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Delores Heston, age 22 and unmarried, was severely injured in an automobile accident. She was taken to the plaintiff hospital where it was determined that she would expire unless operated upon for a ruptured spleen and that if operated upon she would expire unless whole blood was administered. Miss Heston and her parents are Jehovah's Witnesses and a tenet of their faith forbids blood transfusions. Miss Heston insists she expressed her refusal to accept blood, but the evidence indicates she was in shock on admittance to the hospital and in the judgment of the attending physicians and nurses was then or soon became disoriented and incoherent. Her mother remained adamant in her opposition to a transfusion and signed a release of liability for the hospital and medical personnel. Miss Heston did not execute a release; presumably, she could not. Her father could not be located.

Death being imminent, plaintiff on notice to the mother made application at 1:30 A.M. to a judge of the Superior Court for the appointment of a guardian for Miss Heston with directions to consent to transfusions as needed to save her life. At the hearing, the mother and her friends thought a certain doctor would pursue surgery without a transfusion, but the doctor, in response to the judge's telephone call, declined the case. The court appointed a guardian with authority to consent to blood transfusions "for the preservation of the life of Delores Heston." Surgery was performed at 4:00 A.M. the same morning. Blood was administered. Miss Heston survived.

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  • not to offend Kant but the real clash here is between libertarianism and utiitarianism.
    – Manu de Hanoi
    Commented Jan 25, 2019 at 20:36

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On the Kantian side one thinks immediately of the requirement of respect for persons. All the evidence suggests that not only did Ms Heston not consent but that there was no due presumption of consent. I.e., there is every reason to think that had she been in a position to give informed consent she would not have done so, given her religious beliefs. Her status as an autonomous agent was not respected. The mother as releasor did not respect Ms Heston's autonomy but took a gamble that the court would appoint a doctor who would pursue surgery without transfusion. The doctors and the court did what they thought was in Ms Heston's best interests but in doing so did respecting her autonomy, which in this case was plainly disregarded.

Looking at matters from the side of the universalisability of maxims, I can't see that a refusal to accept a full blood transfusion even when one's death is likely or virtually certain without such a transfusion entails a maxim which involves a 'contradiction in conception' or a 'contradiction in the will'. It is logically possible for everyone to act on the maxim, 'even if death is likely or virtually certain without a full blood transfusion, refuse a full blood transfusion' : hence there is no contradiction in conception. Nor does the maxim involve a contradiction in the will in the sense that no rational person could (prudentially) will a world in which the maxim were universalised.

How would the utilitarian respond ? Well, I think we already know since the whole narrative of the doctors' and the court's action is utilitarian. A full blood transfusion would produce the best consequences for the patient and this was all that was actually taken into account.

A more refined utilitarian approach is certainly possible. The above analysis is act-utilitarian; it considers what it would produce the best consequences in a single situation. A rule utilitarian might well take into account the undesirability of ignoring what the patient would (almost certainly) have wanted if they had been in a condition to give or refuse informed consent. A rule of ignoring this might well not recommend itself to this type of utilitarian.

REFERENCES

Richard Galvin, 'PRACTICAL UNCERTAINTY, PRACTICAL CONTRADICTION, AND LOGICAL CONTRADICTION', History of Philosophy Quarterly, Vol. 30, No. 4 (OCTOBER 2013), pp. 349-366.

Torbjörn Tännsjö, 'Utilitarianism and informed consent', Journal of Medical Ethics, Vol. 40, No. 7 (July 2014), p. 445.

R. Gillon, 'Four scenarios', Journal of Medical Ethics', 29, 2003, 267-8.

R. Gillon, 'Medical ethics : Four principles plus attention to scope', British Medical Journal, 3-9, 1994, 184-8.

R. Macklin, 'Applying the Four Principles', Journal of Medical Ethics, Vol. 29, No. 5, Festschrift Edition (Oct., 2003), pp. 275-280. (Johovah's Witnesses and blood transfusions a key case considered.)

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