RUA: Ethical Dilemma Assignment

RUA: Ethical Dilemma By: Stephanie Zepeda, Taylor Brown, Kelsey Dauzat, Tyleisha Bowser

Dilemma Description

● Blood transfusion is an increased risk procedure

● It requires a written consent which can be refused

● Generates medical and ethical concerns ● Understanding patients beliefs and

practices are important ● Jehovah’s Witnesses firmly oppose to

blood transfusions

S.Z.

(Jakubowska, 2018) .

Dilemma Description

● This situation can be difficult especially when dealing with pediatric patients.

● What if the child could make this decision? ○ Case of Jehovah witness

S.Z

(Conti, 2018) (Cobb, 1994).

Pro Position ● Four capacities have been described

for medical decision-making 1. Communicating a choice 2. Understanding 3. Reasoning 4. Appreciation

● Fully developed by age 12 ● Countries such as the Netherlands

involve children in decision making ● Parents may not always know what is

best

S.Z

(Grootens, wiegers, 2017).

Con Position ● Decision making can be affected by

various factors ○ Mental capacity ○ Stress ○ Peer Pressure ○ Easily persuaded

● It can cause a divide in families

S.Z

(Grootens, wiegers, 2017).

Ethical

Principles

❏ Autonomy ❏ Beneficence ❏ Nonmaleficenc

e ❏ Justice ❏ Veracity ❏ Fidelity

T.Brown

(Elarousy and AlNajjar, 2017)

Ethical Principles

Are there special circumstances in which minors can be legally allowed to make autonomous health care decisions?

The mature minor

“In circumstances in which a minor wishes to make an autonomous decision contrary to the wishes of parents or medical professionals, courts may grant the minor total or partial

emancipation (mature minor status) to make decisions. Such judicial actions are based on existing case law, state statutes, or common law practices, and will therefore be determined on a case-by- case basis. Courts often consider the patient’s prior experience with his or her medical condition,

intelligence, and general evidence of maturity in making these determinations”

T.Brown

(Frader and Flanagan, 2017)

Applicable ANA Code of Ethics

Provisions

Provision 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

T.Brown

(Haddad, 2020)

Applicable ANA Code of Ethics

Provisions

Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

T. Brown

(Haddad, 2020)

Applicable ANA Code of Ethics

Provisions

Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

T. Brown

(Haddad, 2020)

Resources to resolve dilemma

❏ The American Academy of

Pedatrics ❏ Consult with anaesthetists,

surgeon, parents, and child (if old

enough to understand) ❏ Assure Confidentially

T.Bowser

(Chand, Subramanya, & Rao, 2014)

Potential outcomes of the

dilemma

❏ The healthcare provider can administer a blood

transfusion to a child without constant of the parent. ❏ The can be temporarily removed from home for child

neglect. ❏ The Court can make a decision to have constant or refusal

blood transfusion if there is no emergency. ❏ Accept receiving blood plasma fractions or the reinfusion

of their own blood ❏ Parents can be okay with healthcare team consulting on

child’s behalf

T.Bowser

(Chand, Subramanya, & Rao, 2014)

Plan for resolving the dilemma ● Respect the child's and family's religious beliefs and

practices. ● Consider the child's development when talking about

spiritual concerns. ● Contact the institution's chaplaincy department for patients

and families who have symptoms of spiritual distress or ask for specific religious rituals.

● Become knowledgeable about the religious worldviews of cultural groups found in the patients you care for.

● Encourage visitation with family members, members of the patient's spiritual community, and spiritual leaders.

● Allow children and families to teach you about the specifics of their religious beliefs.

● Develop awareness of your own spiritual perspective. ● Listen for understanding rather than agreement or

disagreement.

K.D.

(Hockenberry and Wilson, 2018)

Plan for resolving the dilemma

● Establish a therapeutic relationship with the child and family. ● Assess your own personal beliefs about the ethical delimma. ● Educate the child and family of the benefits, risks of blood

transfusions. ● Assess the child's cognitive ability in making medical decisions for

themselves. ● Evaluate and educate on the possible outcomes of treatment vs.

not having the treatment. ● Allow the child and family to make educated desicions for

treatment. ● Respect the desicions made and advocate for their rights.

K.D.

(Levy, 2018)

Key Points

● Religions, such as Jahovah Witness, revokes blood transfusion treatments.

● Parents typically have the legal right to make the decision regarding treatment.

● There are other avenues to treatment.

● The child may have the ability to counteract this decision if deemed appropriate.

K.D

Key Points

● Provide advocacy and autonomy to your patients’ care.

● Be sure to assess your own values and morals in order to make a clear thought out plan.

● Education is important in order for the child and family to make an informed decision.

K.D

References Chand, N. K., Subramanya, H. B., & Rao, G. V. (2014). Management of patients who refuse blood transfusion. Indian journal of anaesthesia, 58(5), 658–664. https://doi.org/10.4103/0019-5049.144680

Conti, A. et. al. (2018). Blood transfusion in children: The refusal of Jehovah's witness parents'. Open Medicine. Vol 13. doi: 10.1515/med- 2018-0016

Grootens-Wiegers, P. et al. (2017). Medical decision-making in children and adolescents: developmental and neuroscientific aspects. V 17: 12. doi: 10.1186/s12887-017-0869-x

El-Arousy, Wafa, and Casestudies Journal. “Ethical Considerations in Pediatric Nursing.” Academia.edu, 10 Oct. 2017, www.academia.edu/36947190/Ethical_considerations_in_pediatric_nursing.

Frader, Joel E, and Erin Flanagan. Minors as Decision-Makers. American Academy of Pediatrics Bioethics Resident Curriculum: Case-Based Teaching Guides, 2017, www.aap.org/en-us/Documents/Bioethics-MinorsAsDecisionMakers.pdf.

Haddad LM, Geiger RA. Nursing Ethical Considerations. [Updated 2020 Sep 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526054/

Hockenberry, M. J., & Wilson, D. (2019). Wong's nursing care of infants and children (11th ed.). Mosby. Jakubowska, K. et. al (2018). Opinions of pediatric nurses about Jehovah’s witnesses refusal of blood transfusion for their child. DOI: 10.2478/pielxxiw-2018-0028

Levy, N. Shibboleth Authentication Request, 12 Jan. 2018, eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=2&sid=d303c3ae-1955-4cc8-888f-fade96c83b01 %40pdc-v-sessmgr04&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3D%3D#AN=T705106&db=nup.