LWD101 Ethics, Law and Health Care Assessment item 2
42 year old Jenny Kim and her 15 year old daughter, Jillian, have been brought by ambulance to the emergency department of a Brisbane hospital following a serious motor vehicle accident. Both patients have sustained serious head injuries and have lost a significant amount of blood. Both patients were unconscious on arrival at the hospital. The attending physician, Dr Franks, ordered that both Jenny and Jillian receive urgent blood transfusions. Shortly after the first transfusion, one of the nurses, RN Huang, checked Mrs Kim’s purse to locate details of the patient’s next of kin. RN Huang found a card in Mrs Kim’s purse with the words “No Blood” on the top. The card indicated that Mrs Kim was a Jehovah’s Witness and, as a practising Jehovah’s Witness, she was opposed to the use of all blood products for medical purposes. She also had in her bag a valid advance health directive (AHD) stating the same. The RN immediately alerted the attending physician to both Mrs Kim’s “no blood” card and her AHD and the RN emphasised that this would affect any future
transfusions. RN Huang located the contact details of Jenny’s husband, Anthony, and phoned him and explained that his wife and their daughter had been in serious car accident and that he needed to come to the hospital immediately. When Anthony arrived at the hospital, his wife was in a serious but stable condition, following the blood transfusion. Unfortunately Jenny’s condition started to deteriorate rapidly and Dr Franks advised Anthony that his wife would require another blood transfusion. Anthony told the doctor, “We are devout Jehovah’s Witnesses and we do not believe in taking the blood of another person. It is against our religion. My wife and I both carry valid ‘No Blood’ Cards with us at all times. If my wife were awake, she would tell you directly that she does not accept another’s blood. I’m sorry, but we cannot consent to that.”
The doctor made it clear to Anthony that without the transfusion, his wife would likely die. Anthony said, “I understand, but we believe that if she is transfused, she may not be able to enter heaven. For us, this is worse than death.” At this time, the doctor was advised that Jillian’s condition had not stabilised and that she would also require a blood transfusion right away. When advised about his daughter’s worsening condition, Anthony told the doctor that he would not be able to provide consent to a transfusion for either his wife or daughter as his daughter had grown up in the Jehovah’s Witness’ church and also closely follows the teachings of their church. Dr Franks believes that he must transfuse both Jenny and Jillian in order to save their lives, despite Anthony’s refusal of consent. Due to the seriousness of both Jenny and Jillian’s condition, RN Huang asked Anthony if there were any family members that he would like her to contact. Anthony told RN Huang that he had already informed his brother about the car accident on the way to the hospital but that he would not need
to contact his sister as they were no longer in contact. He said that his sister was opposed to the family’s religious beliefs and that, after a fight, they no longer talk with each other. He said he didn’t want his sister to know anything about his family as it was a private matter. Unfortunately, Anthony’s brother contacted their sister and the sister has just phoned the nurse’s station asking for information about Jenny and Jillian. RN Huang is unsure whether she should discuss the information with Anthony’s sister. Apply the ethical and legal decision-making framework to the scenario, to determine what Dr Franks and RN Huang should do.