CASE

OF GREGORY NOVAK - An order authorizing the treating physicians to arrange for the
2H 2020 – GROUP 4 blood transfusion was therefore entered.
- The transfusion was promptly carried out;  Gregory Novak
BRIEF BACKGROUND: received three units of packed red blood cells.
- Gregory Alan Novak - His blood count improved significantly, and he suffered no
- 16 years old untoward effects from the procedure.
- Car accident on June 18, 1989
- Numerous injuries anticipating blood transfusion In due course, he fully recovered from his injuries.
- Jehovah’s witness - against their belief to receive blood
- Novak’s father - consented for surgery o In count one of his amended complaint, Gregory Novak
- June Lowery Novak - Mother, rejected transfusion alleges that the administration of the blood transfusion of
June 20-over his mother's and his objection on religious
- Dr. Bradley E. Henderson- concluded that surgery would be grounds-deprived him of the following rights, privileges,
needed to repair Novak's fractured right leg. and immunities secured to him by the Constitution of the
- Novak's father, the only family member on the scene, United States:
consented to the surgery. o (a) His right to be free from the deprivation of life, liberty,
- He did so, however, with the understanding that Novak be or property without due process of law
given no blood during the procedure. (Novak's father was not o (b) His right of religious freedom
a Jehovah's Witness, but his mother, in whose custody Novak o (c) His right of personal privacy
had been since his parents' divorce) o (d) His right to equal protection of law
- Dr. Henderson believed that Novak could withstand the surgical o (e) His right to freedom of contract
procedure without a blood transfusion;  accordingly, in the o (f) His right to have his privileges and immunities as a
early morning hours of June 18, he performed the operation. citizen of the United States free from abridgement by the
- Novak lost a considerable amount of blood as a result of his State of Georgia
injuries and the subsequent triage and surgery. o (g) His right to be free from deprivation of his liberty
- By the early afternoon of June 19, he had become severely interest in maintaining his familial relationship with his
anemic. mother
- Novak's blood count and blood pressure were falling at such a
rate that Drs. Henderson and John David Tucker, the general ETHICAL ISSUES RAISED:
surgeon on the case, after consulting Dr. Richard G. Gray, a - Principle of Autonomy
hematologist, were convinced that, without a blood o No informed consent given to the patient for
transfusion, Novak would likely die. blood transfusion
- Mrs. Novak and her son knew this; they continued to reject the o Patient’s mental and legal competency for the
physicians' recommendations, however, a transfusion would be preferred treatment was compromised
against their religious beliefs. o Patient was not willing to cooperate with the
- They filed their petition in the afternoon of the 19th, at 4:49 medical treatment
p.m. - Principle of Nonmaleficence
- The petition, which sought the appointment of a guardian ad o Patient’s medical problem was critical
litem for the sole purpose of determining whether the blood o Blood transfusion will save the patient
transfusion the physicians were recommending would be in
Gregory Novak's best interest, was assigned to Judge P. Harris - Principle of Justice and fairness
Hines. o Conflict of interest(religion) between the patient
- Because the petition presented a matter that needed and physician
immediate attention, Judge Hines considered it within minutes, o Religious issue affecting the clinical decision
without notice to Novak or his mother. o Third party involvement interested in clinical
- After hearing from Pedrick and Landers and reading Dr. decision of the patient (father)
Henderson's affidavit, Judge Hines granted the petition and o Principle of Patternalism-decision of the mother
appointed Ingram guardian ad litem for the limited purpose was overulled because of the current situation.
described in the petition. -
- The hearing began at 9:35 a.m. in the hospital's intensive care
unit where Gregory Novak was confined. DEVELOPMENTS GENERATED FROM THE CASE:
- Judge Hines handled the hearing himself in that he, alone, • Over the years, court decisions and legislative enactments have
examined the witnesses:  Drs. Henderson and Tucker, Novak's developed laws concerning parents who refuse medical
primary treating physicians, and members of the hospital's treatment for their children.
staff. • Different approaches have developed for life-saving treatments
- The physicians testified that Novak's condition was continuing versus elective measures.
to deteriorate and that, without a blood transfusion, he would • Several states have passed laws recognizing the right of
probably die. patients, including minors to decline treatment that conflicts
- At the conclusion of the hearing, the guardian ad litem asked with their religious beliefs and practices
the court to order a transfusion.
• Courts usually draw a distinction between children requiring
- Mrs. Novak had not changed her position-a blood transfusion
immediate attention and those needing remedial or elective
would offend her and her son's religious beliefs-but held that
care.
her wishes could not be imposed on her minor child given the
life or death situation at hand. • Generally, courts have authorized medical care for children who
require immediate life-saving treatment.
• When parents decline to permit treatment on the ground that
it conflicts with their religious beliefs, actions can be instituted
under applicable child welfare or other laws to have the child
removed (at least temporarily) from the parents' custody.
• The agency or person in whom custody is vested can then
consent to necessary medical care.
• Court intervention in such cases is based on both
constitutional and common law.
• The Supreme Court distinguished between
religious beliefs and practices.
• The court held that the First
Amendment protects religious belief,
but the state may impose restrictions
on practice.
• Thus, a religious practice jeopardizing
the health, safety, or welfare of the
person can be limited.
• The other basis for court intervention is the state's “parens
patriae” power—parents are presumed at law to provide for
the necessities of life required by their children.
• If a parent fails in this, such as by refusing to provide the child
with necessary medical care, the state may step in to protect
the child and get the necessary care

Refusal of Treatment on Religious Grounds

In a similar case with Novak’s, the Supreme Court (1996) found that:

• The issuance of an injunction authorizing the hospital to

administer a blood transfusion to the defendant violated
her common law right of bodily self-determination;
• the hospital's interest in protecting its patients did not
extend to the defendant's baby, whose health was not in
danger, and, as compelling as the hospital's interest in
preserving life and upholding the ethical integrity of the
medical profession might be, those interests were not
sufficient to take priority over the defendant's common
law right to bodily integrity as long as she was sufficiently
informed of the consequences of her decision, was
competent to make such a decision, and freely chose to
refuse the blood transfusion.

Mature Minor Doctrine regarding Right to Refuse Medical
Treatment

• Current legislation which allows a minor to consent to

medical treatment without parental interference already
poses a challenge to physicians treating children.
• The mature minor doctrine, due to its lack of
standardization, certainly adds another layer of confusion
when caring for minors.
• As the debate continues in courts and governing bodies
across the globe, the current rules and restrictions on a
minor’s ability to refuse medical treatment will inevitably
be transformed.