Ethical Issues
Ms. Portman

A 47 year old woman is brought by a paramedic ambulance to the hospital because of severe injuries sustained in a motor vehicle accident. She demonstrates signs of shock including significantly low blood pressure, and appears to be in need of a blood transfusion to prevent death. The emergency physician, Dr. White, explains the seriousness of her injuries, the need for immediate blood resuscitation, and the high risks, including possible death if the transfusion is not administered. In spite of her injuries, she is conscious and appears to comprehend the seriousness of her medical condition. She refuses the transfusion and clearly explains her religious objections since she is a Jehovah's Witness. Dr. White faces the ethical decision as to whether save the patient's life and give her a blood transfusion against her will or honor her religious beliefs and allow her to die.

What should the doctor do?

A 14 year old female is brought against her will to the Emergency Department by her parents. The teenager has been missing from home for three days and when she returned home was found to have bruises on her neck she could not explain. Her parents want her to be evaluated for possible sexual abuse. Dr. Green obtains a history from the parents and discovers that the parents have recently separated. Their daughter provides a vague story of her three day adventure, including sleeping over at her girlfriend's boyfriend's house, going to sleep and waking up with marks on her neck.

What should the doctor do?

An elderly woman is transported to an Emergency Department with severe respiratory distress. She has severe, end-stage lung disease and has clearly expressed to her family, friends, and physicians that she does not want her life artificially prolonged. However, her loving husband and family cannot bear the thought of her death, and beg that "everything be done" to preserve her life. They state that she is mentally depressed by her condition and her family is best able to decide her medical treatment. Her medical condition is precarious and only the placement of an endotracheal (breathing) tube and attachment to a respirator will allow her to survive. If this is done, she may or may not recover sufficiently to come off the respirator.

What should the doctor do?