Ethics of Care: A Case Study on Jehovah Witness and Blood Transfusion

This paper discusses the ethical dilemma faced by healthcare providers when treating a Jehovah Witness patient who refuses blood transfusion based on religious beliefs. It analyzes the ethical principles of beneficence, respect for autonomy, respect for dignity, and veracity, and the importance of self-awareness, personal and professional values, and contentious issues in healthcare. The paper also examines the conflicts that may arise between ethical principles and care needs, and the importance of ethical principles in improving healthcare outcomes.

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ETHICS OF CARE
By students name
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Professor (Tutor)
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The date

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Abstract
Case study description: Nurses usually deal with dilemmas in the clinical field. The case study
outlines the ethical dilemma experienced by providers of healthcare who care for and treat
Jehovah witness who is placed in a serious circumstance because of medical life-threatening
issues. Juan a 20-year-old, a black Hispanic female and pregnant and has been taken to the
emergency department in a dangerous situation resulting from a car accident. She displayed
symptoms and signs of internal bleeding and therefore instructed to have emergency surgery and
blood transfusion in an effort of saving her fetus and her life. However, she declined blood
transfusion basing her fears in regard to her belief in the bible scriptures.
Ethical dilemmas presented: The ethical dilemmas in the case study is whether to compromise
the standard of care and respect the patient's autonomy. This is by ignoring the wishes of the
patients in an effort to save her life.
Analysis: This paper will demonstrate the ethical dilemma, the clinical case and discuss the
virtue of ethical theory and ethical principles that are applicable in this condition.

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Demonstrate enhanced self-awareness in relation to personal, professional and cultural
values.
The process by which ones examine his or herself is referred to as self-awareness. Self-
awareness comprises of examining feelings, emotions, attitude, and behavior. In relation to
Juan’s case, the nurses are aware of the potential threats and risks at hand. She is in a critical
condition that threatens her life. Meanwhile, they understand the decisions that she based her
reason of refusing to have the blood transfusion. It is quite often difficult to develop self-
awareness because it is time-consuming and can be painful at times (Cowan, Wilson-Barnett,
Norman and Murrells, 2008, 530). The emotions, moral and attitudes of nurse ethics cannot
withstand the suffering Juan is going through and thus they must find a solution and intervene.
The concept of self-awareness starts in the awareness of the conscious and might result in one
having struggled for change and thus requires making continuous efforts (Engin and Cam, 2009,
151). For example, Juan and nurses might spend a lot of time together trying to come into a
consensus concerning her belief that his against blood transfusion. Thus, it is of much
significance in starting a therapeutic relationship with the patients. The process of creating a
therapeutic relationship between the nurses and the patients is aided by the self-awareness
concept.
Enhanced Self-awareness in personal, professional and cultural aspects results to success
in care delivery. The nurses are always present to look for the patients and in order for the care to
be active, it is essential to know oneself (Huycke, 2007, 55). The personal value in self-
awareness is important as it assists nurses to relate with their patients by relating with them
(Severinsson, 2001, 44).

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Evaluate the differences that might exist in the provision of services for both services users
and the service providers
Juan is Jehovah witness follower and believes in bible scriptures and it is against blood
transfusion. Diversity is a major difference that occurs between the nurses and the patients.
Meanwhile, the nurses, although they respect Juan's autonomy, they must save her life. This
confrontation brings about conflicts between the nurses and the patients. Stereotyping especially
the negative stereotyping is a problematic issue. Stereotyping often occurs in terms of religion,
gender and race. For example, Juan is a Hispanic and moreover is a Jehovah witness believer,
thus, this might result in her being stereotyped in healthcare.
Analyze the ethical principles which acknowledge individuality, rights, responsibility, and
duty
Juan’s case brings a complex and complicated situation. Ethical principles give the
guidelines for making decisions while they are faced with complicated situations involving the
patients (Beauchamp, 2007, 7). The ethical principles acknowledge individuality, rights,
responsibilities, and duty. They include the following
The principle of beneficence
This principle insists that healthcare providers are supposed to functions in the best
interests of the patients. They should remove harm, prevent harm, and promote the good of the
patients. For example, the nurses must do their best to safe Juan’s life and her fetus.
The principle of Respect for Autonomy
Juan’s decline to receive blood transfusion is regarded as the Autonomy. It is regarded as
having the ability of self-determination or the capability to make a decision of our own
(Beauchamp, 2007, 8). This principle insists that the able patients should be accepted to refuse or

