@gyngyn
@LunaOri
@Med Ed
@Moko
@Tenk
@Maimonides1
I think this is one of those teaching moments!
I haven't followed this debate too closely, but from what I've gathered, we have an unconscious patient who is reportedly a Jehovah's Witness and is coming in with hemorrhagic shock. Strangely the trauma bay is devoid of any attendings, PAs and residents, and somehow this decision is falling upon the interviewee, who I can only presume is playing the role of Chief medical student (MS-V?).
I personally stay away from asking these ethical dilemmas because they often rely on information that is beyond most applicants' knowledge base, e.g. in this scenario, knowing the relevant laws, that not all Jehovah's Witnesses are against blood transfusions, and that patients don't just keel over the moment their hemoglobin drops below 7. These questions also unfairly favor those who have prepared for this type of question (not uncommonly those with superior resources).
Regardless, there is a general framework that I learned from consulting to successfully answer these types of questions. In my opinion, the key is to demonstrate a thoughtful and analytical approach so you get credit even if your answer is "wrong". One should always ask clarifying questions first: the How's, What's and Why's. How do we know this patient is a Jehovah's Witness? Are they carrying a card explicitly stating their preferences, or is there documentation in the EMR about their religious affiliation and preferences regarding blood products? What prior conversations have been documented on this topic? Or is this all hearsay from a family member or friend? What alternatives to blood transfusions are available, and how much time do we have to make a decision? Who is the legal decision maker? Is there concern that the legal decision maker is not acting in the patient's best interest? If so, what does local law say on this topic, and what consulting services are available for further guidance? The interviewer may paint this scenario as emergent and that there is no time to consult others, but by asking these questions, you have demonstrated your framework.
I personally never hesitate to admit my own ignorance as I probe with these questions, and my answer and rationale would include qualifiers specific to the scenario at hand. The few times I was asked these questions, my answers seemed to be adequately received with the above approach. Ethical dilemmas are rarely black-and-white and require nuance when deciding next steps. As a general rule, significant deference should be given to patient autonomy and their expressed wishes, and any attempt to circumvent it must be done with the utmost thoughtfulness and caution*.
An applicant who appears to rush in guns-blazing with transfusions while willfully ignoring others' cultural and/or religious beliefs will probably fair very poorly. The goal is to appear thoughtful, and not be seen as a walking liability for the school/hospital system. Just my thoughts.
* and documentation.. Lots and
lots of documentation.