a physician’s virtue of beneficence? This knowledge question has been

investigated by rationalizing the prospects offered by the two cases discussed above.

“Moral relativism claims that morality is whatever an individual or culture believes is moral”,2

catering to this ethical area of knowledge, Malette and the Manitoba girl had a full moral sense of

denial to the treatment which cannot be considered unethical. The individualistic nature of moral

relativism highlights the presence of subjectivism, an idea that primes the two patients’ autonomic

rights. The fundamentals of autonomy have emerged from Kant’s deontological ethics, claiming

that preserving the dignity of humans and not treating them as mere objects must be one’s prime

moral motive.3 This theory draws a lucid relevance to consent and rights which were violated when

Dr Shulman did not consider Malette’s advanced directive. As per the Health Law Institute,

Dalhousie University, the advanced directive must have been an informed consent for Dr Shulman

to withhold the transfusion.4 The lack of respect for Malette’s dignity and treating her body as a

mere means was a violation of how an ethical healthcare system must progress.

2
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 6). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
3
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 11). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
4
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 296). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.

2
Likewise, being antagonistic to the Manitoba girl’s decision of forgoing the treatment shows

another instance of disrespecting the virtues of dignity and a fundamental right to the human body.

Additionally, this case is also a reflection of contradictory lawful statements regarding substitute

decision-makers i.e., the parents were present as substitute decision-makers however as per the

laws the parents’ religious welfare concerns were overruled keeping in mind the child’s best

interest. The parents who belong to Jehovah’s Witness faiths feel that this law represents

paramount unfairness because they don’t get to make the most important decision of their child’s

life. Their culture also perceives the act of blood transfusion as the end of eternal life. So, in such

a case is it worthy to “risk an infinite loss to make a finite gain”?5 This further proves that unless

there is a strong enough reason to defy the cultural belief of Jehovah’s witnesses, blood transfusion

therefore must not be forceful i.e., autonomy must prevail.

Having said that, it is key to accentuate that autonomy is often misconstrued as “freedom”.6 Susan

Sherwin's piece sharply criticizes this, enunciating that no one is fully independent, and a decision

is a by-product of the relationship abridged between the concerned parties. She asserts that HCPs

are often constrained to promote the patient’s autonomy entirely only to uphold the values of

providing care”.7 This aids in justifying the actions of Dr Shulman, who owing to the facets of

5
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 31). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
6
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 41). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
7
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 41). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.

3
beneficence and non-maleficence of the consequentialist theory, stayed true to the notions of

maximizing goodness.

Seriatim, the idea of maximizing goodness is sought to contradictions i.e., Dr Shulman’s intent of

goodness had been directed towards saving Malette’s life contrarily, in Malette’s idea, a true

representation of maximizing goodness would have been to withhold the blood transfusion and

letting her stay true to her religious beliefs. So, the subjectivism represented in this scenario leaves

a conundrum in analyzing Dr Shulman’s actions being right or wrong. How does one differentiate

the right or wrongfulness of such a situation? This is a representation of a slippery slope wherein

Dr Shulman couldn’t have avoided the consequence of causing a compromise to the patient’s

religious beliefs whilst saving her life. Hence, Doctrine of Double effect can be utilized to stand

Dr Shulman’s position.8 This theory states that an action being performed has an intended impact

which must innate goodness like that of Dr Shulman’s intent of saving Malette’s life and a

foreseeable negative impact that must be unintended i.e., Dr Shulman’s unintended harm to

Malette’s religious beliefs. Consecutively, it is noteworthy that the good impact cannot be brought

sans the negative impact, and “some harm is permissible only if the action itself is moral”.9 So,

was Dr Shulman’s action morally permissible? In its entirety, Dr Shulman’s only motive was to

save Malette’s life, which is justified by the ideology of the Hippocratic oath and the intent of

welfare by exercising further beneficence.

8
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 291). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
9
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 291). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.

4
Talking about the 14-year-old Manitoban girl, it’s evident from previous discussions that the

utilitarian theory is one of the prospects that justifies the mandate of blood transfusion. Another

substantial aspect is that determination of competence would never be enough to make a statement

on a child’s “developing autonomy” because it compromises the characteristics of cognition.10

Hence, the coercion is justified by law in the name of protecting children under their loose

autonomic understanding and assurance of best-interest judgement which is of paramount

importance as per the Canadian Pediatric Society.

Empiricism derived from the two cases persuasively legitimizes that beneficence is not prima facie

deterrent to autonomy.

To reiterate, this case study marks numerous innuendos accentuating autonomy and beneficence.

However, the gist is to disregard the need to confer a superior remark to one out of the two. It is

apparent how the partnership between the two areas is the driving force of medical jurisprudence.

So, instead of choosing one, work must be done in bridging the gap and adding to the already

proposed definitions of the two attributes. For instance, Susan Sherwin, scrupulously mentions

how doctors lack the training necessary to effectively provide the facts patients need to make an

informed decision.11 By strengthening the communicative foundations of HCPs, a healthcare

facility will have HCPs true to their bonafide duty and patients with sound autonomic decision-

10
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 77). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.
11
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 36). story, Oxford University Press. Retrieved March
28, 2023, from https://reader.texidium.com/dist/#/book/17211.

5
making. Besides this, a case-by-case analysis will aid respect and acknowledgement of spiritual

distress which must become key when making best-interest judgements.

All-inclusive, the ethics and laws of Biomedical standards must integrate notions of navigation

and compassion to prevent any infringements concerning the superiority of autonomy vs

beneficence in the medical cosmos.

Word Count: 1198

6
 Bibliography

1. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 94-95). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

2. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 6). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

3. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 11). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

4. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 296). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

5. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 31). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

6. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 41). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

7. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 41). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

7
8. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 291). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

9. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 291). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

10. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 77). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.

11. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 36). story, Oxford University Press. Retrieved March

28, 2023, from https://reader.texidium.com/dist/#/book/17211.