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accept recommended medical intervention. The capability involves the ability to communicate
and make health care decisions. Thus, it was acceptable for Juan refusing medical intervention
regardless of her critical condition.
The principle of Respect for Dignity
This principle is applicable to every person involved in healthcare. It is based on the basic
concept that every person must be treated with dignity and respect. Juan is eligible for receiving
a proper treatment and care despite her being a black Hispanic. Moreover, her personal character
needs the acknowledgment and consideration is taken in all healthcare encounters and in patients
care aspects.
The principle of Veracity
The act of nurses telling Juan that she is in critical condition that she requires blood
transfusion and emergency surgery is regarded as the principle of veracity. The patients who are
capable should be given the complete truth about their medical conditions. This is considered the
only way patients can be able to make an informed decision about rejecting or accepting the
recommended healthcare interventions (Izumi, Konishi, Yahiro, and Kodama, 2006, 14). For,
example, Juan refused to have the blood transfusion.
How derived values from both personal and professional perspectives into your workplace
and their impact on care delivery.
The values personal and professional values that nurses have are critical in improving
Juan conditions as well as making the right decision for treatment and intervention. The values
help in the development of individuals in the healthcare systems and thus improving the patient-
centered decision making by the service providers (Eva and Regehr, 2005, 58). The perspectives
of personal and professional are fundamental in improving the delivery of care. They, have to

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make sure that they contain Juan's risks as well as her fetus by having the blood transfusion as
well as having emergency surgery and this ensures that she is not at risk of dying.
Ethical values derived from the code of conduct, philosophical and cultural issues.
The ability of the nurse to relate well with Juan requires ethical values. This is to
facilitate that at the end Juan will have an improved health outcome. The user nurses require a
high set of values in order to make the service effective. Truth is the first value and is required to
maintain a therapeutic relationship between the client and the service providers. Nurses will have
to develop a sense of trust for Juan to help her remove her fears of having a blood transfusion.
She needs to trust nurses, to help her recover from the accidents injuries. Confidentiality is an
obligation that is moral to safeguard dissemination information obtained from the patients by the
nurses. Informed consent is another value and is a legal safeguard for the patient's autonomy
respects. The welfare of the Juan is promoted by the autonomy and thus avoiding harm to her
and her fetus.
Explain how care may be affected by the decision making process in relation to
geographical differences and target groups.
The case of Juan requires critical thinking in regard to the complexity of the situation.
Decision making in health care is a process that incorporates definite steps in a desirable
consequence (Connelly, Airey, and Chell, 2001, 531). In this regard, effective decision making
will automatically in the effort of enhancing Juan's health outcome. It is central to a policy of
health and medical practice. It is a two-way process of communication between the patients and
one or more health professionals (Runciman, Merry, and Walton, 2017, 50). The decision
making reflects the ethical principles that the patient poses on the right of the main decisions on
what is suitable for them (Légar, et al, 2014, 50). This is in consideration of their beliefs

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personal. It is evident that there are some parts of the countries that receive a high quality of
services than others. Variation can be found at all geographical and targeted group’s levels. For
example, Juan is a black Hispanic, and this means she is a foreigner, and based on this the
decision making tends to vary based on different geographical area.
Analyze the implication for service providers and service users in relation to justice,
advocacy, malevolence, and trust.
The Juan case is sensitive and thus requires several interpretations before action is taken.
Moreover, the nurses are required to adhere to the professional and cultural values. In relation to
advocacy requires people to consult and the agreement is obtained before all things are done.
Thus, the nurses must consult Juan before reaching a medical treatment on her. Medical
confidentiality is a crucial part of advocacy. The nurses are required to warily tread as there is no
special justification for imposing our own professional and personal views about the justice of
others (Hilton and Slotnick, 2005, 57). The providers of service and the users of service are
required to acknowledge the competing moral concerns. For example, respecting the moral
standards of Juan and the fact that she believes in the bible scriptures and thus, respecting her
autonomy in administering treatment.
Discuss the policy, procedures, and legislation that might conflict with an ethical point
raised
In relation to Juan case, there might be conflict in the policy, legislation, and procedures.
Juan is under severe bleeding and her fetus is also under great risk. Thus, although the principle
of ethics articulates respect of autonomy, it might be conflicted at this point. This is because the
nurses are obliged to save lives and ensure quality healthcare to patients. Moreover, the nurses
can move to court and inquire a court order that can facilitate Juan’s treatment. This is in regard

