RESUMO
Nineteen people refusing a blood transfusion in anticipation of thoracic surgery were met at the Clinical Ethics Center (AP-HP, Paris, France). The article reflects on the right place that respect for autonomy plays in medical decisions regarding (non)transfusion when medical practice would recommend it. Three patient profiles emerge: "categorical refusals", "refusals while affirming the need to live" and "refusals accompanied by doubt". Without neglecting the arguments relating to other principles of biomedical ethics (beneficence, non-maleficence, justice), the idea is to enable healthcare professionals to better assess the different situations they face and in particular those in which respect for autonomy seems essential. If the majority of people concerned by the issue are Jehovah's Witnesses, and although this religion is sometimes stigmatized, this work sheds light on the place of their wishes hold in medical decisions on (non)transfusion. Healthcare professionals could contact ethics units and ask them to carry out this same assessment in their own different.
Assuntos
Transfusão de Sangue , Testemunhas de Jeová , Autonomia Pessoal , Recusa do Paciente ao Tratamento , Humanos , Transfusão de Sangue/ética , Transfusão de Sangue/métodos , Recusa do Paciente ao Tratamento/ética , França , Respeito , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's students in nursing and midwifery regarding the attitudes of Jehovah's Witnesses towards refusing blood transfusions. METHODS: 349 master's students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah's Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah's Witness (JW) patients. RESULTS: The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah's Witnesses' stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients' autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah's Witnesses' beliefs on blood transfusions and non-blood management techniques. CONCLUSIONS: Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.
Assuntos
Atitude do Pessoal de Saúde , Transfusão de Sangue , Competência Cultural , Testemunhas de Jeová , Estudantes de Enfermagem , Humanos , Transfusão de Sangue/ética , Feminino , Estudantes de Enfermagem/psicologia , Masculino , Tocologia/educação , Adulto , Recusa do Paciente ao TratamentoRESUMO
This article argues for a ban on the performance of medically unnecessary genital normalizing surgeries as part of assigning a binary sex/gender to infants with intersex conditions on the basis of autonomy, regardless of etiology. It does this via a dis/analogy with the classic case in bioethics of Jehovah Witness (JW) parents' inability to refuse life-saving blood transfusions for their minor children. Both cases address ethical medical practice in situations where parents are making irreversible medical decisions on the basis of values strongly held, identity, and relationship-shaping values-such as religious beliefs or beliefs regarding the inherent value of binary sex/gender-amidst ethical pluralism. Furthermore, it takes seriously-as we must in the intersex case-that the restriction of parents' right to choose will likely result in serious harms to potentially large percentage of patients, their families, and their larger communities. I address the objection that parents' capacity to choose is restricted in the JW case on the basis of the harm principle or a duty to nonmaleficence, given that the result of parent choice would be death. I provide evidence that this is mistaken from how we treat epistemic uncertainty in the JW case and from cases in which clinicians are ethically obligated to restrict the autonomy of nonminor patients. I conclude that we restrict the parents' right to choose in the JW case-and should in the case of pediatric intersex surgery-to secure patient's future autonomy.
Assuntos
Transfusão de Sangue , Transtornos do Desenvolvimento Sexual , Testemunhas de Jeová , Pais , Autonomia Pessoal , Humanos , Transfusão de Sangue/ética , Masculino , Feminino , Transtornos do Desenvolvimento Sexual/cirurgia , Recusa do Paciente ao Tratamento/ética , Cirurgia de Readequação Sexual/ética , Lactente , Criança , Religião e Medicina , Tomada de Decisões/ética , Consentimento dos Pais/éticaRESUMO
BACKGROUND: Prehospital and early in-hospital use of low titer group O whole blood (LTOWB) for life-threatening bleeding has been independently associated with improved survival compared to component therapy. However, when RhD-positive blood products are administered to RhD-negative females of childbearing potential (FCP), there is a small future risk of hemolytic disease of the fetus and newborn (HDFN). This raises important ethical questions that must be explored in order to justify the use of RhD-positive blood products, including LTOWB, both in clinical practice and research. METHODS: This essay explores the ethical challenges related to RhD-positive blood product administration to RhD-negative or RhD-unknown FCPs as a first-line resuscitation fluid in the trauma setting. These ethical issues include: issues related to decision-making, ethical analysis based on the doctrine of double effect (DDE), and attendant obligations incurred by hospitals that administer RhD-positive blood to FCPs. RESULTS: Ethical analysis through the use of the DDE demonstrates that utilization of RhD-positive blood products, including LTOWB, in the early resuscitation of FCPs is an ethically appropriate approach. By accepting the risk of HDFN, hospitals generate obligations to promote blood donation, evaluate for alloimmunization and counsel patients on the future risk of HDFN, and maintain an understanding of the ethical rationale for RhD-positive blood transfusion.
