Ethical issues are increasingly resulting in more complications in clinical practice. Breach of bioethics has seen lawsuits skyrocket in the past decade. This situation makes clinical practice more volatile and risky as many practitioners are always expecting lawsuits (Johnstone, 2019). The following case arose in our facility. A Jehovah witness patient who needed urgent surgery to remove a tumor was admitted, a specialist surgeon for such a surgery existed in the facility. The surgeon was willing and ready to perform the surgery. The surgery went well but the patient lost so much blood during the process and needed urgent transfusion of blood to save his life. The surgeon cognizant of Jehovah’s reservations in blood transfusion and the likelihood of the patient’s family declining this, the surgeon went ahead to recommend blood transfusion for his patient to save his life. The facility was at risk of getting a lawsuit because the surgeon failed to seek the consent of close family members regarding the blood transfusion since the patient was not in a state to provide his consent.
The act of the doctor was ethical but from the patient’s perspective, it was unethical as it failed to acknowledge the patient’s autonomy. The doctor’s procedure saved the patient’s life and the patient recovered well but the issue of patient’s autonomy and disregard of the patient’s religious principles became a problem to both the doctor and the facility. The doctor ought to have consulted the family of the patient before implying that consent had been provided or taking the assumption that the patient’s family was going to decline blood transfusion. However, if the family would have declined blood transfusion that decision should have been respected as it represents the decision that the patient would have made if he was in the right capacity. The family became furious and was threatening to sue the facility but in his defense, the surgeon argued that he had an obligation to do good and save the life of his patient and that is exactly what he did. He also noted that he was aware of the religious limitation and if he had chosen to follow religious ethics as provided by Jehovah's Witnesses’ faith the patient’s life could have been at risk and he could not have saved him either.
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The patient has the right to issue his/her decision regarding treatment and the doctor should not implement paternalism when close family members can be consulted about the treatment decision. Disregarding of the family’s consent regarding the blood transfusion breached the patient’ s autonomy as it took the power of the patient’s family to make decisions they would deem fit for their loved one (Butts & Rich, 2013). Another issue that was involved in this case is non-maleficence, this ethic asserts that one should not harm if no good can be accomplished to avoid inflicting pain to the patient. The dilemma is that from the surgeon’s standpoint he did not harm by going through with the blood transfusion because it saved a life but from both the patient and his family’s perspective the surgeon did harm by disregarding religious ethics provided by their faith.
The following nursing interventions could be appropriate in resolving the ethical dilemma above;
Provision of all the information to the patient’s family regarding the condition of the patient during the surgery to enable the family to understand why the doctor had to make such a decision.
The use of beneficence ethics; the facility’s doctor's intention was first to do good and he did this through saving his life.
Communication is key in this situation; the surgeon failed to communicate his intention earlier on but it is prudent to communicate with both the family and the patient regarding why he did blood transfusion as this resolves any conflicts among them. This should be followed by a formal apology to both the patient and his family.
Medical practitioners are obligated to adhere to all prerequisites of their practice to avoid any ethical dilemmas and make resourceful decisions aimed towards the provision of quality care and respect to the legislation which governs their practice.
References
Butts, J. B., & Rich, K. L. (2013). Nursing Ethics: Across the Curriculum and Into Practice (3 ed.). Burlington,MA: Jones & Bartlett Publishers.
Johnstone, M. J. (2019). Bioethics: A Nursing Perspective (7 ed.). Australia: Elsevier Health Sciences.
