tallguy408 Posted February 9, 2007 Report Share Posted February 9, 2007 You have a patient who is in seriously bad shape. You know from her file that she is a devout Jehovah's Witness. She slips into a coma and requires a blood transfusion. She did not formally refuse a blood transfusion at any point or state that she would not want one, however you know that her religious views would lead her to refuse one were she able to. Do you transfuse? Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 You have a patient who is in seriously bad shape. You know from her file that she is a devout Jehovah's Witness. She slips into a coma and requires a blood transfusion. She did not formally refuse a blood transfusion at any point or state that she would not want one, however you know that her religious views would lead her to refuse one were she able to. Do you transfuse? You wouldn't transfuse in a case like this. If you have previous knowledge that the individual is a Jehovah's witness and is against receiving transfusions, then you would not be able to transfuse. This goes against the patient's wishes and beliefs. Furthermore, if the patient recovers, he/she has every right to charge and sue with negligence/assault&battery and would win if he/she can prove on a balance of probabilities that you had the information that the patient was a Jehovah's witness beforehand and simply disregarded it. Link to comment Share on other sites More sharing options...
optimist Posted February 9, 2007 Report Share Posted February 9, 2007 On the other hand, what if she was devout but chose to make the exception to the 'take no blood' rule? I imagine that some do. By not giving her the transfusion, you would be denying her life-saving treatment when you don't know for sure that she does not want it. Link to comment Share on other sites More sharing options...
eise Posted February 9, 2007 Report Share Posted February 9, 2007 I agree with optimist. Although the patient is a JW, she has not verbally expressed her disapproval with blood transfusions. You cannot assume that she would not consent to the treatment simply based on her religios beliefs. Thus, until you can ask her yourself or ask a family member (proxy decision maker), you have the duty to rescue her in an emergency situation, and should give the transfusion. If the case is not emergent, then you wait for clarification before deciding appropriate treatment. Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 I agree with optimist. Although the patient is a JW, she has not verbally expressed her disapproval with blood transfusions. You cannot assume that she would not consent to the treatment simply based on her religios beliefs. Thus, until you can ask her yourself or ask a family member (proxy decision maker), you have the duty to rescue her in an emergency situation, and should give the transfusion. If the case is not emergent, then you wait for clarification before deciding appropriate treatment. In the OP, it was stated that you HAD previous knowledge that the patient was a Jehovah's witness and against receiving blood transfusions. Based on this information, you CANNOT transfuse the patient eventhough you may think you have the best intentions. It is unethical, and in fact, illegal. Verbal expression for disproval of blood transfusions is not necessary. If you had ample reason to suspect that the patient would have denied a blood transfusion (and having the previous knowledge that the patient is a JH and against blood transfusion is reason enough) then you would not transfuse in this situation. You will be held liable of negligent treatment and also assault and battery. Most likely, you would lose in a civil suit. Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 On the other hand, what if she was devout but chose to make the exception to the 'take no blood' rule? I imagine that some do. By not giving her the transfusion, you would be denying her life-saving treatment when you don't know for sure that she does not want it. You can't be held liable for spontaneous decisions which go against previous knowledge given to you. From a legal standpoint, the average, reasonable practitioner would NOT expect a devout JH to want to receive a blood transfusion. It doesn't matter if this person is the 'exception' or not. On a balance of probabilities, most JH would not have wanted blood transfusions. Since you also had previous knowledge that this patient did not want a transfusion, you cannot, from a legal standpoint proceed with the transfusion (unless new evidence or arguments support that the patient changed his/her mind). Link to comment Share on other sites More sharing options...
tallguy408 Posted February 9, 2007 Author Report Share Posted February 9, 2007 I proposed this one, because it is a real toughie. As I mentioned, you know that the person is a devout JH, AND you know that this religion forbids transfusions. HOWEVER, this individual has not outright rejected transfusion. Also, the argument for letting a family member make the call is moot in my opinion, since it can be argued that the family member would not have the best interests of the patient at heart, and would therefore be unsuitable to make a medical decision. I wanted to get as much input on this one as possible, so keep the posts coming!!! My personal stance is that because you can't know the person's actual wishes for sure, you would err to the side of caution and transfuse. We can all think of many devout people that exclude singular aspects of their religion for more secular beliefs. Think of catholics that will drink, eat red meat on friday etc. Link to comment Share on other sites More sharing options...
