so what is the most correct answer to the blood transfusion question?

[Retsage]

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If you are big enough of an ******* to let a child die because you're afraid the parents will sue you...

Wow. I don't know what to tell you.

 

[unsung]

If you are big enough of an ******* to let a child die because you're afraid the parents will sue you...

Wow. I don't know what to tell you.

It's not about being afraid of consequences (i.e. parents suing), it's about the ETHICAL decision of not respecting a patient's surrogates' wishes.

To analyze an ethical dilemma based on perceived potential self-interest is pretty shallow. For example, if the proposed dilemma is whether or not you should tell on a friend who is cheating, and your response is "no, I wouldn't because I don't want others to see me as a tattletale"... or even "no, I would never cheat myself because I'm afraid of getting caught." That's a sign of being stunted in the development of a personal moral system. It's the lowest level of analysis which we develop as like 6 year olds, when decide not to do something mom tells us not to do because we're afraid of getting punished.

Is it safe to presume most people have progressed beyond that stage? If so, I think it's pretty rude the way you made those unwarranted assumptions about the OP, that his answer was based on selfish considerations. I also disagree with whoever posted above that the OP is just trying to make himself feel better about his interview answer with his repeated posts.

I think the OP is honestly curious about the LEGAL responsibilities and limitations of what physicians CAN or CANNOT do in these situations. I'm curious too. Not because I'm worried about being sued, but I do respect the intentions behind these laws (to respect the sovereignty of the patient or patient's surrogate as medical decision-maker). Even if I were to choose to go against the law in a particular situation, I'd still like to know what the law is in that situation, and I think that is what the OP wants to find out as well. The people who are saying F*** the law, I'd just do XYZ no matter what are being a bit immature, imo.

It's obviously a very difficult issue with good arguments on both sides... otherwise it would not even be a good interview question. So chill out.

 

[Retsage]

*yawn*

There is no moral or ethical dilemma involved here.

 

[OldSchooler]

.

 

[Gut Shot]

but if you treat a minor against the parents wishes... you'd better get a freakin' good lawyer. and even s/he may not be able to save you. don't forget that kids are not people in our game. their parents control EVERYTHING.

Unless it's a life and death decision. That's the only aspect of this scenario that makes it a genuine dilemma.

 

[ngkats]

I think this is a good example of how political correctness can actually kill people. If they parents were not Jehovah Witnesses but a member of their own religion (or an agnostic ethical society) and said they refused blood transfusions for their dying child, would we have the same dilemma? Probably not.

Could a member of a religion stop the police from saving his/her child from a burning car because being 'rescued' was against their religion?

I would transfuse the child.

 

[LizzyM]

I did a little checking and this is what I found:

The law is quite clear regarding transfusing minors. Lifesaving transfusions can be given to minors against parental wishes. In such cases proceed by acknowledging the parent's wishes and informing the parents of the physician's responsibility to notify the child welfare authorities (agencies are obligated to provide administrative consent for treatment) and to transfuse the child in an emergency as required by law. Consultation with legal counsel is advisable in such cases.

http://www.clinicalcorrelations.org/?p=105

I would argue that this is not material that pre-med students are expected to have mastered and interview questions of this type are not helpful in identifying suitable candidates for admission. Some schools don't ask these types of questions but may ask about ethical dilemmas that arise in academic setting (because everyone has had the experience of being a student).

 

[Penguick]

I would argue that this is not material that pre-med students are expected to have mastered and interview questions of this type are not helpful in identifying suitable candidates for admission. Some schools don't ask these types of questions but may ask about ethical dilemmas that arise in academic setting (because everyone has had the experience of being a student).

So, if the question were, "would you tell on cheating students," what would your respond? I probably would say yes, I would tell. Not because I think it's wrong to cheat, but because I think that in an emergency situation, you wouldn't have the time to look things up, and the other doctors you may be working with may be waiting for you to figure things out. In that case, perhaps learning it correctly the first time would've been the saving grace.

 

[pianola]

In pediatrics, acting in the child's best interest will (often) override the parent's wishes. (From a pediatrics book I was reading when I was bored).

I got the same question in an interview (state of Florida) except the interviewers told me ahead of time that I would be legally permitted to transfuse the child in the event that the transfusion was life-saving treatment.

The question I got, however, was: How would you approach the parents? How would you deal with this situation? (Which is actually a much more interesting question than the one originally posed, when you know that both legally and morally you're obligated to save the child's life).

