Chapter 3: Professional Values

John is a 65-year-old man who is admitted to accident and emergency following a car accident and diagnosed with a ruptured spleen which means he is suffering serious blood loss. When informed that he needs an urgent blood transfusion prior to surgery John informs the doctor that he is a Jehovah Witness and does not want any treatment using blood products. The doctor discusses why a blood transfusion is necessary with John but he is adamant that he does not wish to receive a blood transfusion and gives the doctor his Advance Decision Document. This document lists the blood products and autologous procedures that are acceptable to him and which are not. The doctor explains that given his blood loss the chance of his survival was very poor without the transfusion and John acknowledges that he may die.

Later in the coffee room the doctor informs the nurse to get John cross-matched for four units of blood and says that if they wait until he loses consciousness they could then start a transfusion as no one could possibly value their religion more than life. 

Questions

  • What is the conflict here?

  • What should the nurse’s response be?

Answer:

The doctor is wrong to ask the nurse to do this. John has an advanced directive to ensure that his long-held beliefs and values are upheld. The doctor has a duty to provide the best treatment for John but his belief and values that a life must be saved in whatever way possible is failing to demonstrate the professional values of respect for John’s autonomy to make the decision based on his religious beliefs and values.

The nurse would need to inform the doctor that she could not comply with his request and if he should go ahead she would need to inform the senior doctor on duty.