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Friday, July 16, 1999Girl, 15, forced to undergo heart transplant
Judge orders operation
The Daily Telegraph
LONDON - A 15-year-old girl who said she would rather die than receive a heart transplant was recovering in hospital in Britain yesterday after a High Court judge ruled the operation should go ahead against her wishes.
Judge Robert Johnson took the "grave" step of overruling the girl's request after deciding she was "too overwhelmed" to make an informed decision of her own. He accepted she might resent his decision for the rest of her life.
The girl, known only as M, at first refused treatment despite the pleas of doctors, nurses and her mother.
She said she would "rather die with 15 years of my own heart" than live with someone else's. She added she did not want to spend the rest of her life taking anti-rejection drugs.
The girl, who was said at the end of last week to be "close to death," finally agreed to the operation after the judgment was read to her at her bedside on Wednesday.
Her highly unusual case is dividing opinion among doctors and medical ethicists over the age at which young people are "competent" to determine their own medical treatment.
The ruling also raised the prospect of further court action should M refuse to take her medication in an attempt to enforce her original decision.
Professor Jack Scarisbrick, chairman of the anti-abortion pressure group, Life, described the ruling as "manifestly incoherent."
He argued the transplant would have amounted to "physical assault" if the girl had refused to change her mind before being taken to the operating theatre.
However, others, such as Dr. Andrew Fergusson of the Christian Medical Fellowship, agreed with the judge that M had not had long enough to come to terms with her condition before taking such a momentous decision.
Dr. Fergusson also pointed out the girl's statement to the judge had shown she was confused, containing "intense contradictions," as when she said, "I don't want to die, but I would rather die than have the transplant."
The British Medical Association issued a statement acknowledging the legal and ethical position on young people and medical consent was "complicated and confused," adding it was working on new guidance to clarify decision making.
"Doctors find these situations very difficult because all their instincts are to provide life-saving treatment, but equally they are very reluctant to override the wishes of an unwilling patient who may not recover as well if treatment has been imposed," said Dr. Vivienne Nathanson of the association.
The case was resolved in a few hours of intense legal drama late last Friday after M's consultant cardiologist at the Freeman Hospital in Newcastle-upon-Tyne, northeast England, decided she would die within a week if she did not receive the transplant.
The judge was contacted at his home in London. He arranged for a local lawyer specializing in family law to go to the girl's bedside and take a statement of her objections.
These were passed to the Official Solicitor -- responsible for the welfare of minors -- who in the early hours of Saturday morning took them to the judge, submitting that the girl was too ill and confused to make a clear decision.
The judge agreed and made an order authorizing doctors to proceed.
"I was very conscious of the great gravity of the decision I was making in overriding M's wish," he said.
"Seeking to achieve what was best for her required me, on balance, to give the authority that was asked for.
"Events have overtaken her so swiftly that she has not been able to come to terms with her situation. If the operation is successful, then M will live with the consequence of my decision, in a very striking sense.
"There is the risk, too, that she will carry with her for the rest of her life resentment about what has been done to her. Whatever that risk may be -- and it is impossible to assess -- it has to be matched against not simply the risk but the certainty of death."
A hospital spokesman said yesterday M is in "satisfactory condition" after undergoing the operation in the past few days. Her family has asked that no further details to be released.
"While one cannot say she accepted the judge's decision, she was, I think, resigned to the fact," Peter Harris, the official solicitor, said.
"She didn't challenge it in any way. It came as an enormous relief to her parents."
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