Review Question - QID 107058

The patient is most likely a Jehovah's Witness, whose religion prevents him from accepting blood transfusions. The physician must not interfere with the belief of the patient; therefore, the physician must respect the patient's written instructions and not administer a blood transfusion.

As physicians we are bound by four ethical principles: autonomy, beneficence, nonmaleficence, and justice. Autonomy: physicians must respect individuals as patients, their confidentiality, and honoring their preferences for medical care. Beneficence: physicians must act in the patient's best interest and they must balance autonomy and beneficence; but if there is a conflict, autonomy trumps beneficence. Nonmaleficence: physicians must do no harm. Justice: patients should receive equal and fair care. In this case, since previous annotation has been documented, it is required by the physician to withhold a blood transfusion. But in cases of medical emergencies in which there is a lack of written consent or the patient is underage, the physician is allowed to administer a lifesaving treatment such as a blood transfusion.

Guichon and Mitchell review the cases of 3 Jehovah's Witness teenagers who were given blood transfusion based on court orders. The teenagers were not deemed capable of legally making their own medical decisions as they did not fulfill the three criteria set by the court of "competence, adequate information, and freedom from coercion." Therefore, if any underage patient is specifically refusing to receive a lifesaving procedure in a medical emergency, they must have been deemed legally capable when they made that decision. They must have made the decision without being forced to or be free from the fear of reprisal or excommunication from their respective religion. Finally, underage patients should have full medication information to make an informed decision.

Posluszny and Napolitano discuss the treatment of life-threatening anemia in Jehovah's Witness patients. Although they may not be able to receive blood transfusions, they may receive other medical treatments that may increase the body's own production of blood cells such as erythropoietin-stimulating agents, IV iron, and hemoglobin-based oxygen carriers.

Incorrect Answers:
Answer 1,2,4,5: As physicians, the religious views of patients must be respected. If patients are competent or deemed competent at the time of writing their advance directives or requesting their medical care, their wishes must be respected.