 

[LizzyM]

In pediatrics, acting in the child's best interest will (often) override the parent's wishes. (From a pediatrics book I was reading when I was bored).

I got the same question in an interview (state of Florida) except the interviewers told me ahead of time that I would be legally permitted to transfuse the child in the event that the transfusion was life-saving treatment.

The question I got, however, was: How would you approach the parents? How would you deal with this situation? (Which is actually a much more interesting question than the one originally posed, when you know that both legally and morally you're obligated to save the child's life).

Now that's a good question and gets at your instincts in dealing with others. (Not to say that some of those communication skills can't be taught in medical school, they can and should be, but the really ham handed communicators may be beyond teaching.)

 

[unsung]

*yawn*

There is no moral or ethical dilemma involved here.

And what if that *child* refused treatment, in conjunction with his/her parents? Quite recently, a 13 yo British teen refused a heart transplant which could have been potentially life saving. She didn't want to take the risk of making things worse and she didn't want to spend any more time in the hospital. Her parents *supported* her decision to refuse treatment... from a legal perspective, one could say her parents *refused* treatment on her behalf. A similar scenario as this one.

The hospital originally wanted to pursue legal action to force the procedure... until the girl's social worker came out in support of her decision.

Just to be clear, I'm an atheist. So if I were to consider things solely from my perspective, the idea of dying for some "arbitrary" rule is beyond ridiculous. The idea of letting one's child die like that is even worse. BUT. I can detach my own views from that of others. I may not be religious, but I still must respect the religious and cultural beliefs of others drastically different from me. Yes, there are people out there who are so deeply religious, they will die for it, they will let their child die for it.

The issue may seem easy to deal with if the child is either much too young to understand (say < 10), or the child himself/herself desperately wants to live and wants the treatment. But what if the child is, say, 13 yo, and holds the same religious/cultural beliefs as his/her parents? Sure, you could argue that a child doesn't have fully formed views yet, is not a "competent" or "informed" medical decision-maker. Otoh, in some cases, the child may *be* considered a competent decision-maker, as in the case of the British 13 yo who chose to refuse a life saving procedure.

Things are just not so cut and dry. Even at work at the hospital, I run into some coworkers who are always trying to impose their own cultural/religious views on others (i.e. the patients). Just being completely disrespectful and oblivious. It's sad, actually, to see how black and white and insensitive some people's worldviews are.

 

[stoic]

If you are big enough of an ******* to let a child die because you're afraid the parents will sue you...

Wow. I don't know what to tell you.

blah blah blah. and i don't mean to direct this directly at you... but once you grow up into actually being involved in these decisions, it becomes much less clear cut. i'm not pretending i wouldn't want to save the kid.... BUT if the parents say "NO!" then you better have a really, really, good lawyer.

 

[PeepshowJohnny]

blah blah blah. and i don't mean to direct this directly at you... but once you grow up into actually being involved in these decisions, it becomes much less clear cut. i'm not pretending i wouldn't want to save the kid.... BUT if the parents say "NO!" then you better have a really, really, good lawyer.

But people still get lawsuits brought against them from the grandkids of 97 year old demented Alzheimer's patients because no way could "Nana" die of natural causes. People are dumb and they sue over anything. In this case, the law is clear and yes, you need a good lawyer because it probably will get contentious, but you're doing the legally and morally correct action.

 

[pianola]

Now that's a good question and gets at your instincts in dealing with others. (Not to say that some of those communication skills can't be taught in medical school, they can and should be, but the really ham handed communicators may be beyond teaching.)

If you don't mind my asking, LizzyM, how would you have answered the question and/or dealt with the situation?

I'm not convinced I answered the question very well 😳. I just said something along the lines of listening to parental concerns and trying to reassure the parents that I would try to respect their beliefs insofar as I was legally able to do so. I would try to keep the parents as informed as possible about the child's condition (which is clearly critical if the child needs a life-saving transfusion).

In my case, I was told that the transfusion was necessary because the child was in a car crash; regardless of one's faith, a car crash is a traumatic event for a parent, so I said something along the lines of making sure that the parents had appropriate community support (including therapist/psychologist support if appropriate).

It's kind of hard to answer that type of question on the spot...

 

[rocketbooster]

If you don't mind my asking, LizzyM, how would you have answered the question and/or dealt with the situation?

