Ethical Question concerning Jehovah's Witness

[beatsbydre]

I have seen two versions of these from different sources (UWorld #783 + Khan's Cases) and they differ in response. I'm wondering what you think is the correct way (and the correct answer on USMLE) for this situation.

In both questions, a patient requires blood transfusion to live and is incapacitated in the hospital.

In the UWorld question, the patient's spouse is on the telephone line and the spouse is partially informed of the situation and says no to the transfusion because they say that both of them are Jehovah's Witnesses. The UWorld question says that you should still give transfusion because the spouse is not FULLY informed of the patient's health. However, the explanation says that if you had a meaning conversation with the spouse about the patient's health, the spouse can prevent the transfusion from happening.

In Khan's cases, the answer is still to give the transfusion but the explanation says that only don't give blood if the actual patient carries a card (saying that they are Jehovah's Witnesses). It doesn't matter what the spouse says because the spouse might be evil.

I'm confused.

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[Sloo0]

The UW one is because he gave a brief statement and then he wasn't able to be contacted to discuss further treatment if necessary or to confirm his claims.

It would be like you calling me up and be saying my family believes in Barney and therefore I will only allow transfusions with purple fluff and then I hang up and you can't reach me.


Realize that you're taking a medical licensing exam and so it's gonna be geared towards patient benificence and nonmalificence and all that jazz.

Plus I wouldn't worry too much about those type of questions, if SDN threads/Qbanks/NBMEs and the Step 1 I took a few days ago are any indications, the real Step 1 seems to stray away from ambiguous legal questions.

 

[operaman]

The trick to ethics questions is to frame your answer around the 4 pillars (autonomy, beneficence, non-maleficence, justice) as opposed to simply asking yourself what you would do. They're good about making things seem ambiguous if you try to go on instinct.

Obviously you wouldn't give blood products if the patient was awake and had capacity to make the decision because that would violate their autonomy. In the case of the spouse relaying her purported religious convictions, even if he were in the room with you it may not really tell you much about her actual convictions unless he has some sort of signed document attesting to her wishes under the circumstances. If there's only the spouses word, that's a pretty tenuous thread for withholding basic life-saving treatment because even that doesn't really respect HER autonomy, merely his.

What if there were no religious issue and the spouse simply refused to consent for an emergency life-saving intervention? (pt. with internal bleed post-trauma needs emergency surgery) We would not withhold treatment even though the spouse is the surrogate decision-maker.

In both cases, you give blood products/do the procedure because NOT doing so would be doing harm, and the patient is not able to assert their autonomy and their 'best interest' is a subject of debate in these cases. As such, you would err on the side of doing no harm.