Mary, an 87 year old female who presented to the ER with increased weakness and lethargy. She was found to have a GI bleed with a hemoglobin of 5.9g/dL. She is accompanied by her daughter who is also her power of attorney and healthcare surrogate. Mary’s history includes late Alzheimer’s disease, anemia, hypertension, and COPD. She is a Jehovah’s witness and DNR. Mary agrees to an exploratory laparoscopic surgery but insists that she does not want any blood products, her daughter insists that she have them. Upon finishing Mary’s admission paper work the nurse sees an order to administer two units of packed red blood cells, when questioning the order the nurse is informed the daughter signed the consent for the administration of blood product. The nurse is faced with an ethical dilemma of not following the patients wishes and a legal issue if she does not follow the physicians orders.
The purpose of this paper is to discuss the legal and ethical aspects of the administration of blood to Jehovah witness patients. Per the rubric for the final paper, after the scenario, the paper will analyze the issue ethically, legally, and then the issue presented in the scenario is decided by the student. Ethically, first a discussion of the Code of Ethics and provisions that could help guide the nurse. Here, we could include Provision One which guides the nurse to act with compassion and respect to Barbara while respecting Barbara’s right to self-determination.
Additionally, provision Two guides the nurse that the primary commitment is to Barbara and not to the couple wanting the baby. Additionally, this provision directs the nurse to resolve any conflicts – which could include the nurse’s own values towards surrogacy. Ethical principles discussed in this course are listed on page 59, beginning of chapter 3 of the Burkhardt & Nathaniel book. In this case, we might discuss autonomy – the right of Barbara to decide what she wants to do with her own body; we could also include a discussion of confidentiality. Finally, as part of the ethical discussion, an ethical theory is applied. These theories are discussed in chapter 2 of Burkhardt & Nathaniel. We might apply utilitarianism, which is the theory that decides whether an action is good or bad based on the result. In this case, we could argue that if the result is a baby for a couple that very much desires parenthood, then the result is a good one and therefore, the act is an ethical one. Legally, we would have to determine what the law is in the location where the scenario takes place. In Florida, there is a statute that governs: FLA § 742. 15 : Gestational surrogacy contract. This statute should be discussed and highlight a few other states or countries and discuss differences/similarities with Florida law. Part of the discussion would include, what are the requirements (e.g. surrogate must be 18 years or older), don’t have to be a Florida resident, is the money payment legal, etc. Lastly, reach a decision, based on your ethical and legal analysis.