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Ethical case of blood transfusion.... Watch

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    Hello everyone!

    I am currently preparing for university interview and one ethical issue i came across is:

    A boy under age of 16 has being involved in a car accident, he was admitted to hospital and doctors advice to his parents was that he should immediately be given a blood transfusion as to compensate to lost blood. If this is not given then he would die!
    However his parents refused their son to be allowed to have a blood transfusion!!

    The interviewee then ask you whats your opinion on this ethical issue?

    I wanted to know your opinion of how you would structure your answer (for example, would you say pros and cons then your opinion or??) for such an ethical question during interview and what would say. Many thanks in advance!!
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    Are you applying for medicine by any chance? If so, there's a whole thread for this sort of thing.

    Either way, I know what I'd say (and I know the legal bits) but what do you think?
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    Under 16 - children protection issues overrides parents! Parents have no rights when it comes to their children!
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    Call me stupid, but I fail to see how blood transfusions are an ethical issue at all? The blood is given voluntarily... what possible cons could there be? :confused:
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    The child should be asked alone without their parents around. If the parents are forcing an answer on the child he has a chance to confide in his true wishes. But if he sticks with the decision then they must follow it as he's old enough to make his own choices, and to try and persuade him to accept the transfusion is inethical in itself. As long as he is made aware of the probable consequences then the medical service has done all it ethically can do.
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    (Original post by kellybee)
    Call me stupid, but I fail to see how blood transfusions are an ethical issue at all? The blood is given voluntarily... what possible cons could there be? :confused:
    Jehovah's Witnesses (as these cases often involve) believe that the Bible says that taking in another's blood is forbidden. They also believe that life is a gift and as such cannot be extended by an artificial means like taking in extra blood. Jehovah's Witnesses who take blood transfusions are forever shunned. :dontknow:
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    (Original post by aliluvschoc)
    Jehovah's Witnesses (as these cases often involve) believe that the Bible says that taking in another's blood is forbidden. They also believe that life is a gift and as such cannot be extended by an artificial means like taking in extra blood. Jehovah's Witnesses who take blood transfusions are forever shunned. :dontknow:
    ahh didn't know Jehovah's witnesses were involved... Shoulda guessed :rolleyes:
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    This is as much about consent to treatment in general as it is about blood transfusions in particular, though that is admittedly the most common example used.

    Legally, it is perfectly possible to get a court order overriding the parents' refusal (assuming the child is unconscious and cannot consent for himself), and has been done many times before.
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    So the people of Jehovah's Witnesses wouldn't care if he dies just because they don't want the blood transfusion?
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    (Original post by Helenia)
    This is as much about consent to treatment in general as it is about blood transfusions in particular, though that is admittedly the most common example used.

    Legally, it is perfectly possible to get a court order overriding the parents' refusal (assuming the child is unconscious and cannot consent for himself), and has been done many times before.
    Where on the site could I read up on how to deal with and answer ethical case studies please>
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    (Original post by Helenia)
    This is as much about consent to treatment in general as it is about blood transfusions in particular, though that is admittedly the most common example used.

    Legally, it is perfectly possible to get a court order overriding the parents' refusal (assuming the child is unconscious and cannot consent for himself), and has been done many times before.
    Hey the case study doesn’t specifically say how old the boy is, we know he is under 16, this means that he could be 3 or 4 years old. Even if he was conscious he wouldn’t be able to understand the situation and make a decision! My question is if he is very young and conscious can this case be still passed to the court?? Or is this only in the case if the patient is unconscious?
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    (Original post by kristinaalovesu)
    So the people of Jehovah's Witnesses wouldn't care if he dies just because they don't want the blood transfusion?
    The problem is two-fold. Firstly, they believe that when it's your time to go it's your time to go, and so a transfusion is effectively going against god's wishes. Critics argue that all medicine is 'acting as god' so why is transfusion so special? but JWs interpret the bible as explicitly stating that transfusion & transplantation are forbidden. Secondly, they believe that if you accept a transfusion out of choice you can no longer be a JW (i.e. can no longer get into heaven), and so an individual's entire family and community could be ripped away from them by accepting a transfusion (although different churches have different levels of tolerance, some will accept someone back if they show regret and confirm they will never accept a transfusion again, others believe to accept a transfusion is an automatic exclusion from the church). So there's a lot of peer pressure and crisis of faith involved.
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    They can put it before a judge for anyone who is incapable of giving consent, whether that's because they're very young, because they're unconscious, or because they're a loony.

