Who decides on medical help – the parents or the hospital?

camelby Meneer Zjeroen 

Court sides with hospital on Amish girl care
[Via USA Today]

An appeals court has sided with a hospital that wants to force a 10-year-old Amish girl to resume chemotherapy after her parents decided to stop the treatments.

The court ruled that a county judge must reconsider his decision that blocked Akron Children’s Hospital’s request to give an attorney who’s also a registered nurse limited guardianship over Sarah Hershberger and the power to make medical decisions for her


This is a classic rift between civil liberties – the ability to make personal medical decisions – and  authoritarian views – an outside agency decides for us.

If this was just adults, we would have an easier time of it. We usually chose civil liberty and independent thought. Things generally work out best when people can make individual decisions for themselves. Decisions by the state that impinge on civil liberties should be few and very carefully chosen.

In the case of medical decisions, we figure a rational adult makes the choices daily whether to live or die. So they should continue to do that and generally be allowed to make those decisions for themselves.

But when it deals with children it becomes more complex. They do not legally or ethically have the right to make many of the decisions that an adult would.

So someone else does. Usually the parents. 

Yet, what happens when the parents make such a decision that very likely will result in the death of the child, as here where they refuse treatment?

Because this now goes against our desire for civil liberties at all levels. The child is hardly ever going to be allowed to make a choice. There is no individual decision. It becomes making a choice between two authoritarian approaches.

I have not completely worked out which approach should always be used – the state or the parents. How to balance which would be best, not only for the individual but for society at large. But I think I can work out which one might be worst.

That is why I think it should almost always be the parents that decide rather than the hospital, individuals rather than the state. They are closer, they have to personally deal with the consequences and society as a whole is probably better if we keep these sorts of decisions from being made purely by the state.

Because while state coercion in this case may make somewhat easy sense – bay saving the child  we are also doing something – it also opens the way for greater state coercion over individual choice.

The state could decide that obesity is a danger and force people on diets. Or claim any other sorts of medical intervention is required to save someone, even adults, in ways that degrade civil liberties.

There are lots of authoritarians on both sides who want the state to force medical decisions on individuals. I think they are wrong in most cases. 

The power to coerce is great and often abused by the state. Allowing some state coercion might be allowing the camel’s nose into the tent. It may start small but it is almost impossible to keep the entire camel out of the tent.

We must allow people the freedom to make stupid decisions and maybe even allow some people to die because of that. Because this also allows them the freedom to come up with novel, innovative approaches that could benefit us all.

The result is a society that that is freer to make its own individual decisions, decisions that history has shown us more greatly benefits us all.

Of course, the world is perhaps more complex than that and there may be a way to figure out a better approach. But I would rather we start on the side of civil liberties and move a little bit towards authority than the other way around.

We need to keep tight control of the camel al all times.

Because, historically, the camel only leaves the tent by violent conflict.