Medical Ethics Case Study - Essay Example

?Medical Ethics – Case Analysis Medical Ethics Case Case Analysis In this situation, the ethical situation is for a young women patient (from a rare Christian religious sect, that has given birth to a baby boy and following the delivery she is suffering from severe bleeding and may risk her life if not immediate action is taken by the Physician. The doctor considers that Blood transfusion is required as the hemoglobin level is low, the tissue perfusion is seriously affected, and if the same continues, there is chance that the patient would be at a risk to lose her life. However, there is one problem in this case concerning the religion from which the patient belongs. She is from the religious sect Jehovah Witness Group which is totally against blood transfusion (Kee, 1995). The woman does not wish to do the blood transfusion as it is against her religious beliefs. In such a circumstance, the doctor is in an ethical dilemma as whether he should go against the wishes of the patient and perform the blood transfusion or avoid blood transfusion and seek alternative treatment modalities, whose effectiveness may be in question. Here, the patient’s right to self-determination to prevent blood transfusion is put to test against the doctor’s duty to disrespect the autonomy of the patient and perform blood transfusion in order to save the life of the patient. Alternatives need to be carefully weighted considering their effectiveness and safety. Ethical Principles The ethical principle being discussed in this situation is the right to autonomy which is a basic right given to every patient. This is a principle regarding self-determination of every patient to make an informed decision regarding one’s body and such decisions be made on one’ values, principles and beliefs. Others should not interfere with autonomy and not influence a patient’s choice, values and principles. However, considering that in an emergency situation patient’s may be bound to make a decision that may not rightly represent one’s values and beliefs, there are some situations wherein the right to self-determination and autonomy may have to be overlooked based on the patient’s condition. Hence the right to autonomy is not an absolute right. Consideration should be made whether the patient is competent to make a valid decision about one’s self, and that the doctor is acting on the best interests of the patient. Determine alternatives to resolve the ethical issue According to the Jehovah Witness Group Faith, the members of this religious group can accept alternatives to blood transfusion (such as glucose infusion, IV Fluids, etc) and medical and treatment procedures including surgery and administration of drugs (Kee, 1995). However, they are forbidden to accept blood transfusion or products of blood to be infused, as it is against their religious beliefs. The doctor is in a dilemma whether he should go against the patient’s wishes and disrespect the patient’s right to autonomy and act in the best interest of the patient, or respect the patient’s wishes and religion and use alternatives even though they may be less effective and not save the patient’s life. A step-wise process by which the doctor can develop a method of developing his action and considering alternatives ethically has to be used. Legal cases and the Law Past cases demonstrate that blood transfusion may not be important in saving the life of a patient who has lost significant amount of blood (Finfer, 1994). There may be other factors that may ultimately be responsible for fatalities and blood transfusion may not be very important. For example, 2 people suffered serious injuries following a car crash and lost blood and body fluids critically, requiring immediate transfusion. However, both the patients rejected blood transfusion based on their religious beliefs, and the physician had to accept this, respecting their right to self-determination and instead other alternatives were chosen. Both the patient had the same trauma scores and both were high Out of the 2 patients, one had a fatal outcome due to cardiac arrest whereas the other patient managed to survive, thus showing that blood transfusion may not be an effective option and other factors may be responsible for such fatalities (Finfer, 1994). However, in another case titled Re S (In Re S [1991] 4 All ER 671), a woman had to undergo surgery in order to save her life and the life of her baby, whose passage was obstructed in the birth canal. The mother had to undergo blood transfusion as her life and the baby’s life was at risk and there was no other option. However, the mother rejected transfusion based on certain religious beliefs. The court gave an order against the mother’s belief saying that since the life of the baby was at risk, she had to accept blood transfusion so as to avoid imposing a risk on the life of another person. The right to self-determination is subject to various criteria, and if there is a risk to any other person, then one cannot claim the right to self-determination, as there are 2 life’s at stake. It was also noted that in this case, the young woman was acting not out of strong self-determination, but was being influenced by her mother who was a religious leader and was trying to impose her religious beliefs on the patient. Hence, the court had to give such an order (Watch Tower Bible, 2006). In Marlette v Schulman [1991] 2 Med LR 162, the patient suffered injuries from a car accident and was admitted in an unconscious state. The nurse found a card of the patient which said that she belongs to Jehovah’s Witness, and hence blood transfusion could not be performed on her. Non-transfusion methods were used to replace the lost blood. The patient recovered and was discharged from the hospital, but she in turn sued the hospital for being negligent, causing assault, and religious discrimination. However, the court did not accept these charges by the patient saying that the