Ethical Decision-Making: Do Anesthesiologists, Surgeons, Nurse Anesthetists, and Surgical Nurses Reason Similarly?

Abstract

Anesthesiologists tend to transfuse Jehovah’s Witness patients more than did the others. Together with surgeons, they explicitly justify their decision-making less frequently when compared with nurses and nurse anesthetists. Further education in ethical theory is appreciated and needed.

Respecting the Will of the Patient: Between Illusions and Realities: Table 1

“…Nonetheless, the opinions, declarations and even the practices on the part of health professionals regularly challenge this legal and ethical reality in such a way that gives the impression that the right to self-determination is only an illusion, a mirage, unattainable for those depending on it. This is by all means what was revealed in a study carried out relatively recently and published in the journal Pain Medicine [2], regarding a number of ethical positions expressed by caregivers at the University Hospitals of Geneva (I).…”

Overriding the Jehovah's Witness Patient's Refusal of Blood: A Reply to Cahana, Weibel, and Hurst

“…Indeed, an interesting and possibly corroborating fact reported by Cahana et al. is that 2 or 18% of the anesthesiologist OVRs and 5 or 42% of the surgeon OVRs gave no reason as to why they would override the refusing patient's wishes ([1], p. 732). Perhaps for them, reason‐giving was superfluous in light of how intuitively wrong it seems for a self‐respecting or caring health professional to allow such patients to die.…”

“…In the above study, some anesthesiologist OVRs stated that “they were not convinced that ‘the patient really understood what it means to die.’ ” The authors interpreted this to mean that “a Jehovah's Witness who is capable of deciding personal matters may be, in fact, incompetent when it comes to his or her own health, because the harm that might follow their (sic) decision is too serious” ([1], p. 734).…”

“…The authors explain this argument by saying that “being a good professional is not only to be competent but also to be a compassionate ‘advocate’ for the patient” ([1], p. 734). But what would the OVR be advocating in this scenario?…”

“… Some of the anesthesiologist OVRs reported that they were not convinced that these patients really understood “what it means to die” ([1], p. 734); presumably, these OVRs believe that the patient's refusal of a transfusion is not being competently made and, given the gravity of the consequences, should not be honored. A more speculative explanation on the authors' part was that the refusing patient's “extreme existential need” might trigger the OVRs becoming a “compassionate advocate” for the patient, resulting in his or her gainsaying the patient's expressed refusal of a life‐saving transfusion ([1], p. 734). …”