Question

Case Study:

Refusing Treatment

A 35 yea old woman with chronic disease is admitted to your LTC facility. She has developed a problem requiring a transfusion, and if she does not receive one, she will die. Her religious beliefs preclude her from receiving blood products. After a thorough explanation by the physician , she understands that she is likely to suffer permanent physical injury and possibly die if she refuses to accept the transfusion. Her family, which shares the same religious affiliation, support s her decision. The physician refers to the matter to the healthcare ethics committee on which you sit as the healthcare administrator. The committee members all agree that the law permits a competent adult to refuse medical care.

Case Study Questions

1. Is it ethical to speak to this patient in private, away from her family, and offer her the option of a secret transfusion so that nobody knows of it, or is this coercion into sinful behavior?

2. Is it ethical to meet with the family and patient to attempt to convince them to change their minds regarding the transfusion? What can and should be said to them? What should not be said?

3. How does this discussion change if the patient is a child or a ward of the state?

4. What are the legal facts of which the healthcare administrator must be aware in such a case?

Answer 1

1) Blood transfusion in certain community is a sinful act according to their beliefs and practices.It is not ethical to talk to patients in private and transfuse a blood ideally ,but being a major she has the right to accept or refuse the treatment on her own will and should explain to her relatives it's necessity.

2) Blood transfusion is one of the life saving treatment .It's benefits has to be explained first and then the complications if not transfused at the right time.Explain in place of whole blood there are options as well to save the lives of patient.It is not easy to convince them rather to make them understand it's need as a part of treatment.

3) If the patient is a child ,the child usually has no right to make decisions.It is the parents who makes the decisions in the treatment.The parents has to be briefed counselled. About this life saving treatment,where a parent hardly think to refuse for transfusion if it could save the life of the child.

Two physician sould explain its necessity and get consent

4)The health care administrator must be aware of some legal facts, hence to provide issues in later stage

• Informed consent has to be taken
• Relatives has to be explained
• Transfusion reaction has to be explained as well
• Blood cross matched and checked by physician, nurse supervisor or nurse practitioner,and the nurse who is going to administer the blood
• Psychological support can be given