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  #1  
Old 10-12-2011
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Medicolegal and Ethics Jehovah's Witnesses Patients Need blood transfusion

A physician staffing the emergency room at an urban trauma center is caring for a mother and her 6-year-old daughter who were both injured in a motor vehicle accident. The patients have both been seriously wounded sustaining blunt abdominal trauma, and peritoneal lavage reveals blood in both patients. Both patients have a clouded sensorium and do not respond appropriately to questions. The husband and father of the patients arrived at the hospital with the patients, and when the need to operate on both of the patients was discussed with him he states that his wife and his daughter can not receive blood products because it is against their religious beliefs. The physician discussed the risks of operating without blood products with the husband at length, but he continued to refuse stating that his family “would not go to heaven” if these products were administered. The physician plans to treat both patients aggressively with crystalloid solutions and appropriate interventions, but should the need for blood products arise what is the best course of action?

A. Administer blood products to both the mother and the daughter because you can not be sure that they share the religious beliefs of the father.
B. Administer blood products to the mother because she is an adult, but the father is the automatic next-of-kin for the child, so his wishes must be respected.
C. Seek a court order to administer blood products to the mother and the child.
D. The husband’s wishes for his wife must be respected, but a court order should be sought to intervene on the child’s behalf for life-saving treatment.
F. Because the husband does not have documents stating that he is the durable power of attorney for health care for either of these patients, his wishes are irrelevant. Treatment should be rendered.

I am posting this question because I have seen conflicting information about this.


Please post explanation.
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Old 10-15-2011
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Question I Think D Is The Answer

Hey,
Is it D?
For the mother, as an adult, her husband mentioning that her beliefs are against receiving blood is enough to withhold the blood transfusion (somewhat similar mentioning unconscious patient wish of no DNR by his next of kin).
For the child, even the parents can't withhold a lifesaving measure from being done to children (I think the same goes for religion)

So what is the right answer?

Last edited by roodiemd; 10-15-2011 at 03:49 AM. Reason: Change of answer
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  #3  
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C. Seek a court order to administer blood products to the mother and the child.
It's not difficult to decide,whenever patient isn't able to response n lost capacity to make decision & family is in disagreement then just get a court order for the needed treatment.
what's the real answer ? do share !
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Old 10-15-2011
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the answer is d. father can't make decisions for kid if they are not in his/her best interest.
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I would go with answer A. Because this is an emergency situation and the treatment is life saving, parents can't withdraw it from a child. There is no need of court order in emergency situation as delay in treatment might cost patients' lives. Only options left now are A and E. Obviously father/husband doesn't need durable power of attorney and in emergency, both mother and child need blood transfusion, I will go with A. Please correct with if I am wrong.
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Old 10-15-2011
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According to UW choice A is correct!
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Old 10-15-2011
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Quote:
Originally Posted by naziheh View Post
According to UW choice A is correct!
This is a UW question and yes, choice A is correct.
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Old 10-15-2011
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Question ????

So things are contradicting... Why the physician believe the patient's next of kin when mentioning that the patient repeatedly said no DNR (which is a UW question as I think) and now when the husband says that his sick wife doesn't agree with transfusion, the answer would be A because no documentation????
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Old 10-15-2011
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Default I think B

I think it should be B. The physician can administer blood work to the adult cos she is an adult and does not need the fathers permission.
But the doctor needs to follow 1 of the parents advise for the kids since she is a minor. So no blood administration to the mom.

That or either get a court order and dont administer blood work to both mom and kid. But since that is not an option.

I would strongly go with B.
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Well here husband believes that they won't go to heaven, his wife's believes are not mentioned. And I think for DNR orders too, if the patient has persistently mentioned about DNR, no matter what next of kin says, patient s/n/b resuscitated.
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Originally Posted by roodiemd View Post
So things are contradicting... Why the physician believe the patient's next of kin when mentioning that the patient repeatedly said no DNR (which is a UW question as I think) and now when the husband says that his sick wife doesn't agree with transfusion, the answer would be A because no documentation????
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Old 10-15-2011
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B can never be the answer as parents can't withdraw life/limb saving treatment from their child.
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Originally Posted by docji View Post
I think it should be B. The physician can administer blood work to the adult cos she is an adult and does not need the fathers permission.
But the doctor needs to follow 1 of the parents advise for the kids since she is a minor. So no blood administration to the mom.

That or either get a court order and dont administer blood work to both mom and kid. But since that is not an option.

I would strongly go with B.
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Quote:
Originally Posted by tapan View Post
Well here husband believes that they won't go to heaven, his wife's believes are not mentioned. And I think for DNR orders too, if the patient has persistently mentioned about DNR, no matter what next of kin says, patient s/n/b resuscitated.
The husband said receiving blood is against THEIR beliefs (the mother and the child) and didnt say that it is against his belief, that is one
Second thing, in the DNR case I was talking about the doctor have not heard the patient requesting the DNR, the next of kin mentioned that and the physician believed that and didn't recussitate (according to the case answer) so I don't see anything different here, the next of kin is saying that transfusion is against their belief so why not to believe and don't transfuse at least for the mother who is an adult!!!
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Okay, if doctor hasn't heard from patient then he has to go with next of kin's wishes. But here in option where doctor is not giving blood to mother, he has to seek for court order to treat the child. So that's not proper as it is an life saving treatment.
Quote:
Originally Posted by roodiemd View Post
The husband said receiving blood is against THEIR beliefs (the mother and the child) and didnt say that it is against his belief, that is one
Second thing, in the DNR case I was talking about the doctor have not heard the patient requesting the DNR, the next of kin mentioned that and the physician believed that and didn't recussitate (according to the case answer) so I don't see anything different here, the next of kin is saying that transfusion is against their belief so why not to believe and don't transfuse at least for the mother who is an adult!!!
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One thing is certain that the minor will be receiving treatment no matter what as it's a life-saving procedure in this scenario. Now, we have to deal with the wife. Well, she is comatosed and cannot speak for herself. Her husband is just expressing HIS wishes. It is not mandatory that those wishes are shared by the wife as well. If the wife herself said these words that she did not wish to receive life saving techniques, or if she had a card/document stating that "DNR"..that would matter to the physician and he will not treat her. But, this is a life saving technique and you have NO time to judge whether the husband is actually representing the wife's wishes or not. Therefore, go ahead and save her. Thus, answer A. (By the ways, this is question # 783 from Uworld)

Last edited by doc Mm; 10-15-2011 at 09:54 AM.
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  #15  
Old 10-15-2011
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Correct Answer A

For the child, the answer is give life-saving treatment no matter what the parents say, religious reasons or otherwise.
So for the child it is not really whether or not you can be sure that the 6-year old girl shares her father's beliefs, it is life-saving and that's it.
Also for the child seeking a court order, it would not be appropriate because you cannot let the child die while you wait for the court order.

For the mother is a different issue, because in this case if you knew she shares those beliefs (i.e. not only that she attends a particular church, but she has stated in the past that she'd rather die than receive blood products) then the answer is autonomy first. But in this case you do not know, they may be going through divorce, he may want to see his wife dead, who knows.
Also note "The husband’s wishes for his wife must be respected" is wrong. Whenever we respect what the spouse says it is because the spouse speaks on behalf of an incapacitated/unconscious patient, not because those are the spouse's wishes.

Bottom line, A is the best answer, but like I said I wanted to have other people's thoughts because I have seen conflicting information around.
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