Case Study

J.W. is a 34yr old male, Full Code, NKA, no past medical hx, and is a Jehovah’s Witness. He was admitted to the hospital four days ago for nausea, vomiting, and abdominal pain. The patient had a CT abdomen performed in the ED that showed bowel obstruction and perforated diverticulitis. The patient underwent an emergent exploratory laparotomy with abdominal washout and bowel resection. The patient was admitted to the Surgical ICU on mechanical ventilation. Labs show the patient is septic with a lactic acid of 5.8.

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The patient is also extremely hypotensive, with a BP of 40/30 and HR of 138. The patient was sedated on mechanical ventilation and started on pressor medications to improve BP. Over the next couple of days, the patient’s kidney function declined, and the patient had to be placed on continuous dialysis. Today, when reviewing the patient’s lab results, the nurse ME notes the patient’s Hemoglobin level dipped severely and notified M.B., the attending physician’s surgeon. Most likely, the patient will need a blood transfusion to save their life. The patient’s mother, L.M., is their POA and is making decisions for the patient since the patient is unable. When the physician M.B. begins to discuss the severity of a blood transfusion with L.M., she immediately tells the physician no to the blood transfusion because it is against their religion. The physician M.B. states how the patient could die from blood loss if not given a transfusion, but again L.M., the mother refuses the transfusion. Unfortunately, due to the emergent surgery needs, the patient never completed any consent forms before surgery. The POA completed all documents. The physician M.B. then gets palliative care involved as without the blood transfusion, and the patient will die. The cultural issue described in this scenario is called Ethnocentrism. According to our book, Ethnocentrism “refers to the belief that one’s ways are the best, most superior or preferred ways to act, believe, or behave”

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1.) What would you do if this was your patient? Would you accept the decision or possibly get ethics involved?

2.) Do you feel like the POA is following the patient’s wishes by denying them a life-saving blood transfusion?

3.) What is the underlying belief of these actions?

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