Obstetrics & Gynecology>>>>>Ethical and Legal Issues in Obstetrics and Gynecology
Question 2#

A 31-year-old G3P3 Jehovah’s Witness begins to bleed heavily 2 days after a cesarean delivery. She refuses blood transfusion, and says that she would rather die than receive any blood or blood products. You personally feel that you cannot do anything and watch her die.

Appropriate actions that you can take under these circumstances include which of the following? 

A) Tell the patient to find another physician who will care for her
B) Transfuse her forcibly
C) Only provide supportive care
D) Obtain a court order for a blood transfusion
E) Have the patient’s husband sign a release to forcibly transfuse her

Correct Answer is C

Comment:

Determination of ethical conduct in doctor-patient relationships can sometimes be very difficult for the physician who is confronted with a patient’s autonomy in making a decision that the physician finds incomprehensible. However, the autonomy of the patient who is oriented and alert must be respected even if it means that the patient is refusing potentially lifesaving therapy. Attempting to obtain a court order to transfuse an adult against his or her will is almost never an acceptable option, and leads to a tremendously slippery slope of the doctor’s control of the patient’s behavior. A patient’s spouse also does not have legal authority to make decisions for the patient if the patient is competent, awake, and alert. The situation is different when a child is involved, in which case societal interests can occasionally override parental autonomy. It would be inappropriate for a physician to abandon a patient without obtaining suitable coverage from another qualified physician. Transfusing forcibly is assault and battery; thus, in this case, the physician must adhere to the patient’s wishes and, if need be, let her die.