I'm not convinced I answered the question very well 😳. I just said something along the lines of listening to parental concerns and trying to reassure the parents that I would try to respect their beliefs insofar as I was legally able to do so. I would try to keep the parents as informed as possible about the child's condition (which is clearly critical if the child needs a life-saving transfusion).

In my case, I was told that the transfusion was necessary because the child was in a car crash; regardless of one's faith, a car crash is a traumatic event for a parent, so I said something along the lines of making sure that the parents had appropriate community support (including therapist/psychologist support if appropriate).

It's kind of hard to answer that type of question on the spot...

yep, they grilled me on it for 20 minutes trying to get me to change my answer. go read half way up the page, LizzyM put what she'd say.

I just know for me I could not go with the safe answer and say I am not qualified to answer this. The interviewer was rephrasing the question in every way possible to make me answer it. He would have said "okay, based on YOUR experience right now, though, what would you do?" Even if I said I don't have any experience on this issue, he would still rephrase the question to make me give him an answer of what I would do in that scenario. I never backed down, though, and stuck with my answer, whether I was correct or not. Hopefully the interview turned out well, IDK.

 

[pianola]

yep, they grilled me on it for 20 minutes trying to get me to change my answer. go read half way up the page, LizzyM put what she'd say.

I just know for me I could not go with the safe answer and say I am not qualified to answer this. The interviewer was rephrasing the question in every way possible to make me answer it. He would have said "okay, based on YOUR experience right now, though, what would you do?" Even if I said I don't have any experience on this issue, he would still rephrase the question to make me give him an answer of what I would do in that scenario. I never backed down, though, and stuck with my answer, whether I was correct or not. Hopefully the interview turned out well, IDK.

No, the question I got was slightly different than yours. Read my post partway up the page...(I was already told what I was legally obligated to do).

 

[cbrons]

guardian ad litem?

 

[LizzyM]

In pediatrics, acting in the child's best interest will (often) override the parent's wishes. (From a pediatrics book I was reading when I was bored).

I got the same question in an interview (state of Florida) except the interviewers told me ahead of time that I would be legally permitted to transfuse the child in the event that the transfusion was life-saving treatment.

The question I got, however, was: How would you approach the parents? How would you deal with this situation? (Which is actually a much more interesting question than the one originally posed, when you know that both legally and morally you're obligated to save the child's life).

A few things I've picked up from a physician-colleague I know and trust:

Introduce yourself, say that you have some serious decisions to talk about and you'll be back in a moment. Suggest that they takea few minutes, if needed, to gather together the people who need to be there (someone might be in the restroom, etc) and say goodbye of those people who don't need to be in on the conversation (e.g. a neighbor or a classmate).

Sit down. Don't hold the conversation standing. Particularly don't stand while the family sits.

At that point I would inform the family that the patient had lost a lot of blood volume and what was being done to stop the bleeding. Then: "We can give a volume replacer but we have nothing that can replace the red blood cells. Eventually, the body will make red blood cells to replace those that have been lost but this will take weeks. Meanwhile, [child's name] is severely anemic. This means that there aren't enough red cells in the blood. Those cells carry oxygen from the lungs to the rest of the body. Without oxygen, the organs begin to die. This includes the brain and the heart and other vital organs. Over time, those organs may begin to fail. To prevent that from happening, we can give a blood transfusion.

Do you have any questions about what I've told you?"

I might go on to say that while I respect their religious beliefs, I am obligated to do what is necessary to save their child's life and that legally, I am permitted to administer this necessary treatment.

Depending on the circumstances, I might suggest that they talk with a hospital chaplain or other member of the clergy.

 

[pianola]

Thank you, LizzyM. Wow, I wish I'd been able to come up with something like that on the spot. But I guess they probably didn't expect me to know the details of the transfusion.

Anyway thank you. I'll keep some of those lessons in mind. Seems like a good way to handle the situation.

 

[han14tra]

I ACTUALLY WITNESSED THIS IN A HOSPITAL!! My Jefferson interviewer was impressed.

It was in the NICU and a baby of a Jehovah's witness family needed an exchange transfusion (80% of blood is replaced). The doctor I was shadowing got a court order to do it anyway. You are required by law to do what is best for a minor. The family was okay with it. The doctor called it "sinning for the family". If you court order it, then they can't be disgraced by their religious affiliates. In the end, they were just happy something was being done for their child.