In this scenario, I am facing the ethical dilemma of whether or not I should override the recently signed card from Jehovah’s Witness Church found in the patient’s purse that indicates they do not want to get a blood transfusion in an attempt to save their lives. First, it’s important to act quickly and without judgement. The patient’s life is at risk, but I also must respect autonomy. I must recognize the significance of the patient’s religious belief that it is against God’s will to receive blood; betraying this commitment will lead to potential ostracization from their religious community. I also know that many people observe their faith differently, and pressed with an urgent medical matter, often go against this belief. This is why it’s important to investigate and not jump to conclusions.
If the girl’s family was present, I would consult them about the patient’s surmised choice not to accept the transfusion. I would explain clearly and calmly that if the patient doesn’t get the blood transfusion, they will die. An emergency room is also a highly collaborative environment, so I would consult with other physicians about the ramifications of the patient’s decision and confirm that respecting her autonomy is the correct ethical move. The bottom line is that the patient’s choice can reasonably be confirmed by the card, so there is no valid reason to go against their wishes.
If the information was lacking, for example, if I knew the patient was a Jehovah’s witness but didn’t have the card, or their parents weren’t present, then it would still be best to act in the patient’s interest and proceed with the transfusion. In either case, I would need to work with my colleagues and the hospital’s legal team to make sure the legal and ethical ramifications align with the pillars of medical ethics, which also entail nonmaleficence and justice. I think it would also be necessary to review the girl’s medical history to determine if she’s had a transfusion before. Looking at the card’s date, if there is an indication that she did receive a transfusion or similar medical procedures after that consolidation date, this could potentially be grounds to proceed with the transfusion. In summary, because the girl is eighteen, an adult, and the card is valid, I believe it would be best to not transfuse, unless there is an indication from her medical history that she’s had a transfusion or similar medical procedure after the date that the card was signed. (415 words).