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  #1  
Old 07-07-2011
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Medicolegal and Ethics Jehovah's witnesses patients in the ER..give blood?

A mother and a 3 year old daughter suffer severe injuries in a motor vehicle accident. Both have altered mental status and cannot respond to questions appropriately. While they are in the ER, the husband, who is also the child's biological father, arrives and states that the whole family are Jehovah's witnesses and cannot receive blood products because it's against their religion. The doctor discuss the risks with the husband, but he insists they cannot receive blood. The doctor plans to use crystalloids and other alternative strategies as much as they can, but if the patients need blood emergently, what is the most appropriate thing to do?

A) Get a court order to give blood to both patients
B) Do not give blood to the mother because the husband's decision should be respected, and only give to the daughter in event of emergency
C) Give blood to the mother because she is an adult but not to the daughter because she is a minor and the father can make decisions for her.
D) Give blood to both patients because it is an emergency situation and it cannot be confirmed that they share the same beliefs as the husband
E) Do not give blood to either patient because their religious beliefs must be respected
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  #2  
Old 07-07-2011
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D is the answer
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Good question!
well...we'll always give blood to the kid...and, about the mom...I think the best answer is D)
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Old 07-07-2011
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D is the answer,

For the child it has to be given no matter what was the decision of the parent because it is an emegency no matter what they believe.
In case of the mum , because her beliefs cannot be confirmed , she has to recieve blood .. and u dont assume that because she is a Jehova's witness that she doesnt want blood !! she may be a Jehova's witness and at the same time accepts taking blood .. The only time you dont give a blood to patient if he is conscious and tell u clearly that he is a jehova's wittness and doesnt want to take the blood.
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Old 07-07-2011
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Default D

Yes the answer is D because it cannot be confirmed if they share the same beliefs as the husband/father. lol this question is straight out of UWorld.
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Old 07-07-2011
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answer i think D...because they may not share belief...so if u decide in terms of giving blood then there are 2 options A and D. By the time u get court orders it may be late so i will go with D...
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B) Do not give blood to the mother because the husband's decision should be respected, and only give to the daughter in event of emergency

Next of kin's views should be respected in circumstances where no clear direction is available from an adult patient. However, for the child the appropriate actions for emergency measures should be taken.
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Old 07-07-2011
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i think its B...cuz the kid should get the blood no matter what....but then the mother should not because of what the husband has said (substituted judgment)
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Quote:
Originally Posted by jattdoc View Post
i think its B...cuz the kid should get the blood no matter what....but then the mother should not because of what the husband has said (substituted judgment)
Answer is option D !!
lol i picked option B while doing UW but got it wrong as well.

In the question stem it does not say that you have confirmed the religious beliefs of the mother and the daughter (they have altered mental status & cannot respond to questions). Since you can't confirm their beliefs you have to go with treating them normally. Substituted judgement, Surrogative decisions or next of kin can make decisions when there is an advanced directive from the pt. In this case assuming that the Father's beliefs are shared and not providing the proper treatment of care can result in their death!!
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Old 07-07-2011
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i think B) I remember it was told in live lectures at the Kaplan
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Default B

Answer is B
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Default B

Husband can make decisions for his wife, but he cannot withdraw a life of limb saving treatment from his daughter...

So ans B is correct
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i would go with D!!!
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Everyone saying B look at the bottom of the page under "similar threads" .. Heights posted a thread earlier with a different Jehovahs witness question. Refer to that. The answer is D because you cannot confirm their religious beliefs.
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i will also go with (B)
as conrad fischer something like that as far i remember..
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this is the same question explained in cornard's fisher 100 cases and also usmle.. the correct answer is D

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Old 07-07-2011
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Default Correct Ans: D

Behavioral science questions can be tricky, you either know it or you don't so just do a ton of questions until you get good at it

A similar question to this was in UW and only 23% of folks got it right (most picked B), so I thought I'd post it here.
The bottom line is that with any patient, unless the patient tells you or have written documentation (advanced directive or a card carried by Jehovah's witnesses stating that they must not be given blood), always treat in an emergency. Period.

In this case, although the husband says the family is Jehovah's witness, there is no proof that the wife would refuse blood if she were able to. Remember, it's not the husband's wishes that must be respected, it is always the patient's wishes that are important.

With children, the physician always needs to do what is best for the child in an emergency situation, regardless of what the parents wish.

If it's not an emergency, the parents are the primary decision makers and they get to choose what treatment their child gets. However, if their wishes are not in the best interest of the child, the physician can take them to court. For example, I heard of this case where the parents refused chemotherapy for their child, the doctors took them to court and won, treated the child and the child got better.

Thanks for playing
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  #18  
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in this case, where you do not listen to the husband and treat the women anyways....is this a special rule for Jehovah's witnesses?



what if it were any other situation? where a person (not a minor) comes in unconscious, but there is a next of kin present to inform the doctor whether or not that person wants specific procedures that would save their life....what will the doctor do? (and there is no written will or paperwork...just word of mouth)
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Quote:
Originally Posted by jattdoc View Post
in this case, where you do not listen to the husband and treat the women anyways....is this a special rule for Jehovah's witnesses?

what if it were any other situation? where a person (not a minor) comes in unconscious, but there is a next of kin present to inform the doctor whether or not that person wants specific procedures that would save their life....what will the doctor do? (and there is no written will or paperwork...just word of mouth)
No, it's not a special rule for Jehovah's witnesses, it applies to all patients: in emergency situation if the patient is unconscious you always save the person's life regardless of what the next of kin says. The only time you don't do that is if there is a written Do Not Resuscitate order, Advance Directive, or other legal written document.

If it's not an emergency and the patient is incapable of stating their wishes, for example a mentally challenged or person in a vegetative state, then that's when the husband, next of kin, or legally authorized representative can tell the doctor what the patient would wish (note that it's not the husband's etc wishes, they are simply telling the doctor what the patient would want).

Edit: If you think about it, this is a good thing! What if the husband wanted his wife dead so he could get all her money, and he told the doctor not to save her, then the family arrives and you find out he was lying, etc etc...
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Quote:
Originally Posted by heights View Post
No, it's not a special rule for Jehovah's witnesses, it applies to all patients: in emergency situation if the patient is unconscious you always save the person's life regardless of what the next of kin says. The only time you don't do that is if there is a written Do Not Resuscitate order, Advance Directive, or other legal written document.

If it's not an emergency and the patient is incapable of stating their wishes, for example a mentally challenged or person in a vegetative state, then that's when the husband, next of kin, or legally authorized representative can tell the doctor what the patient would wish (note that it's not the husband's etc wishes, they are simply telling the doctor what the patient would want).

Edit: If you think about it, this is a good thing! What if the husband wanted his wife dead so he could get all her money, and he told the doctor not to save her, then the family arrives and you find out he was lying, etc etc...
oh ok...makes sense....i never thought of it in the sense of emergency vs non emergency...thanks
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