Jochi1543 Posted February 9, 2007 Report Share Posted February 9, 2007 OT, but seriously, don't we have OTHER patients to discuss in ethical scenarios that are not Jehovah's Witnesses? I haven't met ONE JW in my entire life, and I've been all over the place. Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 OT, but seriously, don't we have OTHER patients to discuss in ethical scenarios that are not Jehovah's Witnesses? I haven't met ONE JW in my entire life, and I've been all over the place. JW's are always integrated into ethical scenarios because these types of ethical scenarios are very REAL. I've worked with a few JW patients and you have to use extreme caution when dealing with any types of blood products. I would encourage you all to take a Health Law course. It deals with these very 'real' ethical types of situations and what should be done in various scenarios. But I have to stress that in this scenario, many of you think that transfusion would be the 'safest' thing to do. This is incorrect based upon the information available to you. If you transfuse, you will open yourself up to being liable for assault and battery in a civil trial. Link to comment Share on other sites More sharing options...
The Law Posted February 9, 2007 Report Share Posted February 9, 2007 Legally, if the patient gets offended by you saving their life lol... and sues you, in court it would depend on a "balance of probabilties" as TonesRN mentioned. In court they would try to hammer the point "how likely would it be that a DEVOUT Jehova's witness would have all of a sudden changed their mind and wanted a transfusion?!" Then I suppose in defence, the doctor would have to argue... They had not explicitly mentioned not wanting a transfusion, and it was a life or death situation so by not giving the transfusion, they would not be able to have gone back and changed their decision. I'm sure though, the plaintiff would just say that "they are a devout jehova's witness, the chances of them changing their mind are slim... and how often do people talk about not receiving transfusions?!" Legally it would be difficult. Ethically - try not to let your bias (your inherent nature of wanting to save peoples' lives rather than see them die) factor into your decision. If I had a strong feeling that they would not want to be tranfused on, I would not carry through with it. It would be hard to do, but that would be their wish. If I was uncertain (even in the least bit), I would carry through with the transfusion. Link to comment Share on other sites More sharing options...
kaymcee Posted February 9, 2007 Report Share Posted February 9, 2007 This isn't as cut-and-dry as Malette v. Shulman, but, as stated here, "Clinicians should not administer emergency treatment without consent if they have reason to believe that the patient would refuse such treatment if he or she were capable." If the patient is a "devout Jehovah's Witness" and "you know that her religious views would lead her to refuse one were she able to", it's pretty clear that you have to do: do everything possible to save her life without using blood products. Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 "Clinicians should not administer emergency treatment without consent if they have reason to believe that the patient would refuse such treatment if he or she were capable." If the patient is a "devout Jehovah's Witness" and "you know that her religious views would lead her to refuse one were she able to", it's pretty clear that you have to do: do everything possible to save her life without using blood products. Beautiful. Thanks for driving home my previous points. Link to comment Share on other sites More sharing options...
tallguy408 Posted February 9, 2007 Author Report Share Posted February 9, 2007 Thanks for the effort guys. I had been mulling this one over for a while in an effort to understand the whole consent process for someone unable to give consent. Link to comment Share on other sites More sharing options...
