How does the team decide what Sarah would truly want without her input?
Step 2: Gut Reaction The gut reaction is to save this young woman’s life.
Step 3: What are the clinically relevant facts? The Bible states in various places that people should not eat blood. Jehovah’s Witnesses interpret this to mean that they are not to take blood into their body in any manner, including transfusion.
Step 3: What are the clinically relevant facts? Sarah does not have a living will. She is also not carrying a signed card with her stating that she would refuse a blood transfusion in an emergency.
Step 3: What are the clinically relevant facts?
Several court cases have set the precedent that a conscious, competent individual can refuse a blood transfusion, even if doing so will cause their life to be in danger.
Performing the transfusion, we are promoting beneficence and non-maleficence, while seeking to restore Sarah’s autonomy upon recovery. We as providers have a respect for Sarah’s life, but also want to maintain and respect Sarah’s rights and integrity.
Our codes of ethics drive us as providers in the right direction. Sarah is our patient, and as nurse, physician assistant, and doctor, we value our patient first and foremost and act as advocates for her. The best interest of Sarah is to stabilize her such that she can state her wishes so that they can be promoted from there.
Sarah is an adult, and if her mother states she is a Jehovah ’s Witness, those wishes need to be respected. After all, if Sarah’s had ITP for some time, and has yet to receive blood to treat it, is it really that difficult to think that she would not want blood now either?
Sarah has never been put into a life-or-death situation before, and as such, we cannot determine what her wishes are, as they may change given her imminent health status. We as providers have Sarah’s best interest in mind, and her best interest right now is to do everything possible to continue to live.
Step 8: How could this ethical issue have been prevented?
Sarah could have avoided this situation, as anyone can avoid such a situation, via a power of attorney or a living will. These documents would have appointed a sole person as her proxy decision-maker, or described her wishes regarding specific medical treatments in various healthcare situations.