The ethical dilemma presented is whether to respect the patient’s autonomy and compromise standards of care or ignore the patient’s wishes to save her life
The ethical dilemma presented is whether to respect the patient’s autonomy and compromise standards of care or ignore the patient’s wishes to save her life. Jehovah’s witness does not accept blood transfusion or blood products, based on biblical readings. When such group of people need health care, their faith and belief is an obstacle for their proper treatment, and poses legal, ethical and medical challenges for attending health care provider. This paper presents the moral and ethical dilemma that clinicians face in the healthcare industry who care for and treat Jehovah’s Witnesses who are placed in a critical situation due to medical life-threatening situations.
A 20-year-old, Black Hispanic female presented to OB/GYN clinic for her biopsy test results and to discussion a total hysterectomy due to a cancer diagnosis. Dr. G. met with the patient and her mother in the office and the mother informed me that she and her daughter were Jehovah’s Witnesses and that she didn’t want her daughter to receive any blood or blood products before, during, or after surgery. Dr. G. asked the daughter if that was her wish and she sheepishly agreed that it was her decision as well. I had her sign a consent form, with the appropriate documentation, that would absolve our office of any negligence if she should require a blood transfusion and didn’t receive it.
The night before surgery, the physician met with the patient alone in her room. She confided in the physician that she was not as “religious” as her mother — if she needed blood, she wanted to receive it. However, she requested that the physician shouldn’t tell her or her mother if he received a transfusion.
Dr. G thought that was a prudent plan of action, and he documented their discussion in the patient’s chart. He then made calls to the laboratory and the blood bank, to type and hold several units of packed cells
The surgery was a little more difficult than Dr. G. anticipated and the patient lost several units of blood — she had signs of hypovolemia in the immediate post-operative period. At the end of the procedure Dr. G. ordered that the blood be given to the patient in the recovery room. He told the nurses not to allow any family members into the recovery room while the transfusions were being given. He also had the nurses change the IV tubing after the transfusions were given so that there would be no tell-tale signs of blood in the IV tubing that could be seen by the family. He thought he had covered all his bases.
Dr. G then walked out to meet with the family in the family lounge. The mother asked him about the surgery and he told her about the difficulty of the operation but that her daughter was stable and doing well in the recovery room. The mother then asked Dr. G., “Did my daughter receive any transfusions or any blood products?” Pow! Dr. G. know he had the look of a deer stunned by the headlights. There were so many thoughts that raced through his mind in the interval between her questions and his response.
Dr. G. responded, “Why do you ask?” as he was hoping to have just a few more seconds to gather his thoughts. The mother said that someone from the blood bank had come into the family lounge during the surgery and asked if anyone in the family would consider donating blood, as their loved one was going to receive blood. He thought he had taken care of everything but he didn’t give the blood bank a heads up on his agreement with the patient. Dr. G thought, should he tell the truth and risk rupturing rapport between the daughter and the mother and/or between the patient and himself? To give an adult patient blood against their will or wishes could be considered an assault with battery. Dr. G. was truly scared about the legal ramifications the truth would subject him to. Or does he lie and protect the patient? He decided that his responsibility was to the patient and that the patient deserved that he protect her wishes and preserve her relationship with his mother.
Dr. G. replied, “There must have been a mistake as your daughter did not receive any blood.” The mother gave a sigh of relief and he know that inside he, too, was also relieved that the rapport was not blown between the patient and himself, or between the patient and her daughter.
I ask, if you were the doctor in this situation, what would you have done? Would you be perfectly honest and tell the mother about your discussion with the daughter the night before? Or would you do as he did, and lie to the mother to protect your patient, her daughter?
All healthcare providers follow moral and ethical guidelines, which admonishes us “To do no harm.” I believe this dictum refers to more than just clinical harm to the patient, but also to psychological harm. I believe that had Dr. G. been forthright about the transfusions, he would have harmed the patient — the lie protected the patient.
A certain moral goodness is expected in clinicians, and if goodness is not present, education probably will not create it.