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ethics interview question

yoyohomieg5432

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    how would you answer a question along the lines of: "a patient needs a blood transfusion but their religion permits it. what do you do?"

    do you just respect their wishes and try to do your best without a transfusion regardless if they end up dying?

    or do you go against it and save them??

    are there laws regarding this situation? i'm not sure what I would do
     

    TheWeeIceMan

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      how would you answer a question along the lines of: "a patient needs a blood transfusion but their religion permits it. what do you do?"

      do you just respect their wishes and try to do your best without a transfusion regardless if they end up dying?

      or do you go against it and save them??

      are there laws regarding this situation? i'm not sure what I would do

      I'd be like "okay, let's do the transfusion then..."


      Seriously though, I would just present a rational response about explaining the need for the transfusion and what would happen without it. If it goes against their religion and they refuse treatment, you can only do so much. These questions are more about showing you can thoughtfully see both sides of a situation than knowing exactly what a practicing physician might or could do (given state laws, etc).
       

      Womb Raider

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        how would you answer a question along the lines of: "a patient needs a blood transfusion but their religion permits it. what do you do?"

        do you just respect their wishes and try to do your best without a transfusion regardless if they end up dying?

        or do you go against it and save them??

        are there laws regarding this situation? i'm not sure what I would do

        If they are over 18 and don't agree to a transfusion, you can't do it no matter what. The only time you can overrule this is by going to the court.

        Personally, it's their life and who am I to go against their belief? If it was against their religion and they didn't want it, I wouldn't give them blood even if I could. To some people their spiritual life is more important than their physical life, and we would be shattering this if we gave them blood against their will.

        <18 yo - it is up to their legal guardians (parents). If they don't agree to allow their children blood, you can't give it to them.

        I personally don't agree with this, as I don't think people under 18 have matured enough to know what they really want in life. However, there's really nothing you can do as a doctor in this situation but follow protocol.
         
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        AlexMack12

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          I'm a non-traditional applicant and I've worked in a clinical capacity in a hospital. There was a woman who required a blood transfusion but refused to receive one due to her religious beliefs. The only thing you can do as a clinician is make sure the patient is well-informed (I.e., no language barrier, etc) of the risks associated with refusing treatment. Also, ensure they have privacy away from family/friends to communicate their decision so you can be surer it's their own and not caving to external pressures (I once met a nurse who told me about a young woman who was raised a certain religion forbidding blood transfusions but decided to accept one provided no one in her family would find out). Other than that, as tough as it is, a patients decision is their own. It's a tough lesson in medicine but important as a future provider/clinician that you will almost certainly encounter situations where a patient will refuse treatment for some reason and this choice is in disagreement with your clinical judgment but there's not too much you can do. Good luck!
           

          Snakes

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            This is a cut-and-dry ethics question, and it actually has a fairly easy answer. Every mentally-stable adult patient has the absolute right to refuse medical treatment. Of any and all types. A doctor can try to persuade a patient to accept treatment (or find religiously acceptable ways of treating the patient with their consent--there are some types of blood products now that I believe are acceptable to say, Jehovah's Witnesses), but you cannot force treatment in this instance. Children are a completely other matter and doctors can and do obtain court orders in life-threatening emergencies to be able to treat children without the consent of their parents. A meatier ethical question would perhaps involve a suicidal Jehovah's Witness who slashes their wrists and needs a blood transfusion. Is that person mentally stable and able to understand any decisions they may make about consenting to treatment? In the ED's I have seen, treating physicians have operated on the assumption that anyone who has attempted suicide is not mentally stable enough to consent or refuse medical treatment.
             

            Ismet

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              If they are over 18 and don't agree to a transfusion, you can't do it no matter what. The only time you can overrule this is by going to the court.

              Personally, it's their life and who am I to go against their belief? If it was against their religion and they didn't want it, I wouldn't give them blood even if I could. To some people their spiritual life is more important than their physical life, and we would be shattering this if we gave them blood against their will.

              <18 yo - it is up to their legal guardians (parents). If they don't agree to allow their children blood, you can't give it to them.

              I personally don't agree with this, as I don't think people under 18 have matured enough to know what they really want in life. However, there's really nothing you can do as a doctor in this situation but follow protocol.

              There are ways to override the parents if the child's life is at stake. Ethics isn't as cut and dry with minors.
               

              theseeker4

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                If they are over 18 and don't agree to a transfusion, you can't do it no matter what. The only time you can overrule this is by going to the court.