Assuntos
Sistema do Grupo Sanguíneo Rh-Hr , Ferimentos e Lesões , Humanos , Ferimentos e Lesões/terapia , Feminino , Transfusão de Sangue/ética , Gravidez , Eritroblastose Fetal/sangueAssuntos
Transfusão de Sangue , Recusa do Paciente ao Tratamento , Feminino , Humanos , Gravidez , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Transfusão de Sangue/ética , Transfusão de Sangue/legislação & jurisprudência , Tomada de DecisõesRESUMO
In this case study, I consider Mr. A, a Jehovah's Witness with chronic vertebral osteomyelitis in need of surgical debridement. Prior to proceeding to the OR, he was unwilling either to explicitly consent to or refuse blood transfusion, while indicating he was open to transfusion intraoperatively, if the team judged it necessary. Ethics was consulted to determine if it would be morally justifiable for the team to proceed with blood transfusion during the course of surgery without Mr. A's documented consent to being transfused. I argue that in this case, what might be termed indirect consent-namely, delegating decision-making regarding some possible course of action without explicitly consenting to the course of action itself-may be sufficient for discharging the clinician's ethical obligation to obtain consent. Identifying information has been changed or omitted to protect patient confidentiality.
Assuntos
Transfusão de Sangue , Consentimento Livre e Esclarecido , Testemunhas de Jeová , Humanos , Masculino , Transfusão de Sangue/ética , Confidencialidade , Tomada de Decisões , Consentimento Livre e Esclarecido/ética , Osteomielite , Recusa do Paciente ao Tratamento/ética , IdosoRESUMO
There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.
Assuntos
Doadores de Sangue , Transfusão de Sangue , Vacinas contra COVID-19 , COVID-19 , Pais , Criança , Feminino , Humanos , Masculino , Transfusão de Sangue/ética , Procedimentos Cirúrgicos Cardíacos , COVID-19/prevenção & controle , Cardiopatias Congênitas/cirurgia , SARS-CoV-2 , Recusa do Paciente ao Tratamento , VacinaçãoRESUMO
The goal of patient blood management (PBM) is to optimize clinical outcomes for individual patients by managing their blood as a precious and unique resource to be safeguarded and managed judiciously. A corollary to successful PBM is the minimization or avoidance of blood transfusion and stewardship of donated blood. The first is achieved by a multidisciplinary approach with personalized management plans shared and decided on with the patient or their substitute. It follows that the physician-patient relationship is an integral component of medical practice and the fundamental link between patient and doctor based on trust and honest communication. Central to PBM is accurate and timely diagnosis based on sound physiology and pathophysiology as the bedrock on which scientifically based medicine is founded. PBM in all disease contexts starts with the questions, "What is the status of the patient's blood?" "If there are specific abnormalities in the blood, how should they be managed?" and "If allogeneic blood transfusion is considered, is there no reasonable alternative therapy?" There are compelling scientific reasons to implement a nontransfusion default position when there is clinical uncertainty and questionable evidence of clinical efficacy for allogeneic blood transfusion due to known potential hazards. Patients must be informed of their diagnosis, the nature, severity and prognosis of the disease, and treatment options along with risks and benefits. They should be involved in decision-making regarding their management. However, as part of this process, there are multifaceted medical, legal, ethical, and economic issues, encompassing shared decision-making, patient choice, and informed consent. Furthermore, variability in patient circumstances and preferences, the complexity of medical science, and the workings of health care systems in which consent takes place can be bewildering, not only for the patient but also for clinicians obtaining consent. Adding "patient" to the concept of blood management differentiates it from "donor" blood management to avoid confusion and the perception that PBM is a specific medical intervention. Personalized PBM is tailoring the PBM to the specific characteristics of each patient. With this approach, there should be no difficulty addressing the informed consent and ethical aspects of PBM. Patients can usually be reassured that there is nothing out of order with their blood, in which case the focus of PBM is to keep it that way. In some circumstances, a hematologist may be involved as a patient's blood advocate when abnormalities require expert involvement while the primary disease is being managed.
