Ethical health care topics vary in the news and media currently in the healthcare field. Many health care issues can involve the patient’s care, or the policies set forth by healthcare regulatory agencies. In many instances, ethical issues can arise during a patient’s treatment when religious or cultural discrepancies arise that would affect the manner in which the patient receives their care. Ethical issues such as religious beliefs that may cause the patient to decline life-saving treatment can create conflict between not only the patient’s personal values, but also those of the caregiver proving treatment. Additionally, there can be many reasons for the patient to refuse medical care. A patient may refuse medical care simply because they believe there is no integrity among medical providers.
The role of the ethical care worker to promote ethical decision-making in the organization which involves benefiting the patient in a manner that supports their personal values, morals, beliefs, and personal autonomy. Legally, any individual who is cognitively able to make decisions in a competent manner can refuse care for any reason, as their legal rights as a patient. The given assessment will examine and evaluate refusal of care in terms of ethical principles and how ethical principles apply to the issue of refusal of care.
The issue of refusal of patient care is a topic that is controversial in the healthcare field because refusal of care affects the ability provides lifesaving treatments for the patient the medical field. Refusal if care can affect various ethical principles. Autonomy, sometimes called self-determination, includes the patient ability to make their own decisions, and valid consent to treatment, when the patient is competent to do so (Agich, 1993). In terms of autonomy, a patient’s desire to refuse care must be followed, even if the clinician believes the patient is not making a decision that supports their own values (Agich, 1993). The health care provider must also give the patient resources, referrals, and educational materials that will give the patient alternatives for care and treatment, as their moral responsibity (Agich, 1993).
The next ethical principle in refusal of care is beneficence which defines the ability to provide treatment that supports the individual’s wellness. Beneficence can cause disputes between the medical professional’s idea of what is best for the patient, and the patient self-determined decision of what type of treatment may be best for themselves (Agich, 1993). Patients also have the right to receive care free of harm, especially in patients with terminal conditions. Patients also have the right to be treated justly, fairly, equal, and without discrimination by the medical provider when receiving treatment.
Moreover, the issue of blood transfusions in patients who have religious, cultural, and moral beliefs about receiving blood transfusions as lifesaving medical treatments is a controversial issue in the medical field currently. Blood transfusions can be provided to an individual for many reasons including accidents, critical illness, or during surgery. Additionally, all healthcare organizations should have a code of ethics regarding blood donation to assist in dealing with conflicting ethical dilemmas among a patient and medical professionals.
According to ISBT (2000) “patients should be informed of the known risks and benefits of blood transfusion and/or alternative therapies and have the right to accept or refuse the procedure. Any valid advance directive should respect” (p.1). In some cases a patient cannot cognitively give consent, so medical providers should give treatment based on the severity of the medical crisis, and clinical need. According to the ISBT (2000) “blood transfusion practices established by national or international health bodies and other agencies competent and authorized to do so should be in compliance with this code of ethics” (p. 1).
Medical ethics and blood transfusions are most controversial in the cultural group of Jehovah’s witnesses. According to BBC (2009) Jehovah’s Witnesses “refuse blood transfusions, including autologous transfusions in which a person has their own blood stored to be used later in a medical procedure” (p. 1). There are some alternatives that the Jehovah’s Witness will respect in the blood transfusion process. According to BBC (2009), “some Witnesses will accept autologous procedures such as dialysis or cell salvage in which their blood is not stored and the use of packed RBCs (red blood cells), WBCs (white blood cells), plasma or platelets” (p. 1).
The medical professional can have great personal conflict when patients cannot receive blood transfusions for life-saving treatments, and also have a legal obligation to respect the patient’s personal autonomy. A physician can also face criminal repercussion for giving blood to a patient that has refused blood for religious reasons (BBC, 2009). The Jehovah’s witness will sign legal paperwork or advance directives that states they are a Jehovah’s witness and refuse blood transfusions for the medical record to have on file, or may carry the paperwork on themselves as well (BBC, 2009).
