The doctors therefore should comply with her expressed wishes, however unfavourable the outcome. Although it is legally clear that a mentally competent adult is entitled to refuse any medical treatment, including a blood transfusion, physicians have a responsibility to … She refused to accept blood or blood products and rejected the surgery as well. Decisions about access to alternatives may require a discussion about the broader societal good versus the individual good. 5. I have some ethical difficulty in using the Mental Health Act to override a capacitous patient’s wishes based on religious wishes and I would not choose to use my Mental Health Act powers to override his advance decision.” It therefore is a form of consequentialism (Paul and Elder, 2006). Click the button below for the full-text content, 24 hours online access to download content. It is better, therefore, to respect her religious belief and respect her decision not wanting to have the blood transfusion. The difference between risks that should be disclosed and risks that some consider infinitesimal or theoretical is not always obvious. But, when the Mental Health Act comes into play, things become more difficult. Juana was the driver of a sedan involved in a single-vehicle collision. Such cases can be decided by parents, physicians, other members of the health care team and, perhaps, the child looking at the situation together. She displayed signs and symptoms of internal bleeding and was advised to have a blood transfusion and emergency surgery in an attempt to save her and the foetus. I would in this case, therefore, appeal for such rational consideration among the people in her social circle, with the acknowledgement of her predicament and respect for her autonomy and individual capacity and competence. The physician should obtain the patient's informed consent before administering blood products. The utilitarian approach is a straight forward way to determine the best possibilities for all involved, balancing pleasure over pain for everyone (Paul and Elder, 2006). The court determined that the refusal of medical intervention could not be viewed as committing suicide and concluded that it was simply allowing the disease to take its natural course.10 This distinction is important as the Criminal Code of Canada prohibits assisting a suicide. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Lean Library can solve it. She might lose acceptance from her family members and friends. Although it is legally clear that a mentally competent adult is entitled to refuse any medical treatment, including a blood transfusion, physicians have a responsibility to ensure that the refusal is truly informed and voluntary. As Holman J points out (though in neater language than I use) – If you want law, Courts are the right place, if you want ethics you may be in the wrong place. This finding was later upheld by the Supreme Court of Canada.14 A balancing of rights will always be required; however it seems likely that when the risks to the child are serious, the court's parens patriae jurisdiction will be paramount to the parents rights. This approach is supported by ethical principles of non-maleficence and beneficence, that the doctor avoids harming the patient by not withholding necessary intervention and beneficial treatment. The surgery was medically indicated for his condition and had been performed competently. This absolutism and the derivation of values from deity and holy books can hardly be challenged by rational criticism and explanations that seek to give some worth to disallowed practices and procedures such as blood transfusion in this particular case. A competent adult is entitled to refuse or cease any treatment for any reason. The Judge looked at the advance directive and circumstances in which it was signed and concluded this In the case of Werth vs. Taylor, a Michigan court upheld an obstetrician’s order for a blood transfusion after a patient suffered significant bleeding after a cesarean section. Consent forms are merely evidence of consent, they do not constitute "consent." The treating hospital abided by his expressed wish, believing it to be capably stated.” Happily, he in fact survived that event without any blood being transfused. Consensus statement on red cell transfusion. Kant’s Ethical Thought. There is a tendency for us to determine that death as an eventuality is a significant harm, and therefore to consider it a greater good to try and prevent such an eventuality whatever the arguments against it. She decided that she would prefer to die and refused consent to continue using the ventilator. Support your arguments. Her unhappiness from the override of her expressed will in conducting the blood transfusion and possible depression may lead to a deterioration of her health, with suffering and death as possible eventualities as well. Patients with severe injuries who refuse blood transfusion present complex medical, legal, and moral problems. These are the principle of non-maleficence and the related principle of beneficence. The husband then presented the physician with Juana’s blood card, created by the Watchtower Bible and Tract Society, the governing organization of Jehovah’s Witnesses. J is a 23 year old, detained under the Mental Health Act – he has a personality disorder. Oxford: The Clarendon Press. United States: Foundation for Critical Thinking Free Press. As several studies have shown that adolescents consistently demonstrate less understanding than is initially apparent,18 physicians must be careful