Assuntos
Transfusão de Sangue , Tomada de Decisão Clínica , Preferência do Paciente , Transfusão de Sangue/ética , Humanos , Consentimento Livre e Esclarecido , Relações Médico-Paciente , IncertezaRESUMO
El rechazo de las transfusiones de sangre por parte de los Testigos de Jehová representa un ejemplo clásico en el ámbito de la Bioética y la relación médico-paciente, cuando entran en colisión las intenciones y actuaciones de los médicos y las instituciones sanitarias, que tratan de salvaguardar la salud del paciente, con el necesario respeto de las decisiones personales del mismo respecto a las medidas terapéuticas que pudiera necesitar. Conceptos como la debida información, la confidencialidad, la libertad y la ausencia de toda coacción cobran entonces una especial importancia. En este aspecto, presentamos dos visiones cinematográficas sobre el mismo dilema: qué hacer cuando un Testigo de Jehová rechaza una transfusión sanguínea, poniendo en serio peligro su propia vida. La primera de ellas es Vida para Ruth (1962) de Basil Dearden, una película realizada apenas un par de décadas después de que las máximas instituciones de los Testigos de Jehová adoptaran la firme decisión de rechazar este tratamiento. La segunda ella, tras el adecuado sosiego dogmático, nos la proporciona El veredicto (2017) de Richard Eyre, donde una juez especializada en asuntos familiares debe sentenciar respecto a unos padres, Testigos de Jehová, que deniegan una transfusión de sangre a su propio hijo, menor de edad y gravemente enfermo. (AU)
The rejection of blood transfusions by Jehova´s Withnesses represents a classic example in the field of Bioethics and doctor-patients relationship, where the intentions and actions of doctors and health institutions collide, trying to safeguard the healthy of the patient with the necessary respect for his personal decisions regarding the therapeutic measures he mat need. Concepts such as proper information, confidentiality, freedom and the absence of any coercion are especially important. In this regard, we present two cinematographic visions on the same dilemma: what to do when a Jehova´s Witness refuses a blood transfusion, putting his own life in serious danger. The first of them is Life for Ruth (1962) by Basil Dearden, a film made just a couple of decades after the highest institutions of Jehova´s Witnesess made the firm decision to reject these therapeutic measures. The second one, with the appropriate dogmatic calm, provided by The Children Act (2017) by Richard Eyre, in which a specialized judge in family matters must sentence with respect to some parents, Jehova´s Witnesses, who deny a blood transfusion to their own minor and seriously ill child. (AU)
Assuntos
Humanos , Transfusão de Sangue/ética , Transfusão de Sangue/legislação & jurisprudência , Testemunhas de Jeová , Bioética , Filmes CinematográficosRESUMO
Postpartum Hemorrhage is still the leading cause of maternal mortality. The management of patients who refuse allogeneic blood transfusion, like in the case of Jehovah's Witnesses, is clinically and ethically challenging. We describe the case of a woman with several risk factors for major postpartum hemorrhage, specifically the presence of a giant uterine myoma. The multidisciplinary management of this patient included an elective c-section and the use of prophylactic tranexamic acid. The perioperative and peripartum care of Jehovah's Witnesses requires specific strategies to minimize blood loss, optimize oxygen delivery and consumption, enhance hemoglobin production, correct coagulation defects and promote hemostasis. We highlight the need for a multidisciplinary approach, point-of-care testing and the use of fibrinogen concentrate and tranexamic acid, according to the patients' informed consent.
