A 20-year-old, Black female, 32 weeks pregnant, was brought to the emergency department (ED) in an ambulance by the paramedics. She arrived in the ED immobilized on a flat board with a hard cervical collar in place. The client was the driver of a sedan involved in a single-vehicle collision. Her condition is unstable, critical.

The plan of care for her was an immediate blood transfusion and an emergency cesarean section. Matters became complicated when the client informed the medical team that she was a Jehovah's Witness and refused the proposed plan of care. The physician then recommended the use of alternative blood products. The client insisted that this was also against her religion and she refused the alternative treatments being offered. The medical team advised her that Jehovah's Witnesses could choose certain blood byproducts, such as albumin, cryoprecipitate, and globulin (Watchtower Bible and Tract Society, 2004).

According to the client and her husband, both believed that if she accepted the blood transfusion or blood products she would no longer be a Jehovah's Witness and would be condemned to hell. The husband then presented the physician with the client’s blood card, created by the Watchtower Bible and Tract Society, the governing organization of Jehovah's Witnesses. The card stated her advance directives, including the prohibition of blood and blood products.

The client's condition worsened within 2 hours of admission to the ED. She went into labor and delivered a stillborn baby boy. She was immediately transferred to the intensive care unit where, despite continued aggressive attempts to stabilize her, she went into cardiac arrest and died.

1. What is the ethical dilemma?

2. Should the team have ignored the client’s wishes to save the client?  Does the fact that the client was pregnant have any bearing? Support your answer.

3. Was the team correct is honoring the client’s autonomy? Support your answer.

4. What ethical principles govern a health care workers response to ethical issues?