hospital was acting reasonably and within the choices of the patient, even if it included certain religious issues involved (Kee 1995). Medical Evidence It is also important to take into consideration the criteria for which blood transfusion is required. Walsh 2010 found that when a patient with a low haemoglobin level arising from loss of significant level of blood and body fluids, transfusion may not be needed if the patient is properly managed in an intensive care setting, given adequate intravenous fluids, oxygen, and lifesaving drugs. The prognosis is such patients are good. It was found that in transfusion was done in most cases when the haemoglobin level was even above 9 mg/dl and in a good number of cases at 8.2 mg/dl. However, transfusion can be managed in most patients, especially if admitted to the ICU setting even when the haemoglobin level is at 7 mg/dl of blood. The important consideration that should be made is that the patient should be hemodynamically stable. Another study which tried to develop some guidelines with relation to blood transfusion was Sudhindran 1997, which said that blood transfusion should be avoided when the haemoglobin levels are reasonable and the patient is hemodynamically stable. It has been found that in about 50% of the cases, blood transfusion was unnecessary and in most cases the patients can be sufficiently managed in the ICU settings. The main reason to provide blood transfusion was to increase the oxygen-carrying capacity of the blood and this was only required if the haemoglobin was lower than 9 mg/dl. Finfer et al 1994 took into consideration that patients can tolerate low levels of hemodilution and utilise non-transfusion methods. There has also been some level of success with erythropoietin which can immediately promote the production and release of red blood cells and increase the oxygen-carrying capacity of the blood. In fact using erythropoietin, the haemoglobin levels can be increased to 32 g/dl, when 8-9 g/dl would be more than sufficient (Finfer 1994). Use of the Right Alternative The available alternatives would include blood transfusion, plasma expanders, drugs, IV fluids and even artificial blood. In this case, the life of the mother is only at stake and the baby is delivered alive. Hence, she is making a decision for herself and no other person including the baby’s life is at stake. The mother is apparently not being influenced by anybody else, and the religious considerations that she is taking are from within. She is apparently not being unduly influenced by others (Wilson, 1994). Keeping the various non-transfusion treatment methods in mind, to some extent there may be a compromise on the effectiveness, but in this case there are good chances that alternatives could save her life including managing her well in an intensive care setting after using alternatives for a few days. The intensive care measures that may be required for this patient include administrating fluids and IV, drugs, plasma expanders, oxygen therapy, vital monitoring, fluid-balance, etc. Even if transfusion was to be done, her life cannot be guaranteed as blood transfusion itself carries certain risks. In this case, the right to self-determination and autonomy of the patient has to be respected based on the patient’s religious beliefs and that there was no strong evidence that blood transfusion was effective and safe as a method of treating, and the life of the patient was guaranteed to be saved. Here, if blood transfusion was chosen it would be a Utilitarianism principle, whereas if other methods were chosen it would be a deontological principle. Utilitarianism focuses on achieving a situation where the wellbeing of the society is maximised, whereas deontology concentrates on making ends, outcomes and means and achieving the same ethically. Self-determination arising out of religious beliefs is allowed in the American legal system provided that the religious belief is not causing a significant risk to the patient’s life. If such religious beliefs exist, it would go against the very cause and nature of religion (Wilson, 1994). The doctor can avoid transfusion, as blood transfusion may not guarantee her life if used, and its effectiveness may be equal to other procedures that are available including management in the ICU and the use of IV fluid and drugs. It is also important to take into consideration the right to self-determination and religious beliefs provided they do not cause unreasonable risk to the patient’s life. Works Cited DH Wilson. ‘Patients' wishes must be accepted.’ BMJ, 308, (1994):1424-1425. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540362/pdf/bmj00442-0047.pdf ESV Bible. The Holy Bible – Acts 15:28-29. 2001 EVS Bible. 8 April 2012 http://www.gnpcb.org/esv/search/?q=acts%2015:28-29 Health First. Ethics Consultation. 2003. Hospital Services. 8 April 2012 http://www.health-first.org/hospitals_services/ethics_consult.pdf J Watt. Alternative management procedures should be used. BMJ, 308(1994):1424-1426 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540362/pdf/bmj00442-0047.pdf P Kee, Refusal to Consent to Treatment on Religious Grounds. 1995. Medical Laws & Legislation, 8 April 2012 http://www.murdoch.edu.au/elaw/issues/v2n2/kee221.html S Sudhindran. Perioperative blood transfusion: a plea for guidelines. Ann R Coll Surg Engl. 79(1997): 299-301. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2502818/pdf/annrcse01608-0069.pdf Simon Finfer. Major trauma in two patients refusing blood transfusion. 1994. NLM. 8 April 2012 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540362/pdf/bmj00442-0047.pdf TS Walsh. Red cell transfusion triggers in critically ill patients: time for some new TRICCs. Crit Care, 14(3): 170. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911743/?tool=pubmed Watch Tower Bible. Quality Alternatives to Transfusion. 2006. Watch Tower Organization. 8 April 2012. http://www.watchtower.org/e/hb/article_03.htm Read More