Ethics questions help

[Kobebucsfan]

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A 5-year-old child is brought to the emergency department after suffering an acute, severe asthma exacerbation in school. As the child is being treated, the child's parents arrive at the hospital and demand that the treatment be stopped, citing their religious beliefs against medical intervention. At this point the physicians should do which of the following?

B.Discharge the child into the parents' care after the appropriate paperwork is completed
C.Provide whatever care is required to protect the child from harm



Rule #14: Parents cannot deprive the child of life- or limb-saving medical treatment, even for religious reasons


What if they were Jehovah Witnesses and they need immediate blood transfusion, i thought u werent supposed to give. But the RULE here states u cant do that even for religious reasons

 

[zhopv10]

If it is a child you are able give the blood in the case of the Jehovah's Witness (you can court order it). There is perhaps some variability by state? I know it's the case here and I would imagine that holds across the country.

 

[Kobebucsfan]

If it is a child you are able give the blood in the case of the Jehovah's Witness (you can court order it). There is perhaps some variability by state? I know it's the case here and I would imagine that holds across the country.

if a child has a Jehovah ID card, u cant give blood right . I know for adults u dont, is it same for kids too

 

[tasar1898]

That aint true , only if the child is emancipated .. Otherwise disregard religious beliefs and transfuse as needed

 

[Ischemia1032]

I'm honestly not true, typically physicians are supposed to respect patient autonomy and respect their decisions, I am not sure about emergencies but I would presume it is the same, however I have not taken step 1(M1)

 

[worldbeater]

I'm honestly not true, typically physicians are supposed to respect patient autonomy and respect their decisions, I am not sure about emergencies but I would presume it is the same, however I have not taken step 1(M1)

You are usually right, you should respect the patient's wishes, but a minor is a different situation. That's why as the Tasar nicely said, you should transfuse the patient.

The logic is a 5 year old doesn't have the capacity to make the decision of whether to take life saving treatment or not; the parent has no right to refuse treatment for a child for any reason in a critical situation, causing them to die. So you automatically do what it takes to save the life of the minor.

 

[Ischemia1032]

Ah ok, but is it because it is an emergency? Let's say we had a 6 y/o male who needed a removal of a meningioma and he REALLY "needed" it, but the parents said no. Technically speaking it is not emergent, however the boy will die in the coming months without it's removal. Basically, how do the rules change for minors with life-threatening but non-emergent conditions.

 

[worldbeater]

Generally on practice questions, it will be pretty clean cut. It will be a minor in a critical situation that will die without treatment, and they will throw a screwball (like a Jehovah's witness, can't get in touch with parents, etc). The concept they are trying to teach is that you have to give treatment.

Your scenario is more complicated because of the longer timeframe, if I came across that type of question I would choose "consult hospital ethics committee", because from the content we are suppose to know, there is not a clear line of thinking of what to do as the single physician on the case.

 

[tasar1898]

I really am curious about the Jenovah witness thing.. Why is it emphasized so much on books , are there so many of them in USA??

About minors its simple as that

1)Will die now : Treat as needed
2)Will die/suffer limb-losing injury soon/near future ( meningioma impinging , leukemia w/e) : Court order to treat
3) Will not die/suffer limb-losing injury ( i.e kid has just severe acne or something ) : Respect kid's parents wishes

 

[worldbeater]

Why is it emphasized so much on books , are there so many of them in USA

It's probably because they are seeing a lot cases in the ER and physicians are not sure what to do, they emphasize certain questions so the next cohort of doctors will be better trained in that type of situation.

2)Will die/suffer limb-losing injury soon/near future ( meningioma impinging , leukemia w/e) : Court order to treat

Court order would be a good option too.

 

[Ramius]

If it is a child you are able give the blood in the case of the Jehovah's Witness (you can court order it). There is perhaps some variability by state? I know it's the case here and I would imagine that holds across the country.

I had a somewhat similar case of a Jehovah's Witness with a ruptured spleen, a smashed face, a fractured femur, and a hemoglobin = 3. He underwent splenectomy, facial repair, intramedullary rodding, and administration of androgen in the ICU with intravenous feeding for ~3 weeks, and survived. He returned to say he would pay nothing because I had not saved his life: "The Lord God Almighty did."

There was no arguing with that.

My wife is a pediatrician from Austria. A recruiter was passing through town; we had an exchange student from Germany living with us that year. The recruiter for the USAF had nothing in Europe, but the Army did. We went there for 7 years; wife took a fellowship and later we transferred to the Navy. All in all, the freedom to practice medicine in the military was wonderful. I would do it again. Write if you have questions.

H.E.Butler III M.D., FACS
CDR, USNR, Fleet Reserve
Instructor, Psychiatry, EVMS
Instructor ACLS, ATLS
[email protected]