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Clune-Taylor C. Arguments for a ban on pediatric intersex surgery: A dis/analogy with Jehovah witness blood transfusion. Bioethics 2024; 38:460-468. [PMID: 38470400 DOI: 10.1111/bioe.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/28/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
This article argues for a ban on the performance of medically unnecessary genital normalizing surgeries as part of assigning a binary sex/gender to infants with intersex conditions on the basis of autonomy, regardless of etiology. It does this via a dis/analogy with the classic case in bioethics of Jehovah Witness (JW) parents' inability to refuse life-saving blood transfusions for their minor children. Both cases address ethical medical practice in situations where parents are making irreversible medical decisions on the basis of values strongly held, identity, and relationship-shaping values-such as religious beliefs or beliefs regarding the inherent value of binary sex/gender-amidst ethical pluralism. Furthermore, it takes seriously-as we must in the intersex case-that the restriction of parents' right to choose will likely result in serious harms to potentially large percentage of patients, their families, and their larger communities. I address the objection that parents' capacity to choose is restricted in the JW case on the basis of the harm principle or a duty to nonmaleficence, given that the result of parent choice would be death. I provide evidence that this is mistaken from how we treat epistemic uncertainty in the JW case and from cases in which clinicians are ethically obligated to restrict the autonomy of nonminor patients. I conclude that we restrict the parents' right to choose in the JW case-and should in the case of pediatric intersex surgery-to secure patient's future autonomy.
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Affiliation(s)
- Catherine Clune-Taylor
- Program in Gender and Sexuality Studies, Princeton University, Princeton, New Jersey, USA
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Taylor BES, Narayan V, Jumah F, Al-Mufti F, Nosko M, Roychowdhury S, Nanda A, Gupta G. Ethical and medicolegal aspects in the management of neurosurgical emergencies among Jehovah's Witnesses: Clinical implications and review. Clin Neurol Neurosurg 2020; 194:105798. [PMID: 32222653 DOI: 10.1016/j.clineuro.2020.105798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
When an incapacitated Jehovah's Witness neurologically deteriorates and requires immediate craniectomy, institutional protocols may delay surgery if the patient's refusal of blood products is ambiguous. We are among the first to describe such an ethically contentious case in emergency neurosurgery, review the morbidity of operative delays, discuss medicolegal concerns raised, and provide a detailed guide to hemostasis in patients who refuse blood products. We discuss the case of a 46-year-old woman presented with nausea, vomiting, and right-sided weakness, progressing to stupor over several hours. When an initial Computed Tomography (CT) scan showed a large, left-sided intraparenchymal hematoma with significant midline shift, she was booked for an emergency hemicraniectomy. According to the family, she was a Jehovah's Witness and would have refused blood consent, but was without the proper documentation. Despite her worsening neurological status, an indeterminate blood consent delayed surgery for more than two hours. Her neurological exam did not improve postoperatively, and she later expired. The ethical, legal, and operative concerns that arise in the emergency neurosurgical treatment of Jehovah's Witness patients pose unique management challenges. Since operative delay is a preventable cause of mortality in patients requiring urgent craniectomy, and the likelihood of requiring a transfusion from hemorrhage is minimal, an ambiguous blood consent should not postpone a potentially life-saving treatment. For the beneficence and autonomy of Jehovah's Witness patients, institutional policies should respect the family's wishes in order to expedite surgical decompression. In addition to discussing the nuances of such ethical considerations, we also provide a detailed list of commonly used, topical and parenteral hemostatic agents from the neurosurgical operating room which, depending on whether they are blood-derived, either should or should not be used when treating a Jehovah's Witness.
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Affiliation(s)
- Blake E S Taylor
- Department of Neurosurgery, Rutgers- New Jersey Medical School, Newark, NJ, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Fareed Jumah
- Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Fawaz Al-Mufti
- Department of Neurology and Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Nosko
- Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Neurology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, Rutgers- New Jersey Medical School, Newark, NJ, USA; Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Jillella AP, Arellano ML, Heffner LT, Gaddh M, Langston AA, Khoury HJ, Mangoankar A, Kota VK. Managing acute promyelocytic leukemia in patients belonging to the Jehovah's Witness congregation. Hematol Rep 2017; 9:7083. [PMID: 29071052 PMCID: PMC5641824 DOI: 10.4081/hr.2017.7083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/07/2017] [Accepted: 06/11/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anand P Jillella
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Martha L Arellano
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Manila Gaddh
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Amelia A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hanna J Khoury
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Vamsi K Kota
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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