Case Study on Legal and Professional Issues in Nursing Ethics

This case study presents a scenario involving a pregnant Jehovah's Witness patient with severe aplastic anemia requiring an urgent blood transfusion, which she previously refused. Due to her incapacitated state and lack of written documentation, the clinical team proceeds with the transfusion to save her life. The patient later dies, and the husband sues the hospital, alleging a violation of the woman's dignity. The dilemma centers on balancing patient autonomy with the healthcare team's professional duty. Legal considerations include the patient's right to autonomy and informed consent, and the hospital's right to prescriptive liberty in emergencies. The litigation finds no violation of ethical or professional standards, emphasizing the necessity of documentation for refusal of medication and the prioritization of life. The analysis supports the litigation's view, asserting the team acted within its rights given the emergency and lack of documented refusal.

Legal And Professional Issues In Nursing
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 Patient description: A pregnant woman in her second trimester
complaining of nosebleeds, dizziness, fatigue, headache and
shortness of breath.
 Religious Orientation: Jehovah Witness
 Diagnosis: severe aplastic anemia
 Proposed treatment: Urgent blood transfusion
 Competency: Weak and unconscious (incapacitated)
Healthcare Scenario

 The husband refuses blood transfusion
 The brother advocates for blood transfusion
 Written documentation by the woman indicting refusal is
unavailable at that time
 As a matter of necessity to save life, the clinical team decides
to perform the blood transfusion
 The woman dies later
 The husband sued the hospital on arguments that the hospital
violated the woman's dignity
Healthcare scenario Continued…

 The healthcare team is torn between the patients freedom and
their professional duty to provide optimal treatment to the
patient (Chand, Subramanya & Rao, 2014).
 Duty demand respect the patient’s autonomy and its violation
may cause discrimination or accusation (Gutierrez-Vega,
Gallegos-Garza & Fajardo-Dolci, 2014).
 The loss of a patient they could have saved may be distressing
(The Royal College of Surgeons of England, 2016).
Dilemma

Patient's right: right to autonomy and informed consent (Chand,
Subramanya & Rao, 2014).
 Incase of incapacity of the patient, decision makers must consider the
best interest of the patient, and make attempts to decide the same
way the patient would have done if they were competent (Snow &
Fleming, 2014).
Hospital's right: To choose not to treat a patient who as refused blood
transfusion.
 to prescriptive liberty incase of an emergency and necessity to
preserve life (Gutierrez-Vega, Gallegos-Garza & Fajardo-Dolci,
2014)
Legal Considerations

 The hospital did not violate ethical or professional
standards
 Documentation must be provided incase of refusal of
medication
 Otherwise, life is preferable to death
 The hospital has a right of prescriptive liberty incase of
lack of documentation for incapacitated patients
Litigation of that Case

 In agreement with the litigation
The healthcare team did not violate any ethical or
professional guidelines since there was no documentation
indicating the patient’s refusal of blood transfusion.
The team acted according to its rights to prescriptive liberty
in emergency situations.
The prioritization of the patient’s life is also justifiable.
My view

 Banja, J. D. (2009). Overriding the Jehovah's Witness patient's refusal of blood: A reply to
Cahana, Weibel, and Hurst. Pain Medicine, 10(5), 878-882. doi:10.1111/j.1526-
4637.2009.00648.x
 Chand, N. K., Subramanya, H. B., & Rao, G. V. (2014). Management of patients who refuse
blood transfusion. Indian journal of anaesthesia, 58(5), 658–664. doi:10.4103/0019-
5049.144680
 Gutierrez-Vega, R., Gallegos-Garza, A. C., & Fajardo-Dolci, G. (2014). Blood transfusion in
jehovah's witnesses, a dilemma in medicine?. Revista Médica del Hospital General de
México, 77(4), 195-198. doi:10.1016/j.hgmx.2014.10.001
 Snow, H. A., & Fleming, B. R. (2014). Consent, capacity and the right to say no. The Medical
Journal of Australia, 201(8), 486-488. doi: 10.5694/mja13.10901
 The Royal College of Surgeons of England (2016) Caring For Patients Who Refuse Blood A
Guide To Good Practice For The Surgical Management Of Jehovah’s Witnesses And Other
Patients Who Decline Transfusion. Retrieved from
https://www.rcseng.ac.uk/-/media/files/rcs/library-and-publications/non-journal-publications/
caring-for-patients-who-refuse-blood--a-guide-to-good-practice.pdf
 Wheeler R. (2014). Adults who refuse blood transfusion in emergency, urgent and elective
circumstances. Annals of the Royal College of Surgeons of England, 96(8), 568–570.
doi:10.1308/003588414X14055925058193
References

Questions?
The end
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