Additionally, in some cases children of Jehovah’s Witness parents are considered to not retain personal autonomy and the medical provider can override the parent’s decisions through legal proceedings (BBC, 2009). Alternatively, the four ethical principals can be applied to the case of the refusal of blood transfusions and a given cultural group. A patient who is competent in their decision making always overrides the physician’s choice for the patient. Macklin (2003) states that “the respect for persons principle mandates that physicians should comply with the expressed wishes of a competent adult patient even if the predicted consequences are unfavorable or grave” (p. 275-280). No maleficence and beneficence are ethical principles that could be used to contradict the patient’s ethical rights in specific situations.
Macklin (2009) states that the “principle of no maleficence requires physicians to avoid harm, whenever possible, so withholding a proven, beneficial treatment is likely to have the consequence of producing harm” (275-280). The next type of ethical principle, beneficence explains that the physician can increase benefits, and reduce detriment to the patient can also be useful when the clinician wishes to give blood to the patient even when the patient opposed the transfusion (Macklin, 2009). In the case of the blood transfusion scenario, all four principles cannot be adequately used to solve ethical issues in the healthcare organization. Macklin (2009) states that the principles can conflict with conflict resolution because of “the allegedly conflicting principles of respect for persons and beneficence into congruence. It is clear that respect for persons requires the physician to accede to the patient’s refusal of a blood transfusion” (p. 275-280).
The physician also has to disseminate the pros and cons, and the benefits and consequences of the treatment, as well as what the patients views as harmful in terms of their religion, or adding time to their morality (Macklin, 2009). Mackin (2009) states that “from the perspective of the Jehovah’s Witness, refusal of a blood transfusion has a favorable balance of benefits over harms” (p.275-280).
The Jehovah’s Witness is also give alternatives to receive a blood transfusion that is bioengineered to not contain red blood cells in the transfusion, but the option is also costly to the patient. Macklin (2009) concludes that “rights based justice and legal justice are on the side of honoring the patient’s wishes, so all three principles line up in favor of the conclusion that the ethical solution to the dilemma” (p.275-280). It is also the clinicians duty to really seek the autonomous truth of the individual, without coercing the family or church, and finding out what the patient really desires for their wishes concerning blood transfusions (Macklin, 2009).
In the case of an infant or a child Jehovah’s witness, the medical provider can make decisions for the patient’s own well-being concerning blood transfusions. The lack of capacity standard can be used in the case of the child meaning “that the child is not (yet) an autonomous agent, and therefore someone else should be authorized to make decisions on behalf of the child. In most cases, the parents are the appropriate decision makers” (p.275-280). The Jehovah’s Witness parent will sometimes refuse blood transfusions that would cause the toddler or baby to die, in which the physician can decide that this decision is not in the best interest of the child’s wellbeing. Many states explain that a child can be autonomous until they are adults and best interest cannot be decided until this time.
The four principles can be useful in making decisions based on ethical decision making in the healthcare organization. Blood transfusions and the Jehovah’s Witness can be a controversial moral dilemma among the patient and the provider. In most cases beneficence can be the most difficult principle to apply because it forces the provider to determine what is morally good or bad for the patient. The given assessment has provided an examination and evaluation of refusal of care in terms of ethical principles and how ethical principles apply to the issue of refusal of care.
Agich GJ. (1993). Autonomy and Long-term Care. New York: Oxford University Press. Print. BBC. (2009). “Ethics” (p.1). Retrieved from
http://www.bbc.co.uk/religion/religions/witnesses/witnessethics/ethics_1.shtml ISBT. (2000). A code of ethics for blood donation and transfusion (p.1). Retrieved from
http://www.isbtweb.org/fileadmin/user_upload/ISBT_Code_of_Ethics/Code_of_ethics_new_logo_-_feb_2011.pdf Macklin, R. (2009). Applying the four principles. Journal of Medical Ethics; 29: 275-280.