Reference no: EM133938184

Assignment:

Mrs. Gutierrez is a prominent businesswoman in the community, who is widowed, 72 years old, Hispanic, and a Jehovah's Witness. She is brought to the emergency room following a major vehicle crash. As a result of her crash, Mrs. Gutierrez has severe body trauma. She requires a blood transfusion and surgery. She is non-responsive but her vital signs are stable for the moment, after receiving fluids. However, her current status won't last more than 1-2 hours.

Mrs. Jones, 42 years old and Mrs. Gutierrez's daughter, a passenger in the car, was also taken to the same emergency room with minor cut and scrapes from window glass.

The ER physician approaches Mrs. Jones to determine whether she was aware of an advance directive related to her mother's health care wishes. In response, Mrs. Jones informed the physician that she wasn't aware of any advance directive and, despite the fact that her mother is a Jehovah's Witness, the daughter wants the physician to provide any and all lifesaving treatments. "We don't need to tell her, right?" In some Hispanic cultures, the family unit tends to make critical decisions regarding medical care options.

The ER physician is aware that Jehovah's Witness beliefs prohibit blood transfusions, yet she will need the treatment during surgery. Therefore, the physician contacts you, the Medical Ethicist, to initiate the Ethics Committee.

Your Ethics Committee Team Members are:

ER Physician: Physicians are committed to their patients, and pledge an oath (Hippocratic Oath) to use all methods available to cure the sick and injured. Her daughter begged us to perform any necessary treatments. If Mrs. Gutierrez was conscious, she may have be persuaded about the use of blood transfusions.

Chaplain: As a Jehovah's Witness, any type of blood transfusions, even in critical situations or when consent cannot be granted, is seen as "eating blood" and considered a grave sin. By committing this sin, the Jehovah's Witness sacrifices their "entry into eternal life". We should respect the rights of the patient to practice the tenets of their religion.

Surgeon: Surgery can be performed without a blood transfusion but the risk of hemorrhagic shock, and subsequent death, is extremely high. Mortality is most certain. With the transfusion, she has a 50% chance of full recovery, or a 65% chance of recovery with some disability. Besides, the patient may not have prescribed to that tenet of her religion.

Patient Advocate: Mrs. Gutierrez's religious preference is Jehovah's Witness, and the daughter believes her mother adheres to the restriction of blood transfusions. However, the daughter admits that she has never discussed this specific practice with her mother nor her particular wishes. The treatment plan should be based on the suspected decisions that Mrs. Gutierrez would choose, and the religious directives that guide her life.

Employing your learnings from Week 12 and incorporating the perspectives of the ER Physician, Chaplain, Surgeon, and Patient Advocate, students are asked to respond thoroughly and concisely to the following:

1. Do you respect her religion (and her autonomy) even though she is unconscious?
2. What are the harms and benefits to the patient?
3. Which ethical terms are in conflict? In what ways are these terms in conflict?
4. Would the hospital be liable to the patient in the event a blood transfusion was given?
5. Who also should be included in the hospital's Ethics Committee and is not?
6. If the patient becomes conscious after surgery and a blood transfusion was given, should Mrs. Gutierrez be told about the transfusion? Or, should the family's Hispanic culture of protecting their elders from difficult medical decisions be taken into account?
7. What is the Ethics Committee's final decision? Should the physician and surgeon respect the patient's religion (and most likely her wishes) or respect the family member's wishes by performing life-saving treatment?