A hemorragia obstétrica continua a ser a principal causa de morbimortalidade materna, sendo que a abordagem de grávidas que recusam alotransfusão, como é o caso das Testemunhas de Jeová, coloca importantes questões médicas, éticas e legais. Reporta-se um caso de uma doente Testemunha de Jeová, submetida a cesariana com fatores de risco para hemorragia major, incluindo existência de um mioma gigante, em que se evitou a transfusão e foi utilizado ácido tranexâmico profilático. A abordagem de Testemunhas de Jeová em contexto de cirurgia obstétrica com risco hemorrágico major implica a definição de estratégias anestésico-cirúrgicas para a minimização de perdas hemorrágicas, a otimização da entrega e consumo de oxigénio, o aumento da síntese de hemoglobina, a correção de defeitos de coagulação e melhoria da hemostase. Revemos a importância do planeamento multidisciplinar, o recurso ao tromboelastrograma e a administração precoce de fibrinogénio e ácido tranexâmico, de acordo com o consentimento informado das doentes.
Assuntos
Antifibrinolíticos/administração & dosagem , Testemunhas de Jeová , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Hemorragia Pós-Parto/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Transfusão de Sangue/ética , Feminino , Humanos , GravidezRESUMO
The rapid onset and worldwide spread of the COVID-19 epidemic (caused by SARS-CoV-2 coronavirus) has been associated with a profound impact in clinical practice also in the hematologic setting. First of all, given the immunosuppressive effect of many therapies that are normally administered to patients with hematological diseases, with a consequent increased risk of contracting a more severe viral infection, it has been necessary to reconsider in each individual patient the urgency and priority of the treatments foreseen by the normal standards of care. In particular, as regards allogeneic (and to a lesser extent autologous) hematopoietic cell transplantation and CAR T-cell therapy, specific recommendations have been issued by the transplant community on the criteria to be used to decide whether or not to postpone these procedures and on the clinical management of recipients and donors exposed to COVID-19. As to cytotoxic chemotherapy and other antineoplastic therapies, criteria have been proposed to decide, in the various clinical situations, which treatments were not deferrable and which instead could be postponed or replaced by less aggressive therapies. In the outpatient clinics, various organizational solutions for telemedicine have been adopted, resorting to telephone interviews and/or Information Technology, with the aim of reducing the influx of patients while maintaining an adequate control of their clinical condition. The collection of blood by the transfusion centers has been the subject of organizational measures, in order to avoid the transmission of COVID 19 while maintaining a sufficient blood collection for clinical needs. Finally, some hematologic laboratory alterations have been identified, such as thrombocytopenia, lymphopenia and coagulation abnormalities, useful for the prognostic evaluation of infected patients.
Assuntos
Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/terapia , Doenças Hematológicas/terapia , Pandemias , Pneumonia Viral/terapia , Tromboembolia Venosa/terapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Transfusão de Sangue/ética , COVID-19 , Tomada de Decisão Clínica/ética , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/imunologia , Doenças Hematológicas/virologia , Transplante de Células-Tronco Hematopoéticas/ética , Humanos , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , SARS-CoV-2 , Telemedicina/métodos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/imunologia , Tromboembolia Venosa/virologiaRESUMO
Can transfusions of blood plasma slow down ageing or even rejuvenate people? Recent preclinical studies and experimental tests inspired by the technique known as parabiosis have aroused great media attention, although for now there is no clear evidence of their effectiveness. This line of research and the interest it is triggering testify to the prominent role played by the idea of combating the "natural" ageing process in the scientific and social agenda. While seeking to increase the duration of healthy living time may be considered a duty, it also raises ethical questions about how to pursue this goal. Specifically, therapies and techniques accessible only to a fraction of the population seem destined to exponentially increase social inequality and to produce undesirable consequences. In this article we address the issue precisely in the light of the prospected use of plasma for the rejuvenation of a small elite of people.
Assuntos
Envelhecimento/fisiologia , Transfusão de Sangue/ética , Rejuvenescimento , Transfusão de Sangue/métodos , Humanos , Longevidade/fisiologia , Parabiose/ética , Parabiose/métodos , Inibidor Tecidual de Metaloproteinase-2/biossínteseRESUMO
PURPOSE OF REVIEW: Jehovah's Witnesses have religious beliefs that preclude transfusion of blood products and certain medical interventions. This presents a unique dilemma and ethical challenge to healthcare providers, especially in a surgical setting. RECENT FINDINGS: The growing number of followers of this faith warrants a deeper look at the ethical, legal, and clinical implications of their beliefs. Advances in patient blood management now allow timely optimization before surgery. SUMMARY: Anticipating the challenges associated with managing and optimizing patients who refuse blood products allows for more favorable outcomes in the preoperative period.
