Should she have been allowed to change her mind?

[Jonathan M]

http://news.bbc.co.uk/1/hi/england/hereford/worcs/8174064.stm


OK, this sort of follows on from the thread discussing the young alcoholic who died when he didn't meed the criteria for a liver transplant ie e hadn't been off booze for >6 months, etc.


But alongside that story is the one in the BBC link above. This young lady initially refused a heart transplant, but since her condition has improved has changed her mind.

So should she have been allowed to refuse a transplant in the first place, and what impact does this have to others on the waiting list??

 

[Landslide]

The right to refuse? Yes (with certain exceptions).
The impact on others? Donated organs tend to have a very short shelf-life, and waiting lists tend to be long. Any organ that might have been a suitable match for her will most likely have gone to another suitable recipient. If anything, she'll have speeded up the waiting process for others.

 

[summerdays]

From what I saw on TV she was apparently able to argue the case for not having the transplant very clearly - and her parents supported her in her decision. I don't see a problem with her changing her mind though - you have to accept that probably neither decision were made quickly without considering the pro's and cons. This girl was ill through no fault of her own unlike the alcoholic. (Not saying that alcoholics don't have the right for treatment - but that this case is different to his).

 

[Mr Pig]

I don't see a problem with her changing her mind though

No, the kid's fourteen, give her a break. Big decisions for such a young head.

 

[Night Train]

No, the kid's fourteen, give her a break. Big decisions for such a young head.

Good answer.
I suppose it is also very dependent on what information she had and how it was told to her and how she perceived it at the time.

At three decades older then her I would struggle to make such a decision and stick to it as things progressed.

 

[ComedyPilot]

No, I don't want a transplant, I want to die with dignity..........

(cue the usual round of magazine and paper interviews - Kerchiiing)

No, I don't want to die, I want a transplant........

(cue the usual round of magazine and paper interviews - Kerchiiing)

Sorry, but in a cynical mood tonight.

 

[Jonathan M]

OK, another tack (& I'm playing devils advocate here, so don't flame me).

What happens if in say 18 months she chooses to stop her anti-rejection drugs* becuase she is pee'd off with the regime and/or the side effects that they have caused? She can't be forced to take them - no court order in the land can make her do that, neither could she be sectioned and forced to receive meds that way, as the mental health act & administration of meds is specifically for those meds to treat whatever mental health condition a person has.


*adolescents can be notoriously poor at compliance to medicines, and often find the issue of peer pressure, conformity etc overcomes the need for maintaining a long term health condition, so it would not be the first time that such an issue has arisen.

 

[notsolazy]

So should she have been allowed to refuse a transplant in the first place, and what impact does this have to others on the waiting list??

Yes - anyone has the right to refuse medical treatment if they do not wish to undergo it. In this case it would have meant that someone else would have gotten a new chance of life that they may not have had before the initial transplant was refused

As for her getting a transplant now - lets hope that it goes well for her and she has a long and fulfilling life

 

[Cathryn]

It's an interesting one...personally I don't think her parents should have let her make that initial decision. I really feel for her, but 14 is too young to make such a momentous decision...as she clearly has come to realise. I'm so glad she changed her mind...and it wasn't too late.

 

[summerdays]

OK, another tack (& I'm playing devils advocate here, so don't flame me).

What happens if in say 18 months she chooses to stop her anti-rejection drugs* becuase she is pee'd off with the regime and/or the side effects that they have caused? She can't be forced to take them - no court order in the land can make her do that, neither could she be sectioned and forced to receive meds that way, as the mental health act & administration of meds is specifically for those meds to treat whatever mental health condition a person has.


*adolescents can be notoriously poor at compliance to medicines, and often find the issue of peer pressure, conformity etc overcomes the need for maintaining a long term health condition, so it would not be the first time that such an issue has arisen.

She could also decide she wanted to take up drinking large quantities of alcohol or alternative drugs. For a child you have to accept that there will be some battles and you shouldn't not give her treatment because she might as a teenager change her mind again. I guess you look at the probabilities of it happening. In the case of the alcoholic he had never shown that he could do without alcohol so the probability was fairly high that he was going to drink again.

 

[wafflycat]

OK, another tack (& I'm playing devils advocate here, so don't flame me).

What happens if in say 18 months she chooses to stop her anti-rejection drugs* becuase she is pee'd off with the regime and/or the side effects that they have caused? She can't be forced to take them - no court order in the land can make her do that, neither could she be sectioned and forced to receive meds that way, as the mental health act & administration of meds is specifically for those meds to treat whatever mental health condition a person has.


*adolescents can be notoriously poor at compliance to medicines, and often find the issue of peer pressure, conformity etc overcomes the need for maintaining a long term health condition, so it would not be the first time that such an issue has arisen.

The above could apply to absolutely any transplant patient regardless of age.

Of course she should be able to change her mind - as should any patient, be it to accept or reject medication, course of action. The key is whether they are informed of and understand the risks associated with their decision/medication/course of action.

 

[Jonathan M]

The above could apply to absolutely any transplant patient regardless of age.

Of course she should be able to change her mind - as should any patient, be it to accept or reject medication, course of action. The key is whether they are informed of and understand the risks associated with their decision/medication/course of action.

True, but adolescence is increasingly being seen as a specilaity in its own right, with doctors being neither adult or paediatric specialists, but adolescent specialists. Removes the need for a young person to transfer at the age of 16 or 18 according to local policy. The point to be made is that people who endure a long term condition through adolescence will often make decisions that they later regret. An example is the young lady with Type 1 diabetes who became blind in her mid 20's or so, she freely admits that this was due to her lack of compliance in teenage years in order to loose weight, and who is now an advocate trying to encourage fewer young people to go down the same route. At the point that she was maing those decisions to miss insulin she will have been fully informed of risks & consequences, but as an adult she now recognises that her decisions were not the same as those that an adult may make.

Re-transplants, there are documented cases of people stopping anti rejection drugs, particualry those who have undeergone some of the early face/limb transplants in adulthood. But would allowing this young lady in the future to stop anti-rejection meds, and all the consequences not be like transplanting the alcoholic lad only to find he carries on drinking al Georgie Best?

As I say, I'm just throwing more points for discussion into the mix

 

[summerdays]

So you would advocate not treating teenagers due to their fickle behaviour?

 

[wafflycat]

I'm asking virtually the same question as summerdays. Are you in favour of not treating teenagers because they act like normal teenagers?

 

[Jonathan M]

So you would advocate not treating teenagers due to their fickle behaviour?

No, never said that (I work with teenagers with health problems). But discuss the alcoholic transplant scenario and inevitably the Georgie Best case raises its head, and that is why the young alcoholic was not eligible for transplantation, the furore surrounding Best lead to quite explicit guidelines that had to be met.


Who is to know whether the young alcoholic would have changed his behaviour if he'd been given another chance.

I'll reinforce I'm just throwing things in for discussion, none of these actually represent my own personal opinions, I just feel that there is some "asymetry" in the cases that warrants discussion.