Your patient is a 44-year-old G4P4 with symptomatic uterine fibroids that have been unresponsive to medical therapy. The patient has severe menorrhagia to the point that when she menstruates, she cannot leave the house. Since she has failed medical management, you recommend a hysterectomy. You counsel her that she may need a blood transfusion if she has significant blood loss during the surgical procedure. Her current hematocrit is 25.0%. The patient is a Jehovah’s Witness who adamantly refuses to have a blood transfusion, even if it results in her death.
Respect for the patient’s autonomy requires that which of the following be assessed?
A. The needs of societyPatient preferences, quality-of-life issues, and medical indications are all examples of ethical concerns that must be taken into account when working through ethical dilemmas. Consideration of legal issues is not a factor in ethical decision-making. If the patient’s insurance company refuses to pay for the indicated procedure (in this case, hysterectomy), the ethical principle of justice (the patient should be given her due) is being challenged. Autonomy is the ethical principle whereby the patient has the right to self-determination. Therefore, the needs of society (a contextual issue) are not considered as a factor of autonomy. Informed consent requires that the patient be able to understand the risks, benefits, indications, and alternatives of a particular medical procedure. If the patient is unable to understand the medical information, a legal guardian can be assigned to make those decisions for him or her. A patient’s desire not to have his or her medical history discussed with anyone else involves the ethical concept of confidentiality.