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that she can later sue the hospital of conducting unwanted treatment. The decision making
between the nurses and the patients in this case Juan is supposed to be arrived at a mutual
consent, however, due to the criticality of Juan's conditions they can decide to have a blood
transfusion and emergency surgery without the involvement of her will.
The importance of contentious or controversial issues to contemporary health and social
care providers.
Nurses often experience contentious situations in their workplace. Contentious concerns
to contemporary health and a social care provider has a lot of importance. These issues help the
nurses improving their ability on decision making in cases involving healthcare. Contemporary is
regarded as the current situations in health. These controversies in health help in attracting
attraction to the health and social care and thus resulting in improved healthcare standards (Daly
and Lewis, 2000, 283). Moreover, assist nurses in applying the ethics of care when required and
overcome the challenges of the ethical dilemma.
Empowering individuals by creating the right climate for making choice and complain in
decision-making service providers.
The major goal of healthcare is enhancing the patients' health outcomes. The decision-
making process is aided by several developed comprehensive models. The decision making
comprehensive models combines the elements of consequentialism, formalism and virtue ethics
(Gilson, 2003, 1458). It is essential to point out that problems of ethics are framed in terms of
who is affected and the conditions. The action initially chosen is based on the consequences
predicted. It is of much essence for nurses to establish the right climate with Juan for making the
right decision. Making the patients feel comfortable enough results in opening up of their style of
living choices (Gilson, 2003, 1458).

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Analyze the theoretical and ethical principles in exercising rights of the services users may
conflict with care needs.
In regard to the Juan case, the ethical principles and ethical theories provide a basis for all
ethical acts. The contemporary ethical principles have developed a variety of sources. Veracity,
autonomy, no maleficence, confidentiality, beneficence, role fidelity, and justice are the primary
principles guiding the contemporary ethical decision making. Each of the ethical principles
consists of two components patient rights and professional duty. In exercising the rights of
service users may conflict with the care needs. The ethical dilemmas can be a problem from the
nutrition support clinicians who are directed to evidence-based practice. The personal and
emotional nature of the decision making on ethics can cause difficulties and thus conflicts
usually arises when people hold different perspectives of ethics. These include the principle of
harm to the autonomy, and this implies that if people chose not to receive a treatment due to loss
of life quality, it implies that imposing treatment on the person is not right. Deontological
theories that state that evaluation of human actions are in accordance with the principle of duty
What are ethical principles and their importance?
In relation to Juan’s case ethics are systems of moral principles dealing with wrong and
right. Ethics influences how decisions are made by the nurses in healthcare. This is in regard to
improving the patients' healthcare outcome. The ethical principles have several advantages. The
health and lives of the patients significantly improve and there is a well-developed
communication between the providers of service and the patients (Limentani, 2009, 396). The
principle also ensures that health care improves in terms of service delivery to the people. This is
due to facilitated guidelines that mostly aim at healthy quality improvement. Moreover, the

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healthcare principles assist in dealing with complex situations that nurses experience such as
Juan’s case.
Conclusion
In nursing practice, the incidences of patients rejecting blood transfusion or other
intervention are more frequent. Thus, the content concerning ethical issues, such as Juan's case,
requires to be assimilated into the nursing clinical arena and curricula. Thus, requires critical
thinking in clinical decision-making circumstances can make experienced and novice nurses to
handle ethical dilemmas that are complex. Thus, it is of much essence the learning processes to
be assisted through integrated learnings with case studies and thus using the patient’s trainers and
thus further enhancing the process of learning. The teachings approach provides an opportunity
for exposing the nurses to scenarios of patients having acute conditions and thus helping them
decrease anxiety and promote learning. This will facilitate in improving the decision making
over the ethical dilemmas in healthcare thus enhancing patient health outcomes.

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