By Elton Chizindu Mpi, Esq.
Patients’ rights vary in different countries and in different jurisdictions, often depending upon prevailing cultural and social norms.
Some patients refuse medical treatment that can save their lives due to a lot of factors ranging from religion, morals or ethical codes and this has been a controversial and topical issue all over the world. Chief amongst the argument is that those who refuse life saving medications are simply being suicidal. Attempted suicide In Nigeria and under the criminal law is a criminal offence. For instance Jehovah’s witness as a church, believe that it is against God’s will to receive blood and, therefore, they refuse blood transfusions often even if it is their own blood. The willing acceptance of blood transfusions by Jehovah’s Witnesses has in some cases led to expulsion from and ostracisation by their religious community.
According to Wikipedia, “ a suicide attempt is an attempt where a person tries to die by suicide but survives. It may be referred to as a failed suicide attempt or nonfatal suicide attempt…”
Section 327 of the Nigerian Criminal Code Act made provision on attempting to commit suicide. It provides thus that:
“any person who attempts to kill himself is guilty of a misdemeanor and is liable to imprisonment for one year”.
This Act, however doesn’t provide for ways a person attempts to kill himself and does not make reference to refusal of life saving medications in hospitals which can eventually lead to death and such decision is made by the patient regardless.
The big puzzle here is, can you really classify the right to refuse treatment which can lead to death as suicide? Or should the right to religion, thought and expression in the constitution be respected?
Section 38. (1) of the 1999 Constitution as amended provides that “Every person shall be entitled to freedom of thought, conscience and religion, including freedom to change his religion or belief, and freedom (either alone or in community with others, and in public or in private) to manifest and propagate his religion or belief in worship, teaching, practice and observance”.
It is ethical, more human and proper for a patient to give consent before receiving any type of medical treatment, from a simple blood test to deciding to donate their organs after death. Where the patient is not old enough to give consent or make rationale decisions, in coma or critical condition, then the family members should be consulted to make decisions concerning the medical procedures that should be adopted.
Section 23 (1)of the National Health Act 2014 every health provider shall give a user relevant information pertaining to his state of health and necessary treatment relating to—-
a) the users health status except in circumstances where there is substantial evidence that the disclosure of the user’s health status would be contrary to the best interest of the user
b) the range of diagnostic procedures and treatment options available to the user
c) the benefit, risks, costs and consequences generally associated with each option; and
d) the user’s right to refuse health services and explain the implications, risks or obligations of such refusal.
For better understanding, User under the Act was defined as “the person receiving treatment in a health establishment, including receiving blood or blood products, or using a health service….”
Legal Approach
In several cases the courts have refused to override the patient’s decision, in others, they have found ways round the problem of the paramountcy of the patient’s consent. What is important is that in no case has the decision to override the patient’s decision been left with the medical practitioner or the hospital. This emphasizes the fact that the consent of the patient or user is paramount and they reserve the right to choose whether or not they want medication or treatment.
Several of these cases have been noted and given judicial notice. For instance In re-Yetter (1973) 62 Pa D & C2d 619, upon evidence that the patient was a mature, competent adult, had no children, and had not sought medical attention and then attempted to restrict it, the court said that the constitutional right of privacy includes the right of a competent, mature adult to refuse treatment that may prolong one’s life even though that refusal may seem unwise, foolish or ridiculous to others. (see 93 ALR 3d 77).
In Re Osborne (1972, Dist Col App) 294 A2d 372, the court affirmed the lower court’s order refusing to appoint a guardian to give consent for the administration of a blood transfusion to a patient who had refused it on religious grounds, and whom the physician feared would die without blood, upon evidence that the patient had validly and knowingly chosen this course, and upon the lower court’s finding that there was no compelling state interest which justified overriding the patient’s decision to refuse blood transfusions.
The principle of these cases is to some extent reflected in the opinions in Sideway v. Board of Governors Bethlem, Royal Hospital (find citation) where at page 645 (of [1985] 1 All ER)
Lord Templeman, at p. 666, said:
“The patient is free to decide whether or not to submit to treatment recommended by the doctor …. If the doctor making a balanced judgment advises the patient to submit to the operation, the patient is entitled to reject the advice for reasons which are rational or irrational or for no reason.”
In Conclusion, whether or not a patient’s decision is suicidal, stupid or reckless, the patient has a fundamental right to privacy, to the confidentiality of his or her medical information, to consent to or to refuse treatment, and to be informed about relevant risks involved. This right is Constitutional and fundamental and therefore cannot be construed to mean attempted suicide which is an offence under Nigerian law where such decision will eventually lead to the death of such patient
Ace Juris 