Assuntos
Transfusão de Sangue , Testemunhas de Jeová , Assistência Perioperatória/métodos , Guias de Prática Clínica como Assunto , Transfusão de Sangue/ética , Humanos , Assistência Perioperatória/ética , Relações Médico-Paciente , Religião e MedicinaRESUMO
When an incapacitated Jehovah's Witness neurologically deteriorates and requires immediate craniectomy, institutional protocols may delay surgery if the patient's refusal of blood products is ambiguous. We are among the first to describe such an ethically contentious case in emergency neurosurgery, review the morbidity of operative delays, discuss medicolegal concerns raised, and provide a detailed guide to hemostasis in patients who refuse blood products. We discuss the case of a 46-year-old woman presented with nausea, vomiting, and right-sided weakness, progressing to stupor over several hours. When an initial Computed Tomography (CT) scan showed a large, left-sided intraparenchymal hematoma with significant midline shift, she was booked for an emergency hemicraniectomy. According to the family, she was a Jehovah's Witness and would have refused blood consent, but was without the proper documentation. Despite her worsening neurological status, an indeterminate blood consent delayed surgery for more than two hours. Her neurological exam did not improve postoperatively, and she later expired. The ethical, legal, and operative concerns that arise in the emergency neurosurgical treatment of Jehovah's Witness patients pose unique management challenges. Since operative delay is a preventable cause of mortality in patients requiring urgent craniectomy, and the likelihood of requiring a transfusion from hemorrhage is minimal, an ambiguous blood consent should not postpone a potentially life-saving treatment. For the beneficence and autonomy of Jehovah's Witness patients, institutional policies should respect the family's wishes in order to expedite surgical decompression. In addition to discussing the nuances of such ethical considerations, we also provide a detailed list of commonly used, topical and parenteral hemostatic agents from the neurosurgical operating room which, depending on whether they are blood-derived, either should or should not be used when treating a Jehovah's Witness.
Assuntos
Transfusão de Sangue/ética , Serviços Médicos de Emergência/ética , Testemunhas de Jeová , Neurocirurgia/ética , Procedimentos Neurocirúrgicos/ética , Perda Sanguínea Cirúrgica , Descompressão Cirúrgica/ética , Feminino , Hemostasia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Exame Neurológico , Tempo para o Tratamento , Tomografia Computadorizada por Raios XRESUMO
PURPOSE OF REVIEW: Jehovah's Witness patients with critical anemia or undergoing major surgery are challenging for healthcare providers to manage, as most will decline transfusion of whole blood and its main components. Recent advances in our understanding of hemostatic agents, alternative hemoglobin-based oxygen carriers, and patient blood management have culminated in a complex array of options to manage critical anemia and bleeding in this patient population. RECENT FINDINGS: Refusal of blood products in the setting of critical anemia is associated with significant risk of morbidity and mortality. With implementation of patient blood management measures, targeted treatment of anemia and coagulopathy has reduced the need for transfusions. Likewise, increased clinical experience with hemoglobin-based oxygen carriers in Jehovah's Witnesses with critical anemia has provided new insights into their potential benefits and pitfalls. SUMMARY: Options and alternatives to manage the Jehovah's Witness patient in the perioperative setting or in the setting of critical anemia will be reviewed.
