Case Study -"Juana" (fictitious name) a 20-year-old, Black colored Hispanic feminine, 32 weeks pregnant, was brought to the emergency team (ED) in an ambulance by the paramedics. She arrived in the ED immobilized on a flat board with a difficult cervical collar set up. Juana was the driver of any sedan involved with a single-vehicle collision. She stated she was traveling at approximately 60 miles each hour on the road and abruptly lost control of the automobile and crashed into a light pole. She also stated her head strike the windshield and shattered the a glass. She denied lack of consciousness. Upon her arrival in the ED, Juana was alert and driven to person, place, and time and had a Glasgow Coma Size of 15/15. Her initial claims were lightheadedness, weakness, remaining shoulder pain, and severe belly cramping that began immediately following the car accident. She had a past health background of sickle cell disease no earlier pregnancies. Her lungs were clear bilaterally. Juana's heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her primary blood circulation pressure (BP) was 130/80, and fetal pulse rate was 90. After the cervical spine motion pictures were considered and the chiseled plank was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm. Medical diagnosis and interventions
Juana was positioned on a 100% nonrebreather mask. Peripheral intravenous lines were started out bilaterally to displace fluid damage that was indicated by the change in essential signs. It had been suspected that she was bleeding internally into her thoracic or stomach cavity. Blood vessels specimens were attracted and delivered to the lab. A hemoglobin of 6 g/dl and hematocrit of 21% indicated inner bleeding. Ultrasound revealed blood vessels in the amniotic cavity and Doppler affirmed a fetal heart rate of 90 bpm indicating fetal stress. The patient was educated by the medical team of the critical character of her condition.
The plan of care for her was an immediate blood transfusion and a crisis cesarean section. Things became complicated when Juana up to date the medical team that she was a Jehovah's See and refused the proposed plan of care. The physician then recommended the use of alternative blood products. Juana insisted that this was also against her religious beliefs and she refused the alternative treatments on offer. The medical team encouraged her that Jehovah's Witnesses could choose certain bloodstream byproducts, such as albumin, cryoprecipitate, and globulin (Watchtower Bible and System Population, 2004).
According to Juana and her hubby, both assumed that if she accepted the blood transfusion or blood products she'd no longer be considered a Jehovah's See and would be condemned to hell. The hubby then shown the physician with Juana's blood greeting card, created by the Watchtower Bible and Area Society, the regulating organization of Jehovah's Witnesses. The card stated her progress directives, including the prohibition of blood and blood products. Jehovas see are taught never to accept any blood vessels or blood vessels products. They may be instructed to expel and shun members who do accept blood or blood products. The Watchtower population talks about that any participants who do acknowledge blood will be condemned to hell and they should only agree to the bood of Jesus. Because of this policy patients healthcare decision making is jeopardized.
Juana's condition worsened within 2 hours of admission to the ED. She proceeded to go into labor and supplied a stillborn baby son. She was immediately used in the intensive good care unit where, despite prolonged aggressive endeavors to stabilize her, she proceeded to go into cardiac arrest and passed on. (de franka, Baptista, Brito, 2008)
This research study represents an honest dilemma, which is defined as, the need to choose from among several morally acceptable classes of action, when one choice stops selecting the other; or, the necessity to choose between equally undesirable alternatives (Hamric, Spross, and Hanson, 2000). These decisions can produce results that can be negative or positive for the people involved. In cases like this Juana chose to continue to be steadfast with her decision to refuse treatment so that she can be true to her religious beliefs. In this instance her choice resulted in death of her and her baby. If she experienced paid attention to the physcians and Interdisciplinary teams recommendations the end result might have been different sparing her and her babies life but woud possess the undesired effect of violating her religious principles. The health professionals honest dillema was that by respecting the patients autonomy and accommodating her spiritual beliefs, they were confronted with circumventing their moral obligation to provide job care adhering to established standards. This case is a predicament where Ethics and Legislation collide. Guido (2010) areas:
the law identifies the skilled patients to refuse therapy. The individual keeps this right whether health care deliverers acknowledge or disagree with the folks choice(Guido, 2010). Guido (2010) expresses, If there are overriding status interests, treatment may be mandated against a patients or parents needs(p. 4). For example, the Illinois Supreme Judge case (Illinoise v. Dark brown, 1996) sided with a mothers decision to refuse blood vessels transfusions even though they were severly needed for both the mother and the fetus to make it through. In the health care field nurses use several different ethical guidelines daily in their practice, a guiding theory is the patientss right to autonomy alternatively than religious values. Autonomy involves health care deliverers admiration for patients protection under the law to make decisions influencing good care and treatment, even if the health attention deliveres do not buy into the decisions made(Guido, 2010). The American Nursing Connection code of ethics for nurses (2001) claims, the Client (patient) hold the right to make decisions for his or her health (example up to date consent); to be given exact information to make these educated decisions; to be helped in making these decisions; to be given emotional support; and be able to recognize, refuse, or terminate treatment with no coercion (p. 1).