    However in an emergency there may not be time to find a judge, in which case doctors tend to do what they think best anyway and sort it out later. I believe there's a good faith clause somewhere.
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    yes i am appplying to medicine by i search so much on tsr but coldnt find the thread for such issues, can anyone give me thread name please so i would be able to have a look at that as well.

    from what i understood, is that if the child is conscious then he is allowed to make his own decision irrespective of his parents decision (i.e that if he wants the blood transfusion he is allowed to have it even if his parents or guardians doesn't accept this).

    The way i would approach this is that i would say that the doctor has to give full information about the case and what is best option, if as with this case the parents and their son doesn't accept either than the doctor would have to ask for the reasons why that is the case! if the reason that they are followers of Jehovah's witness then thats an example of a reasonable reason not to get the blood transfusion. in that case the doctor has to give all other options available to the parents and child and if it still against their e.g religious beliefs or any other reason than it is patients right and the doctor cannot overrule it. in that case, i think doctor has to get a signed paper that everything has being flly discussed with all options available and that there is a possibility of their son dying at any moment.

    This is what i think but i would really like to hear from other members of what they think about this and whether i could any further add detail i may have missed!
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    (Original post by Svenjamin)
    The problem is two-fold. Firstly, they believe that when it's your time to go it's your time to go, and so a transfusion is effectively going against god's wishes. Critics argue that all medicine is 'acting as god' so why is transfusion so special? but JWs interpret the bible as explicitly stating that transfusion & transplantation are forbidden. Secondly, they believe that if you accept a transfusion out of choice can no longer be a JW (i.e. can no longer get into heaven), and so an individual's entire family and community could be ripped away from them by accepting a transfusion (although different churches have different levels of tolerance, some will accept someone back if they show regret and confirm they will never accept a transfusion again, others believe to accept a transfusion is an automatic exclusion from the church). So there's a lot of peer pressure and crisis of faith involved.
    Surely some parents won't tolerate it even if they are a member of JW especially when its their own child? That's crazy though, i know its their religion but it's their own son. It shows how much they love their religion more than their own blood.
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    (Original post by A_5)
    yes i am appplying to medicine by i search so much on tsr but coldnt find the thread for such issues, can anyone give me thread name please so i would be able to have a look at that as well.

    from what i understood, is that if the child is conscious then he is allowed to make his own decision irrespective of his parents decision (i.e that if he wants the blood transfusion he is allowed to have it even if his parents or guardians doesn't accept this).

    The way i would approach this is that i would say that the doctor has to give full information about the case and what is best option, if as with this case the parents and their son doesn't accept either than the doctor would have to ask for the reasons why that is the case! if the reason that they are followers of Jehovah's witness then thats an example of a reasonable reason not to get the blood transfusion. in that case the doctor has to give all other options available to the parents and child and if it still against their e.g religious beliefs or any other reason than it is patients right and the doctor cannot overrule it. in that case, i think doctor has to get a signed paper that everything has being flly discussed with all options available and that there is a possibility of their son dying at any moment.

    This is what i think but i would really like to hear from other members of what they think about this and whether i could any further add detail i may have missed!
    Have a look at this thread - lots of interview discussion going on there.

    You are certainly right that the doctor should discuss all the options with the parents. However, regardless of their reasons for refusing the blood transfusion (whether it's because they are Jehovah's Witnesses or because they don't like red, both of which I think are not "reasonable reasons"), if it is in the child's best interests to receive it, doctors are able to do so even in the face of parental refusal. You can usually get an emergency court order very quickly to allow this, or if the child really is in extremis do it first and sort out the legal side later. This is the legal case for England and Wales at least; for other countries the situation may be different.

