Objective

1. Demonstrate understanding of professional and ethical responsibility
2. Demonstrate critical thinking in the application of ethical principles to ethical decision making when presented with an ethical dilemma.

Instructions

Answer the questions at the end of this case study.  Write a paper that is 3 to 6 pages in length, created using APA format.  Use 1-inch margins, double spaced text, 12-point font, and Times New Roma font.  Include a reference page with a minimum of 3 relevant citations or quotations.  Create a cover page with student name, title of the course, title of assignment, date, and name/title of instructor.

Submit your paper response to the assignment box on or before the due date.  Late responses will not be accepted.

Refer to the grading rubric provided for this assignment

Case Study

“Juana” (fictitious name) a 20-year-old, Black Hispanic female, 32 weeks pregnant, was brought to the emergency department (ED) by the paramedics.  She arrived in the ED immobilized on a flat board with a hard cervical collar in place.  Juana was the driver of a sedan involved in a single-vehicle collision.  She stated she was driving at approximately 60 miles per hour on the highway and suddenly lost control of the vehicle and crashed into a light pole.  She also stated her head hit the windshield and shattered the glass. She denied loss of consciousness.  Upon her arrival in the ED, Juana was alert and oriented to person, place, and time and had a Glasgow Coma Scale of 15/15.  Her initial complaints were lightheadedness, weakness, left shoulder pain, and severe abdominal cramping that started immediately following the car accident.  She had a past medical history of sickle cell disease and no previous pregnancies.  Her lungs were clear bilaterally.  Juana’s heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her initial blood pressure (BP) was 130/80, and fetal pulse rate was 90. Once the cervical spine films were taken and the flat board was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm.

Juana was placed on a 100% nonrebreather mask.  Peripheral intravenous lines were started bilaterally to replace fluid loss that was indicated by the change in vital signs.  It was suspected that she was bleeding internally into her thoracic or abdominal cavity.  Blood specimens were drawn and sent to the laboratory.  A hemoglobin of 6 g/dl and hematocrit of 21% indicated internal bleeding.  Ultrasound showed blood in the amniotic cavity and Doppler confirmed a fetal heart rate of 90 bpm indicating fetal distress.  The patient was informed by the medical team of the critical nature of her condition.

The plan of care for her was an immediate blood transfusion and an emergency cesarean section. Matters became complicated when Juana informed the medical team that she was a Jehovah’s Witness and refused the proposed plan of care.  The physician then recommended the use of alternative blood products.  Juana insisted that this was also against her religion and she refused the alternative treatments being offered. The medical team advised her that Jehovah’s Witnesses could choose certain blood byproducts, such as albumin, cryoprecipitate, and globulin (Watchtower Bible and Tract Society, 2004).

According to Juana and her husband, both believed that if she accepted the blood transfusion or blood products she would no longer be a Jehovah’s Witness and would be condemned to hell.  The husband then presented the physician with Juana’s blood card, created by the Watchtower Bible and Tract Society, the governing organization of Jehovah’s Witnesses.  The card stated her advance directives, including the prohibition of blood and blood products.

Juana’s condition worsened within 2 hours of admission to the ED.  She went into labor and delivered a stillborn baby boy.   She was immediately transferred to the intensive care unit where, despite continued aggressive attempts to stabilize her, she went into cardiac arrest and died.

Questions

1. What is the ethical/legal dilemma presented in this case?
2. Do you support/oppose Juana’s decision to refuse the blood transfusion?
3. What ethical principles are involved in this case?
4. What are the obligations or duties involved in this case?
5. What are the consequences of each possible action?
6. What are the proper ethical actions? Support your arguments.
7. What can you do to assist the patient and family during this difficult time?

Ethical Dilemma Jehovah’s Witness refuses blood transfusion