The libertarian in me wants to say, Let the patient's judgment rule. (Martin Marty puts this with considerably more elegance when he speaks of the "covenant" between patient and physician.) Problem is, medical decision-making is often not so neatly simple as to be a clear, two-party affair. The primary players may be the doctor and patient, but the patients' family is as likely to be involved, particularly in critical medical issues. And guess what? The family may not always agree among themselves (including with the patient), particularly when there are religious, ethical and moral issues involved.
If anyone thinks this is a rarity--and made even more difficult when the patient may not be fully in control of his/her faculties--then think again. In some cases, family members may bring in lawyers, pushing critical care issues into the courts. We live in a litigious society.
In a question like this, we might also do well to try to think beyond the rather limited frame of middle-class America. In many areas of the globe, other, considerably more formidable actors may get involved. Police, armies, governments: there are many parts of the world where armed individuals make their way into hospitals and feel perfectly at liberty to offer medical advice to doctors treating patients considered politically suspect for some reason or other. And then the physician will face questions involving her religious convictions that go well beyond whether to refer the case to another doctor. We ought not to forget that in the former Soviet Union, the state security apparatus used drugs to "treat" certain political dissidents.
We might also recall the incident that followed the Khmer Rouge's victory in Cambodia on April 19, 1975. Within days of capturing the country's capital, the victors emptied the city, driving its entire population into the countryside. That included the bedbound patients in the city's hospitals, who would face near-certain death in the process. I can imagine that a good Buddhist doctor, when confronted with such an order, might well bring his or her religious convictions into play, acting out of compassion (and not just for the patients), by killing the officer who issued such a command. After all, the doctor, in so doing, might well spare the officer the negative karma that would otherwise accrue to him for his role in creating such suffering and so possibly also save him from enduring a terrible re-birth.
As I say, these decisions can be a complicated business.
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