to assess their capacity. A qualifier on disclosing the risks of a particular treatment, alluded to by Krever4 in his interim report, is that the risks should not be presented to the patient in isolation. She had a past medical history of sickle cell disease and no previous pregnancies. The Court felt uncomfortable about trying to resolve this dilemma without someone speaking on behalf of J, and decided that J’s voice had to be heard before any decision could properly be made. The purpose of this discussion is to help psychologists provide informed, ethical consultations and support by investigating the values of the Jehovah’s Witness community and the origin of the blood transfusion taboo, how medical and legal professionals have approached this dilemma, exploring relevant ethical principles and standards for psychologists, and suggestions for how to move toward a better understanding of harm with Jehovah’s Witness families. She was immediately transferred to the intensive care unit where, despite continued aggressive attempts to stabilize her, she went into cardiac arrest and died. It is difficult to reduce the legal and ethical obligations of physicians to a set of guidelines. I will definitely come back and refer you to my friends. 14. Depression could result from either of the choices, if the blood transfusion is conducted or not. If specific or general advance directives exist, physicians should ensure that each directive has been properly executed before following it and that no directive has been executed, or decision-maker appointed, before referring to the statutory list of substitute decision-makers. It is not an intended procedure that she willingly sought, but is necessitated by her medical predicament after the accident. In the case of adults who were once competent, but have become temporarily or permanently incompetent, substitute consent laws, generally, provide that their prior wishes regarding treatment decisions should be respected to the extent that they are known or can be determined. Author Ally McInroy 1 Affiliation 1 University College Hospitals NHS Trust. . An Ethical Dilemma: Jehovah's Witnesses' Refusal of Blood Products Purpose of This Presentation Why Mainstream Christians don't Refuse Blood Ethical Principles Biblical Basis understanding of scripture within contextual clues Noachide and Mosaic law (not intended for all people, Oxford University Press. She wouldn’t have to have the procedure in a state of adequate health and well-being. For them, it is either that religion is their morality or that morality is part of their religion (Childress, et al., 1986). (ID: 2), Ethical dilemma of a patient’s refusal of blood transfusion. If there is a contrary argument that the power under section 63 should be positively exercised in circumstances such as this, then it will be very important indeed for the court to hear it. A hemoglobin of 6 g/dl and hematocrit of 21% indicated internal bleeding. 17. Peripheral intravenous lines were started bilaterally to replace fluid loss that was indicated by the change in vital signs. ” is an ethical dilemma. 16. Another aspect of this case is that, because of some history of thrombosis, he is prescribed the anti-coagulant, Warfarin, which has the effect that when he does bleed, he bleeds more profusely than he might otherwise do. What is the ethical/legal dilemma presented in this case? Login failed. What happened to comercial farm workers after the famous land reform (grab) programme in zimbabwe? Below Simon Finfer and colleagues describe how they managed two patients who presented after a car crash. Create a link to share a read only version of this article with your colleagues and friends. View or download all the content the society has access to. That is a matter for doctors alone, applying such guidance, if any, as they can obtain from their professional medical bodies. The landmark Canadian case on the issue of informed consent is the Supreme Court of Canada decision in Reibl v. Hughes.1 Mr. Reibl underwent surgery to remove a blockage in his carotid artery. In a number of cases, parents have attempted to withhold consent to treatment on behalf of disabled children, largely because they have felt it would be better for the child to die.15,16 As society's view of disabled citizens has evolved, the courts have increasingly upheld the child's right to life and the appropriate treatment. Serious risks have been held to be nonmaterial and, therefore, not worthy of disclosure: for example, a 0.3% chance of a serious hematoma2 and a 0.25% chance of chronic pain. In rare cases where the physician feels the parent's decision is unjustified, the advice of colleagues and the hospital ethics board or similar resource should be sought. Another aspect of the case is that his parents are of the Jehovah’s Witness faith. She refused to accept blood or blood products and rejected the surgery as well. In the analysis of this ethical dilemma we assess a case of a 20-year-old, pregnant, black Hispanic female presented to the Emergency Department (ED) in critical condition following a car accident. By continuing to browse The psychologic benefit to the donor may outweigh the cost to society. In the utilitarian view, the young lady in this situation risks losing her own life and that of the foetus she carries if she does not allow the blood transfusion and surgical procedure to bring her to health. Nottinghamshire Healthcare NHS Trust and J, http://www.bailii.org/ew/cases/EWHC/COP/2014/1136.html. 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