b. Legal Requirements. In most localities, there are laws requiring the
physician to report sexually transmitted diseases, gunshot and knife wounds, and
spousal and child abuse. When there is clear evidence that the reportable condition
exists, the physician should obey the statute. Exceptions should not be taken lightly.
The states vary on reporting requirements for HIV-positive cases.* Some states have no
laws on HIV-positive, some require the simple reporting that an incident has occurred,
others require a case number, and still others require the name of the patient for the
purpose of contact-tracing the sexual partners of the individual.
All states require the reporting of full-blown AIDS cases.
2-14. PRESERVING THE SANCTITY OF ALL LIFE: MINORS AND INCOMPETENT
As stated earlier, decision makers acting on behalf of minors and incompetent
individuals have a more limited right to refuse, because of their overriding obligation to
act in the best interests of the patient. The courts generally authorize Major
surgery/treatment, such as removal of gangrenous limbs, surgical treatment of an
infant's hydrocephaloid condition to prevent mental retardation, and chemotherapy, for
minors and incompetent persons. When parents or guardians are not following
reputable medical advice, courts authorize treatment that is likely to be beneficial for
life-threatening conditions, for example, chemotherapy for a child with leukemia. When
parents have refused treatment, for example, blood transfusions on religious grounds,
the courts have generally authorized such treatment when the minor had a life-
threatening condition and was not terminally ill.
2-15. PROTECTING INNOCENT THIRD PARTIES (DEPENDENTS)
When an adult with responsibility for the care of minor children and other
dependents refuses treatment that would probably restore the adult to normal
functioning, the state may intercede. Thus, the state asserts an interest in protecting
minors and other dependents from the emotional and financial damage of the patient's
refusal. This has come up in cases in which Jehovah's Witness patients with children
have refused transfusions. The state may authorize a transfusion in such cases,
because of the individual's responsibility for dependents.
2-16. IRRATIONAL SELF-DESTRUCTION
Courts have generally recognized that there can be a competent rational decision
to refuse treatment when the treatment involves substantial risk or death is imminent.
There are also many court decisions in which it was decided that the patient could do
whatever he or she wanted so long as the individual in question was competent and
there was no third party (minor or dependent) being adversely affected. In an
emergency, however, when the patient's competence cannot be immediately assessed,
a physician should treat the patient under implied consent. (See para 2-10.)