    Of course, in a medicine interview you should also say that you would discuss it with your seniors; nobody would expect you to be making this decision on your own as a med student or a junior doctor.
    (Original post by bahar_bp)
    Hey the case study doesn’t specifically say how old the boy is, we know he is under 16, this means that he could be 3 or 4 years old. Even if he was conscious he wouldn’t be able to understand the situation and make a decision! My question is if he is very young and conscious can this case be still passed to the court?? Or is this only in the case if the patient is unconscious?
    If the child is conscious and deemed to have capacity to make the decision, they can consent to treatment even if the parents refuse. However, if the child were to also refuse, it is still possible to override this with a court order. And yes, cases can be brought to court regardless of the child's conscious state.
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    (Original post by kristinaalovesu)
    Surely some parents won't tolerate it even if they are a member of JW especially when its their own child? That's crazy though, i know its their religion but it's their own son. It shows how much they love their religion more than their own blood.
    Some do leave the church if it means giving life-saving treatment, but others don't. As with any religion, there comes a point where faith is tested and it's up the individual whether they take the leap or not.

    Blood salvage (techniques for recovering bled blood and feeding it back into the patient) wouldn't exist if it wasn't for JWs, so they have done a lot of good for medicine. Without people refusing the traditional treatments there would be no research into alternatives. Blood salvage has been found to have many advantages over blood transfusions, so it's even used for non-JW patients. Over the years research has discovered that transfusions aren't necessary in many cases (partly by watching how low levels in JWs can go without dying, along with research into how transfusions function) and are simply a product of an archaic medical dogma (patient's vitals going a bit weird? give them blood and hope that sorts it out), so now JWs like to act very smug about that.
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    (Original post by A_5)
    from what i understood, is that if the child is conscious then he is allowed to make his own decision irrespective of his parents decision (i.e that if he wants the blood transfusion he is allowed to have it even if his parents or guardians doesn't accept this).
    So does this mean that if the parents wanted the treatment but the child refused it, then it would have to be refused?
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    thanks helenia very useful
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    In an emergency doctors have a legal defence to give life saving treatment so I would just treat the boy. Managing a life-threatening patient on A&E is not the time for ethics and law faff so this is pretty clear cut for me.

    Try and avoid knee-jerk rash answers. I personally would say that unless you are pretty sure of your answer avoid coming up to rash knee jerk decisions as it can get you into big trouble. If you had said follow the parents decision, for example, I would be pretty horrified as you are effectively condemning the boy to death which is utter madness! Such ethical scenarios are way over the heads of pre-medical so you are unlikely to know what to do. If you do not know what to say and start with saying you are uncertain and just give the reasons for going with both sides, it's probably more what they are looking for. I'm not sure they expect the right answer at such a junior stage. I sure as hell would not know myself years ago so dont worry about it. You can also have an ethical opinion that is against the law (e.g. euthanasia) but if you have good reasons it is fine so there is often no 'right' or 'wrong' answer.

    Legally a 16 year old is an adult under the law and the assumption is they have capacity to make their own medical decisions. This is irrelevant in an emergency as are likely not to have capacity. As helena said in the non-emergency to override a competent person, even if you suspect parental forcing the child, you need a court order to go ahead and treat. To be honest though I have had a lot of experience of ethics and law in osce and only lately have I understood what they are looking for. It is very much not about the law. The station is mostly all being compromising and seeming nice and understanding. In practice in hospital you would are never going to go to the faff of getting court orders - forget about it - never going to happen in most places. Annoying the family with fights is the wrong move as well even if you disagree. Osce is very much a smiley exercise where you try every single way you can work with the family (actor) to reach an agreement and since I know this I find the stations easy now. I do much better than the ones that require medicine knowledge, haha. Love it! HTH
 
 
 
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