Jochi1543 Posted February 9, 2007 Report Share Posted February 9, 2007 Define "devout...." And while in a standard situation you may have the time to have an extensive conversation with relatives about the patients' beliefs, how realistic is this in an emergency situation? And even if you talk to the relatives, how do you know their opinion is 100% correct? My former roommate's parents were convinced that she was a devout Evangelical Christian, all while she drove around town at 3 AM after 20 drinks screaming "FYUCK ME" to random people. Link to comment Share on other sites More sharing options...
positiveoutlook Posted February 9, 2007 Report Share Posted February 9, 2007 Define "devout...." And while in a standard situation you may have the time to have an extensive conversation with relatives about the patients' beliefs, how realistic is this in an emergency situation? And even if you talk to the relatives, how do you know their opinion is 100% correct? I don't really think it matters how 'devout' this patient was. What is important is that we know that they are opposed to blood transfusions. As the previous post mentioned: "Clinicians should not administer emergency treatment without consent if they have reason to believe that the patient would refuse such treatment if he or she were capable." The choice is clear. It also doesn't matter what the family says if the patient wishes are known. If the patient's wishes are unknown or unclear, then it becomes a bigger battle (as in Terri Schiavo). But in this scenario, because you know the patient's wishes, you have a DUTY to uphold it and not transfuse. Link to comment Share on other sites More sharing options...
kaymcee Posted February 9, 2007 Report Share Posted February 9, 2007 Jochi, I would assume "devout" in this scenario came from conversations between the patient and the physician. Comparing the doctor–patient relationship to a parent–college-age child one is silly. The patient has nothing to gain or lose by lying to the doctor. The college-age child is rebelling against her parents. I agree with you, positiveoutlook, but it's not cut-and-dry in the way you say it. We do not know the patient's wishes, but we do know her beliefs. That's the whole point. Link to comment Share on other sites More sharing options...
Satsuma Posted February 9, 2007 Report Share Posted February 9, 2007 Also, the argument for letting a family member make the call is moot in my opinion, since it can be argued that the family member would not have the best interests of the patient at heart, and would therefore be unsuitable to make a medical decision. Actually, the point isn`t moot. It's what would happen, by law, unless that individual had another pre-designated POA. If you want to deem that person incapable then you would need to go through the steps to do so, but you would need to have a better reason than the fact that their religious views were different than that held by the patient's medical staff. In the case decribed all that is charted is that this individual in a Jehovah's witness. It is not documented anywhere that that person wouldn`t want a blood transfusion and when it comes to life or death, you really can't make the assumption about what that person would choose. In an emergency situation, where a family member could not be contacted,I think you would be safe to go ahead with a transfusion if there was no other option. People make all kinds of choices that are inconsistent with their faith...catholics have premarital sex and use condoms ...there are Jehovah's witnesses who choose blood transfusions and all the consequences that go along with it. How do you know what this pt would choose? Of course, if the pt while able to explicitly said they did not want a transfusion then that is pretty black & white...no transfusion! But in the OP this choice was never documented....so makes for a more interesting discussion really. I am not sure...but would JW carry a card explicitly stating they would refuse blood transfusions? It would probably reduce the chances they would receive unwanted Tx. Link to comment Share on other sites More sharing options...