Assuntos
Anemia/terapia , Transfusão de Sangue/ética , Transfusão de Sangue/psicologia , Terapias Complementares , Ética Médica , Testemunhas de Jeová , Fatores Etários , Terapias Complementares/métodos , Gerenciamento Clínico , Humanos , Medicina Perioperatória/ética , Medicina Perioperatória/métodos , Medicina Perioperatória/normasRESUMO
BACKGROUND AND OBJECTIVES: The perception of transfusion-transmitted infections (TTIs) is sensitive to various concerns besides the probability and impact of infection, and some of these concerns may be ethically relevant. This paper aims to advance thinking about blood safety policies by exploring and explaining stakeholders' reasons to consider TTI risks tolerable or intolerable. MATERIALS AND METHODS: Inspired by critical empirical ethics and phenomenological hermeneutics, we held interviews and focus group discussions to explore the moral experience of policymakers, hematologists, blood donors and recipients. Respondents were invited to discuss general concerns about the blood supply, to address the tolerability of TTI risks compared with other hazards and to comment on the costs of blood safety. Arguments for tolerance or intolerance towards TTI risks were analysed qualitatively. RESULTS: Stakeholders' views could be clustered into seven categories: (1) clinical impact; (2) probability of infection; (3) avoidability of infection; (4) cost and health benefits; (5) other consequences of safety measures; (6) non-consequentialist ethical arguments; and (7) stakeholders' interests. Various arguments were offered that resonate with current ethical thinking about blood safety. Assuming that resources spent on inefficient blood safety measures could be applied more beneficially elsewhere, for example, responders typically expressed tolerance towards TTI risks. Some other arguments seem novel, for instance arguments for risk intolerance based on the low probability of infection and arguments for risk tolerance if patients have a poor prognosis. CONCLUSION: Understanding the moral experience of stakeholders enriches ethical debate about blood safety and prepares developing more widely acceptable policies.
Assuntos
Doadores de Sangue/ética , Segurança do Sangue/ética , Transfusão de Sangue/ética , Reação Transfusional/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação Transfusional/epidemiologiaRESUMO
OBJECTIVE: To point out principles of blood sparing surgery. Medical ethical moral and legal aspects of operations on Jehovahs Witnesses. DESIGN: Retrospective clinical study. Review of articles. SETTING: Dept. of Gynecology and Obstetrics, University Hospital, Olomouc; Dept. of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlín. MATERIALS AND METHODS: 72 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases since 2007-2017. All patiens were operated according to the rules of blood sparing surgery. RESULTS: There were no excesive blood loss at any of the operations. The estimated blood loss was between 10 to 550 ml. CONCLUSIONS: The main principles of blood sparing surgery should be applied not only for Jehovahs Witnesses but for all patients. Even if the blood transfusion is the last resort for excessive blood loss during complicated operations it always carries some health risks. There are also the economical aspects. Blood transfusions should be therefore used only at very rare occasions. Jehovahs Witnesses refuse blood transfusions at all even if it is the only life saving resort. Our legislation deal with this problem but there are also moral and ethical aspects. The attitude of gynecological surgeons how to solve this problem differ a great deal.
Assuntos
Transfusão de Sangue , Ética Médica , Testemunhas de Jeová , Princípios Morais , Religião e Medicina , Transfusão de Sangue/ética , Parto Obstétrico/ética , Feminino , Hemorragia , Humanos , Legislação Médica , Gravidez , Estudos RetrospectivosRESUMO
PURPOSE: To determine motives and attitudes towards life-sustaining treatments (LSTs) by clinical and preclinical medical students. METHODS: This was a scenario-based questionnaire that presented patients with a limited life expectancy. The survey was distributed among 455 medical students in preclinical and clinical years. Students were asked to rate their willingness to perform LSTs and rank the motives for doing so. The effect of medical education was then investigated after adjustment for age, gender, religion, religiosity, country of origin, and marital status. RESULTS: Preclinical students had a significantly higher willingness to perform LSTs in all cases. This was observed in all treatments offered in cases of a metastatic oncologic patient and an otherwise healthy man after a traumatic brain injury (TBI). In the case of an elderly woman on long-term care, preclinical students had higher willingness to supply vasopressors but not perform an intubation, feed with a nasogastric tube, or treat with a continuous positive air-pressure ventilator. Both preclinical and clinical students had high willingness to perform resuscitation on a twelve-year-old boy with a TBI. Differences in motivation factors were also seen. DISCUSSION: Preclinical students had a greater willingness to treat compared to clinical students in all cases and with most medical treatments offered. This is attributed mainly to changes along the medical curriculum. Changes in reasons for supplying LSTs were also documented.