drvic
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while doing UW questions, i came across two questions regarding Jehovah's Witnesses - with different answers.
the first involved a trauma case where father and son were injured gravely, both needing blood transfusions to survive. father told the paramedics that he does not want any transfusions for himself or his son. father was managed without transfusion but son was given transfusion on the grounds that life saving treatment cannot be withheld from a child even if it goes against the parents' wishes....the explanation also clarified that in such situations seeking court orders is not necessary keeping in mind the risk involved to the child's life....well, fine....no problems with that so far.....
Later there was another question in the same block - a neonate born to Jehovah's Witness parents, develops Rh Isoimmunisation and hyperbil within the first 24 hours of life, levels reaching upto 22.8mg/dl despite phototherapy - obviously necessitating exchange transfusion. the question also mentions that the neonate is at risk of severe brain damage or death if he doesn't undergo ET. the parents were informed this and they refused consent. what is the physician supposed to do? well going by the above vignette, one should proceed with ET. but the answer marked in UW is - to seek court's permission for ET!!!! where is the time for that???????? i don't agree with this answer....also look at what explanation they gave for the first vignette....so why there is an ambiguity in the response?
so i just wanted to ask if there is any standard/published guideline we can quote/refer to for this? are there any infallible rules for ethics questions....?
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| yelenatx
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http://www.clevelandclinic.org/bioethics/policies...
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| drvic
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thnaks yelenatx
but that still does not solve my query. to quote from the guideline that you've suggested -
"...However, the best interests of a patient who is a minor or ward supersede a treatment refusal requested by parents or guardian when the refusal conflicts with the interests of the minor or ward....."
in that case, why do we have to wait for even the court's permission then, we can just proceed with the exchange transfusion in the case of the neonate mentioned above...but that's not the answer that UW gives...
any other suggestions...
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| yelenatx
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If it is emergency life threatening condition, for example trauma with acute bleeding and minor will die in less than an hour if you don't transfuse, you don't need a parental consent to transfuse and you can disregard parents religious believes.
How long would it take the infant to die or have a permanent brain damage from high bilirubin? Probably several hours. Enough to get a court order. I remember we needed a court order for involuntary hospitalization for longer than 24 hours. We called house supervisor and it took them less than 2 hours to get one. Of course, at night or weekends you won't be able to get a court order. I had a Jehovah's Witnesses patient, an elderly man who had successful stenting of his CAD, but developed a huge hematoma in his groin, and died from anemia due to blood loss. Very stupid death. The man was completely in his mind, surrounded by his family, also Jehovah's Witnesses, who supported his decision to reject blood transfusion and die.
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| drvic
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ok thanks, yelenatx. that's a reasonable explanation
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