Pathophysiology (Blood and blood components)
A 16-year-old involved in a motor vehicle accident is brought via ambulance to the emergency room you work at. She needs an emergency blood transfusion. Her mother, a devout Jehovah’s Witness, refuses to give permission for her daughter to receive blood products because it goes against her faith.
As a culturally and religiously sensitive nurse, how might you explain to this mother why her daughter needs blood?
What are the ethical issues raised by the mother refusing blood products for her daughter?
If the mother continued to refuse to allow her daughter to receive blood products, what would you do as a provider?
Sample Answer
Blood Transfusion and Jehovah Witnesses
The religion and culture of individuals greatly influence their perspectives on healthcare and providers of healthcare. Cultural competence in healthcare provision involves healthcare organizations and providers’ abilities to deliver healthcare services meeting the religious, social, and cultural needs of the family and patient. Provision of healthcare services that are culturally competent achieves the goal of ensuring consistency in care quality for every patient regardless of their ethnic, religious, cultural, or racial background. One of the strategies utilized in improving cultural competence and religious sensitivity includes encouraging the family’s participation in healthcare decision-making (Swihart and Martin, 2020). In this case, explaining to the mother why her daughter needs blood would involve negotiating with her and empowering her to select the best option for her child with due consideration of her values and beliefs as a Jehovah Witness. Empowering her would involve provision of information about her daughters’ scenario, explain the situation, share opinions from a health perspective, and making it possible for her to analyze the risks and benefits of their decision. Such counseling promotes trusting relations between surrogate decision-makers and healthcare professionals. Findings show that proper dialogue and counseling can convince Jehovah’s Witnesses in accepting blood transfusions (Shela, 2018).
Ethical Issues
Ethical issues that arise in the case are based on the ethical principles that govern the medical treatment and the relationship between the care provider and the patient. Respect for the autonomy of the patient and their human rights requires that informed consent is obtained before any medical intervention. Beneficence requires the care provider to act in the best interests of patients, while nonmaleficence requires the care provider to avoid harming whenever possible (Straker et al., 2018). The blood transfusion rejection creates an ethical dilemma between the freedom of the patient to reject or accept medical treatment regardless of consequences and the duty of the care provider to provide optimal treatment that reduces harm and maximizes benefits. It becomes more complicated when the patient is a child or minor who cannot decide about the medical intervention applied. The parent exercises the right of autonomy on their behalf, which leaves the care provider at odds with the principle of justice, which involves ensuring the equal distribution of risks, benefits, and costs (Straker et al., 2018).
Suppose the mother continued to refuse to allow her daughter to receive blood products. In that case, a specific issue order could be requested from the courts if a complete and candid discussion with the parent, the healthcare team, and the child does result in a favorable decision in the child’s interests. If time does not permit, blood should be given since the surrogate’s preference reveals more harm than benefit. Failing to give a child life-saving treatment renders the care provider vulnerable to criminal prosecutions. US Supreme Court rulings on the legal rights of minors and children of Jehovah Witnesses have asserted that parents cannot withhold blood on their children’s behalf when blood is necessary for life or death situations (Straker et al., 2018). Such decisions are based on three legal principles. The first is parens patriae, which points out that the child’s welfare and the interest of the state outweigh the rights of parents to refuse treatment. It is rooted in common law and is applied to children, mentally ill or mentally incompetent adults. The second is that the parents’ rights do not include the power of life or death over their offspring, and the third is that parents do not have an absolute legal right to withhold medical treatment for their children based on their beliefs.
References
- Shela, A. A. H (2018). Respecting Parent’s Cultural Beliefs or Saving Child’s Life: an Ethical Dilemma Surrounding Blood Transfusion. Prog Asp in Pediatric & Neonat 1 (1). PAPN. MS. ID, 104.
- Straker, T., Rajan, S., & Anitescu, M. (Eds.). (2018). Anesthesiology: A Problem-based Learning Approach. Anesthesiology a Problem Based. p 190
- Swihart, D. L., & Martin, R. L. (2020). Cultural religious competence in clinical practice. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493216/