The circumstance was examined by the ethics committee due to ethical dillema accessible. The parties involved with this case were the woman, fetus, husband, physician and his interdisciplinary professional medical team(de franka, Baptista, Brito, 2008). In studying this ethical problem, the case fell under the honest theory of virtue ethics. While using the autonomy model the committee anaylized the decision making process used in this circumstance. Autonomy model facilitates decision making process for the capable patient (Guido, 2010). They identified the problem being the 32 week pregnant woman who was involved with a car accident was suspected to get internal hemorrhage by the ED doctors. The team advised the individual that the best mode of treatment was bloodstream transfusions and a crisis cesarean section. The individual and her husband refused this option because of their religious beliefs plus they provided written documents stating that the patient would not agree to blood or blood products. Because of this refusal of treatment both patient and fetus passed on. The health care and attention teams principles were conflicted because the success of the woman and her fetus was based mostly upon receiving blood vessels however the womans religious integrity would be at stake. The ethical concepts included were autonomy, nonmaleficence, justice, veracity and value for others. The way the patients religious beliefs influenced her decision also needs to be taken into consideration. Juana was a competent patient who made the prepared decision to refuse bloodstream transfusions and a cesarian section. Using virtue ethics, the medical team reputed her autonomy by honoring the individual and her husbands decision which is based after her religous beliefs and prices( de franka, Baptista, Brito, 2008). The health health care providers used the process of beneficence, this means their actions were promoting the good of the individual (Guido, 2010). They also used principle of nonmaleficence by not inflicting injury on the individual by honoring her desires. Guido (2010) expresses the aspect of harm differs for individual patients. For this situation violating her spiritual values could be the harm. Medical treatment providers also implemented the priciple of veracity and respect when you are truthful to the patient and allowing her to make the best decision and respecting that decision. The ethics committee discovered that at this medical center there were no jehova witness protocols in place for dealing with this type of situation. So a choice for image resolution is to build up a protocol necessitating patients who refuse blood or bloodstream product transfusions to sign a waver that releases a healthcare facility and caregivers from any responsibility, recognition of jehovas see early, completing move forward directives for these patients, to monitor the hemoglobin and hematocrit levels closely, and to have a list of medical center affiliations that are well equipped for bloodless modalities of treatment. The World for the Progression of Blood vessels Management has a repository of these clinics that provide blood conserving services in america, Canada, Chile, Krea, and south Africa(Population for the Progress of Bloodstream Management, 2008). Another image resolution option from the health care providers perspective is always to supply the patient blood vessels products because when she was rapidly declining she most likely would not be competent at that point and in disaster situations without a move forward directive and the individual being truly a full code the health professionals and staff would have to do whatever possible to save lots of her and her fetuss life. This resolution option would not work in this case because the husband would be her decision manufacturer if she actually is not competent. That's the reason it is important for jehova see to obtain their legal documents and progress directive on them all the time and also have them easily accessible so that within an emergency situation medical care providers can honor their wants. By honoring their desires the health treatment providers would be using virtue ethics.
This problem is difficult since it is difficult to witness death whenever there are life saving measures that you can do and the individual is choosing to refuse the treatments. By honoring her desires the professional medical team had to put their moral worth aside to respect her autonomy and deliver good care that is appropriate to the set up standards. When asked by the committee which option I would choose I said the choice of allowing the patient to refuse treatment and start a process which gets rid of legal ramifications from the hospital and their caregivers. (de franka, Baptista, Brito, 2008) By doing so the healthcare providers would be training beneficence and nonmalefcince without forcing their values on what is the right move to make. This process would be very beneficial in the professional medical settings because it would benefit not only the private hospitals but also the healthcare providers and patients when these kind of situations happen.