Jochi1543 Posted February 9, 2007 Report Share Posted February 9, 2007 Jochi, I would assume "devout" in this scenario came from conversations between the patient and the physician. Yes, but as I mentioned above, this is not always an option, especially in an emergency situation (and a good # of blood transfusion-requiring situations would fall in that bracket) - the patient might be passed out, etc, so you still have to make a decision without being able to communicate with him or her. Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 In the case decribed all that is charted is that this individual in a Jehovah's witness. It is not documented anywhere that that person wouldn`t want a blood transfusion and when it comes to life or death, you really can't make the assumption about what that person would choose. In an emergency situation, where a family member could not be contacted,I think you would be safe to go ahead with a transfusion if there was no other option. Sorry, but I have to disagree with you here. It should common knowledge (and is definitely the case among qualified health professionals) that JW's do NOT accept blood transfusions. It doesn't matter if they explicitly tell you or not. If you were to go ahead and transfuse, you would still be held liable. If this went to court (and it no doubt would), the expert witnesses (other physicians similar to you) would be asked the question: "Would the average, reasonable, prudent physician have transfused a JW patient even if it wasn't verbally stated?" The answer would CLEARLY be no. The average physician is well aware that JW patients do not accept blood products. Based on this test (which is the actual legal test performed in civil malpractice suits), you would lose if you transfused the patient. If you had other contradictory information at the time of the incident (which supported transfusion), it wouldn't be as black and white. But based upon what we know here, the average physician would know that JW patients do not receive blood products and therefore you would be liable if you decide to transfuse. Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 9, 2007 Report Share Posted February 9, 2007 OT, but seriously, don't we have OTHER patients to discuss in ethical scenarios that are not Jehovah's Witnesses? I haven't met ONE JW in my entire life, and I've been all over the place. Really? I think I would consider myself agnostic...it must be written all over me...b/c I have met a tonne of JWs, I must attract them or something. I in fact have one friend who lives in Austrailia who is a JW, she never preaches it or anything...so you would not know it. Their efforts of preaching on me are futile anyway, so I'm sure that is why. Back to the original dilemma though, I would err on the side of saving the patient's life, and give the transfusion b/c even though you know he/she is a JW, the patient has not explicitly told you she refuses blood transfusions and/or it is not in writing/living will format. I think it would be making a huge assumption to infer that just b/c she is JW she would automatically decline the blood transfusion unless she has actually stated that to you and you have charted it. Probably not every JW would refuse a blood transfusion in life or death circumstances, just like not every person that says they are "Christian" is pro-life. Don't you think it would be better to err on saving the patient's life rather than not giving the transfusion, the patient dies and the consequences involved with that....? Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 Back to the original dilemma though, I would err on the side of saving the patient's life, and give the transfusion b/c even though you know he/she is a JW, the patient has not explicitly told you she refuses blood transfusions and/or it is not in writing/living will format. I think it would be making a huge assumption to infer that just b/c she is JW she would automatically decline the blood transfusion unless she has actually stated that to you and you have charted it. Probably not every JW would refuse a blood transfusion in life or death circumstances, just like not every Christian is pro-life. Don't you think it would be better to err on saving the patient's life rather than not giving the transfusion, the patient dies and the consequences involved with that....? I feel that I should be beating myself on the head rather than trying to get my point across. But for the last time, you CANNOT give the blood. Why do people think that what is always right is trying to save the patient's life?? Why do people see the patient's predicament through THEIR OWN eyes and values?? You ALWAYS have to respect and uphold a patient's values and not YOUR OWN values. If not, you are certain to face legal rammifications (in this scenario at least)!!! Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 I agree with you Tones. You know your SH** Link to comment Share on other sites More sharing options...
TonesRN Posted February 9, 2007 Report Share Posted February 9, 2007 That last post was a joke....I want someone to see where I'm coming from!!! lolol. Link to comment Share on other sites More sharing options...
positiveoutlook Posted February 9, 2007 Report Share Posted February 9, 2007 That last post was a joke....I want someone to see where I'm coming from!!! lolol. Haha...no worries. I agree with you (and btw, you do know your SH**) Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 9, 2007 Report Share Posted February 9, 2007 I feel that I should be beating myself on the head rather than trying to get my point across. But for the last time, you CANNOT give the blood. Why do people think that what is always right is trying to save the patient's life?? Why do people see the patient's predicament through THEIR OWN eyes and values?? You ALWAYS have to respect and uphold a patient's values and not YOUR OWN values. If not, you are certain to face legal rammifications (in this scenario at least)!!! I sense a little frustration coming from you...don't beat yourself on the head. I thought the purpose of this forum was for each of us to present our decisions and reason them through. I know we have to respect the patient's values, but the problem in this situation is I would not feel comfortable "pigeon holing" the patient into what we presume all JWs would decide unless the patient explicitly told me that he/she would never accept blood transfusions. The original poster posted this b/c it is a complex "grey" scenerio and I think the purpose was for us to generate discussion, work as a team and look at the problem through different eyes. I think we are all doing that:) Link to comment Share on other sites More sharing options...
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