Another Ethical Dilemma: To Transfuse or Not Transfuse But Is That the Bloody Question?

WK was a 14 year old male and involved in a motor vehicle accident and was brought to the nearest community trauma center. The patient’s mother also involved sustained only minor injuries and was transferred to the same trauma center. WK sustained an open femur fracture with significant intra-pelvic trauma resulting in bowel injury and hemorrhage. When the trauma surgeon informed the mother that the seriousness of the boy’s injury would require blood transfusion in order to save his life, the mother refused to consider this option as it was not compatible with their faith. The trauma surgeon emphasized to the mother the severity of the boy’s condition and explained that the alternative treatments would not be sufficient. However the mother was adamant and continued to deny permission for transfusion. Operative auto-transfusion was also discussed with the mother but also not allowed.

Despite the lack of consent for blood product transfusion, the surgeon took the boy to the operating room. At the time of the operation the patient’s blood pressure was low because of the bleeding and trauma but conscious and alert. He understood he was going to undergo an emergency surgery. He was also made aware of the surgeon’s opinion that blood product transfusions were a necessity for his survival. But in addition, he was also made aware of his mother’s refusal to consent for these transfusions. On the ride to the operating room, in the elevator, the patient asked to be given whatever blood products were necessary to save his life. The surgeon documented the conversation with the patient’s own words “do whatever it takes for me to make it “. The patient also requested the surgeon to keep his transfusion record confidential and not disclose it to his mother. The patient had significant intra-pelvic hemorrhage and was given multiple intra operative transfusions. His intra-pelvic injuries and fractures were ultimately repaired and the bleeding stopped. Postoperatively his blood pressure was normalized and stable. He made a full recovery and was discharged. At the patient’s request, the mother was never notified of the patient’s transfusions. (Or did the mother finally find out from the hospital bills?)

So here are the issues that an ethics committee might have to discuss, but of course in retrospect:

Did the mother have the final decision-making capability?

To what extent can a 14 year old, who had the mental capacity of a 14 year old, make his own medical decisions?

Should the surgeon have honored the mother’s request over that of her son?

Should there have been disclosure by the surgeon of the transfusion to the mother?

What would happen if the patient, having received the transfusions, suffered a severe transfusion reaction or developed hepatitis or AIDS? Was the surgeon to blame?

Well, if you were a member of the ethics committee, how would you answer these questions? ..Maurice.

Graphic: Blood drop image via Google Image then concocted by me using ArtRage and Picasa3.