Question: Part 1: Patient Refuses Blood (Pozgar, P. 137) Case Study Mrs. Jones Has Gangrene Of Her Left Leg. Her Hemoglobin Slipped To 6.4 G/dL. She Has A Major Infection And Is Diabetic. Has No Spouse And No Living Will But Has Two Adult Children. The Patient Has Decided Hat She Does Not Want To Be Resuscitated If She Should Go Into Cardiopulmonary Arrest. She …

Part 1: Patient Refuses Blood (Pozgar, p. 137) Case Study

Mrs. Jones has gangrene of her left leg. Her hemoglobin slippedto 6.4 g/dL. She has a major infection and is diabetic.  has no spouse and no living will but has two adult children. Thepatient has decided hat she does not want to be resuscitated if sheshould go into cardiopulmonary arrest. She may need surgery. Shehas agreed to surgery, but refuses a blood transfusion, even thoughshe is not a Jehovah’s Witness. The surgeon will not perform thesurgery, which is urgent, without Jones agreeing to accept a bloodtransfusion if it becomes necessary. The attending physicianquestions the patient’s capacity to make decisions. Her childrenhave donated blood. She says she is not afraid to die.

1. Should the physician refuse to treat this patient? Explain youranswer.
2. Should the family have a right to override the patient’sdecision to refuse blood? Explain your answer.

Part 2: A Son’s Guilt, a Father’s Wishes (Pozgar, p. 137) CaseStudy

Following a massive stroke, Mr. Smith was transported from theRope Nursing Facility to a local hospital by ambulance on July 4,2004. Smith, 94 years of age, had been a resident at the RopeNursing Facility for the past 12 years. Before being placed inRope, Smith had been living with Mr. Curry, a close friend, for theprevious 8 years. He had an advance directive indicating that hewould never want to be placed on a respirator.

Smith’s son and only child, Barry, who now lives in Los Angelesand had been estranged from his father for more than 20 years, wasnotified by Curry that his father had been admitted to the hospitalin a terminal condition. Smith had mistakenly been placed on arespirator by hospital staff contrary to the directions in hisadvance directive, which had been placed on the front cover ofSmith’s medical chat. Curry, who was legally appointed by Smith toact as his healthcare surrogate decision maker, called Barry andexplained that, according to his father’ wishes and advancedirectives, he was planning to ask hospital staff to have therespirator removed. Barry asked Curry to wait until he flew in fromCalifornia to see his dad. Curry agreed to wait for Barry’s arrivalthe following day. After arriving at the hospital, Barry told Currythat he would take responsibility for his father’s care and thatCurry’s services would no longer be needed. Barry told hospitalstaff that he objected to the hospital’s plan to remove his fatherfrom the respirator. He said that he needed time to say goodbye tohis dad, which he did by whispering his message in his father’sears. Smith, however, did not respond. Barry demanded that thehospital do everything that it could to save his father’s life,saying, “I don’t know if Dad heard me. We have to wait until hewakes up so that I can tell him how sorry I am for not havingstayed in touch with him over the years.” Smith’s physicianexplained to Barry that there was no chance Smith could ever awakenout of his coma. Barry threatened legal action if the hospital dinot do everything it could to keep his father alive. Smith’sphysician again spoke to Barry out the futility of maintaining hisfather on a respirator. Barry remained uncooperative. The hospitalchaplain was called to speak to Barry, but had little success.Finally, hospital staff requested an ethics consult.

1. Discuss the ethical dilemmas in this case.
2. Discuss the issues and the role of the ethics committee in thiscase.
3. Do YOU have an advance directive or living will? Let’s sharethis information: Yes, I have an advance directive; or No, I needone. If yes, great job! If no, why not…time to ‘adult’.