                Personally, it's their life and who am I to go against their belief? If it was against their religion and they didn't want it, I wouldn't give them blood even if I could. To some people their spiritual life is more important than their physical life, and we would be shattering this if we gave them blood against their will.

                <18 yo - it is up to their legal guardians (parents). If they don't agree to allow their children blood, you can't give it to them.

                I personally don't agree with this, as I don't think people under 18 have matured enough to know what they really want in life. However, there's really nothing you can do as a doctor in this situation but follow protocol.

                The statement that a parent's will is absolute is false. For life-saving treatment, parent's will is often overruled.
                 

                Womb Raider

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                  Whoops yes, meant to include the court bit on the bottom.. You can get a court order for both parents and children, thought that was common knowledge.

                  It is by no means easy, however.
                   

                  yoyohomieg5432

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                    alright guys, appreciate the help. that's what i would do but i wasn't sure if it comes off callus if you just respect their wishes and let them die in a sense.

                    how about this one: "what would you do if you resuscitated a DNR patient?" i think one context of this was like if a patient had just collapsed somewhere and then you saved him and found out later he was DNR.
                     

                    kyamh

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                      I know an ortho surgeon who operates by the following philosophy in his practice: he often takes on cases with people who are uncomfortable with a transfusion and talks at length about the risks etc with them. What he has done is he uses several less-common techniques that allow him to do his best to avoid a transfusion during surgery. The patients consent to the use of these techniques but also agree that, in a life-or-death scenario, he can give them a transfusion. Although many people won't make that concession, there are many who really appreciate the honest effort he makes to try and avoid a transfusion and go to him for services while they wouldn't go to a large hospital that wouldn't change their protocols in the same way.
                       

                      Doctor Bob

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                        how about this one: "what would you do if you resuscitated a DNR patient?" i think one context of this was like if a patient had just collapsed somewhere and then you saved him and found out later he was DNR.

                        We run into this all the time in the ED...
                        If a person comes in and does not have DNR documentation on their person (or accompanied by a family member with the paperwork) then I resuscitate them.

                        If they end up on a ventilator and it is later found that they have a DNR, it's easy to disconnect them. It's much harder to revive them 2 days after they are dead when it's found out that their DNR request wasn't actually real.

                        I can get sued pretty easily for wrongful death (failing to provide resuscitative care to someone who would be assumed to want it); to my knowledge nobody has yet successfully sued a doctor for "wrongful life" (reviving them when they wanted to die).
                         

                        Ismet

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                          alright guys, appreciate the help. that's what i would do but i wasn't sure if it comes off callus if you just respect their wishes and let them die in a sense.

                          how about this one: "what would you do if you resuscitated a DNR patient?" i think one context of this was like if a patient had just collapsed somewhere and then you saved him and found out later he was DNR.

                          that's really not a big ethical dilemma. no official DNR documentation at the time = resuscitate.
                           

                          mvenus929

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                            alright guys, appreciate the help. that's what i would do but i wasn't sure if it comes off callus if you just respect their wishes and let them die in a sense.

                            how about this one: "what would you do if you resuscitated a DNR patient?" i think one context of this was like if a patient had just collapsed somewhere and then you saved him and found out later he was DNR.

                            That one's not really that difficult either. You want a real dilemma, how about this one:

                            A child is in the PICU and codes. Team starts resuscitation efforts. Mom comes in and sees the efforts, and tells people to stop, but she doesn't speak English. What do you do?

                            Actual scenario that happened when I was in the PICU. Attending voted to continue efforts while we tried to get an interpreter on the phone. The nurses were very upset by this decision, though, saying that Mom clearly did not want us to continue resuscitation. Mom later explained (via interpreter) that she thought her child was dead and that we were desecrating the body, but was very thankful that we saved the life.
                             

                            Ismet

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                              That one's not really that difficult either. You want a real dilemma, how about this one:

                              A child is in the PICU and codes. Team starts resuscitation efforts. Mom comes in and sees the efforts, and tells people to stop, but she doesn't speak English. What do you do?

                              Actual scenario that happened when I was in the PICU. Attending voted to continue efforts while we tried to get an interpreter on the phone. The nurses were very upset by this decision, though, saying that Mom clearly did not want us to continue resuscitation. Mom later explained (via interpreter) that she thought her child was dead and that we were desecrating the body, but was very thankful that we saved the life.

                              Even if she spoke clear English, would a mother's verbal request to stop resuscitation be enough to stop resuscitating in absence of formal documentation?
                               

