Journal of Clinical Research & Bioethics

Does Religion Kill? An Ethical Analysis

Mehdi Hayat Khan^1*, Tanzeel ul Rehman², Alia Rafiq³ and Muhammad Bilal^{4 1}Department of Nursing, University of Lahore, Lahore, Pakistan
²Punjab Population Welfare Department, Lahore, Pakistan
³Dera College of Nursing, Ghazi Khan Punjab, Pakistan
⁴Independent College of Nursing Faisalabad, Pakistan
^*Correspondence: Mehdi Hayat Khan, Ms Nursing Student, Department of Nursing, University of Lahore, Pakistan, Email:

Received: 21-Feb-2020 Published: 13-Mar-2020, DOI: 10.35248/2155-9627.20.11.351

Case Scenario

A 26-year-old pregnant lady (32 weeks of gestation) was landed in the emergency department through an Ambulance. She was driving on the motorway, at a speed of 80-kilo meters per hour, when suddenly, hit into the pole of light and crashed with the windshield of the car, but remains conscious. After her car accident, she complained of lightheadedness, left shoulder pain, weakness, and abdominal cramps. She had no previous history of pregnancies but a known case of sickle cell disease. CT scan showed clear lung field, bilaterally and her vital signs recorded as B.P13/82 mmHg, HR 90 bpm and RR 30 bpm. The cervical spine scan was performed and upon removal of cervical collar, orthostatic changes of B.P (90/60 mmHg) were noted at that time. Her blood analysis revealed Hb of 5.2 g/dL. Ultrasound and Doppler scan confirmed amniotic blood with fetal distress indicating 90 bpm fetal HR. Medical team reached to the consensus that the patient needs immediate blood transfusion and an emergency cesarean section but patient refused for blood transfusion considering her religious restriction. But HCP’s taken the decision and transfused the blood products with c/ section to save patient life [1]. However, this could have violated patient ’ s autonomy but somehow, provided benefits to the patient and met the principle of beneficence.

In Jehovah's Witnesses, blood transfusion creates an ethical dilemma for healthcare providers by considering the patient’s rights; an appropriate decision was taken by the HCP’s that, it is the moral and ethical responsibility of the medical team to save the patient s life by respecting the values and belief. The ethical issues arising in the hospitals are uncommon related to patient refusal to seek medically justified treatment. On the other hand, fetus was in distress and if the emergency c/section was not performed by the surgical team, it will also lead to fetus, as well as mother’s death.

Analysis of Ethical Dilemma

If we analyze, the patient was a victim of an accident whose critical condition needs urgent medical and surgical treatment. The young patient has the right to take the decision for herself but also depends on the surrogate decision maker in that critical situation. If the right decision is taken promptly, then the survival of the patient will be improved. However, the case became complicated when the family did not want to lose the patient by respecting their religious values and believes. Whereas, HCP’s wanted to save the patient’s life by respecting their profession and maintaining standards of practices.

If HCPs could have transfused the blood against Jehovah's Witnesses, then, the legal action could have against them. But, if we see the standards of practice for HCPs, it says as “ It is incontestable that medical professional should always follow the Oath of Hippocrates in treating the normal, critical and terminally ill patient, to save their life, at any cost and did not violate the professional law and discipline in blood transfusion for own or patient betterment to save their lives” [2].

From the Lens of the Organization

The American Nurses Association states that HCP’s should be committed with an organization to respect the patient's cultural values and belief and save their life at any cost [3]. There should be a legal stand for handling such critical and emergent conditions, so that continuity in treatment should be ensured. In an organization, health professionals perform practices with genuineness by following ethical principles, patient values, and beliefs. On the other side, health care systems also practice unethical, illegal acts, and commit medical error which is becoming common [4]. Ethics and values are central to positive organizational performance. In our case the HCPs took ethically justified decision, when the principle of autonomy and beneficence overlapped, as the client was not willing for blood transfusion and c/section, due to the limitation imposed by her religion. Due to which, she was unable to select one particular treatment option; moreover, organizational policy justified blood transfusion and fetal termination.

From the Lens of a Healthcare Provider

HCPs negotiated with the patient and her family to empower them to choose the best medical and surgical treatment plan. They explained the family about the patient's current health status. HCPs selected the single best option to save her life based on their standards of practice but they also had to respect patient’s autonomy for which they were trying to convince them by mentioning all risks and benefits of family’s decision [5].

Whereas literature showed that in Jehovah’s Witnesses patient, they can be convinced for blood transfusion through dialogue and proper counseling [6].

Counter Arguments

This position respects the values, belief, and autonomy of the patient and insured beneficence for the patient. A sickle cell disease is a life-threatening condition that requires blood transfusion and also affects the future medical management plans for the patient considering patient’s religious values and beliefs, blood transfusion and emergency c/section were performed but patient may regret for her entire life for transfusing someone else's blood in her body system [7]. However, this could be a short-term solution with a long-term repercussion.

Emergency fetus termination was performed to save the patient’s life and hospital surgical team ensured by approaching surrogate. Surrogate decision-makers can assist medical team in making the decision for the patient’s best medical and surgical management, available for the patient. Time-consuming and repetitive counseling can delay the treatment, which can lead to poor prognosis [8,9]. Furthermore, patient ’ s refusal to safe treatment option creates disharmony in the healthcare organization [7]. If the patient dies in such critical condition, the stressful environment may result in the family and for the healthcare providers as well.

Recommendations

HCPs should analyze the ethical dilemma critically and act according to the nature of the scenario but should not be violating the professional code of ethics. The final decision should be taken after analyzing the short- and long-term outcomes and its impact on a patient’s life. In surrogacy, the family should be involved in a major medical/surgical treatment plan. An ethical committee should be made who give solution in the light of ethical principles. The policy should be made and implemented for refusal of blood transfusion, fetus termination and any other emergent treatment base on cultural and religious issues at all levels.

Conclusion

An ethical principle of autonomy and beneficence is discussed in this paper. HCPs should respect the principle of autonomy of the patient and her right to choose appropriate possible outcomes directed by her religion. In a same way, many ethical theories suggest that the autonomy of the patient should not be violated and the decision should be taken according to the nature of health issue. In a clinical practice, refusal to medical treatment is common and HCPs understands and follow ethical principles then act, accordingly.

An ethical committee should be made for legal and ethical consideration to ensure a sound decision for such critical dilemma. The organization should conduct some educational program for the HCPs, so that ethical dilemmas may be resolved on a timely and in efficient manners.

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