                              Lya

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                                Even if she spoke clear English, would a mother's verbal request to stop resuscitation be enough to stop resuscitating in absence of formal documentation?


                                First of all, thank you all for your comments. Many things have been clarified even though they are common ethical questions.

                                As someone said above, in life/death situations, parents' will or verbal request can be overruled, among other ways, by court orders (but do these orders get decided in a timely manner in such a short amount of time?) because the best interests of the child is to get resuscitated.

                                Someone can correct me if I'm wrong.
                                 

                                Ismet

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                                  First of all, thank you all for your comments. Many things have been clarified even though they are common ethical questions.

                                  As someone said above, in life/death situations, parents' will or verbal request can be overruled, among other ways, by court orders (but do these orders get decided in a timely manner in such a short amount of time?) because the best interests of the child is to get resuscitated.

                                  Someone can correct me if I'm wrong.

                                  I know. I'm one of the ones that said the parents can be overruled. I should have clarified, I guess...it was more of a rhetorical question. I don't see how the doc had any other choice but to continue the resuscitation, and I don't see why the nurses were so upset. Unless I'm missing something.
                                   

                                  mvenus929

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                                    Even if she spoke clear English, would a mother's verbal request to stop resuscitation be enough to stop resuscitating in absence of formal documentation?

                                    Generally, if the parents speak clear English, someone will pull them aside, explain what is going on, and if they want to stop, their wishes will be honored. Of course, the kids I saw die in the PICU were those with life-threatening diseases: pulmonary HTN so bad that the child had to be heavily sedated to not go into crisis, children with really complex cardiac anatomy, children that are probably brain dead but haven't been determined to be so yet, etc, so most of the time, the entire team agrees with the course of action. In the particular case above, we were getting ready to send the kid to the floor, so we didn't think the kid was on that downslope of disease, but some of the nurses still had a lot of problems with the decision.

                                    This is why those type of discussions are crucial in the PICU (and other ICU settings), because it's really hard to get a clear idea of wishes when a patient is circling the drain. We have a surgeon who refuses to talk to parents about DNR/DNI while their children are in the PICU following surgery, even if the child isn't doing so well, so there is some tension in that mentality as well.

                                    First of all, thank you all for your comments. Many things have been clarified even though they are common ethical questions.

                                    As someone said above, in life/death situations, parents' will or verbal request can be overruled, among other ways, by court orders (but do these orders get decided in a timely manner in such a short amount of time?) because the best interests of the child is to get resuscitated.

                                    Someone can correct me if I'm wrong.

                                    In emergency situations, consent is generally not required for life-saving treatment. In certain situations, a court order can be obtained to overrule the parents (as in cases of Jehovah's Witnesses and blood transfusions, especially in minors), but these generally aren't decisions that are made in emergency situations; they're done when the risks and benefits of treatment are considered and the parents choose to forgo what is deemed to be life-saving treatment (chemo, blood transfusions, etc).

                                    So generally, in absence of a sit-down discussion with parents, the default is full code and full resuscitation, parents' wishes be damned.
                                     

                                    Ismet

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                                      Generally, if the parents speak clear English, someone will pull them aside, explain what is going on, and if they want to stop, their wishes will be honored. Of course, the kids I saw die in the PICU were those with life-threatening diseases: pulmonary HTN so bad that the child had to be heavily sedated to not go into crisis, children with really complex cardiac anatomy, children that are probably brain dead but haven't been determined to be so yet, etc, so most of the time, the entire team agrees with the course of action. In the particular case above, we were getting ready to send the kid to the floor, so we didn't think the kid was on that downslope of disease, but some of the nurses still had a lot of problems with the decision.

                                      This is why those type of discussions are crucial in the PICU (and other ICU settings), because it's really hard to get a clear idea of wishes when a patient is circling the drain. We have a surgeon who refuses to talk to parents about DNR/DNI while their children are in the PICU following surgery, even if the child isn't doing so well, so there is some tension in that mentality as well.



                                      In emergency situations, consent is generally not required for life-saving treatment. In certain situations, a court order can be obtained to overrule the parents (as in cases of Jehovah's Witnesses and blood transfusions, especially in minors), but these generally aren't decisions that are made in emergency situations; they're done when the risks and benefits of treatment are considered and the parents choose to forgo what is deemed to be life-saving treatment (chemo, blood transfusions, etc).

                                      So generally, in absence of a sit-down discussion with parents, the default is full code and full resuscitation, parents' wishes be damned.

                                      I see. Thanks for the clarification, that was helpful. :thumbup:
                                       
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