An unconscious man is brought to the emergency department for a motor vehicle accident hemorrhaging profusely, hypotensive and stuporous. You have never met the patient before and no one at your institution knows him. He is wearing a T-shirt that says, “Kiss me, I’m a Jehovah’s Witness.” What should you do about the blood transfusion?
a. Give the blood.
b. Wait for him to awaken enough to sign consent,
c. Wait for the family.
d. Seek a court order.
e. Give intravenous fluids alone.
Explanation:
A - Give the blood. In an emergency, unless there is an extremely clear advance directive, there is implied consent to procedures. This patient is not conscious to make a decision. He cannot be fully informed to make a choice. There is no advance directive, proxy, living will, or family available there to be the “substitute” for his judgment. Hence, we must make a decision in the best interests of the patient. A shirt is not a sufficient advance directive. You cannot document that he knows the risks of deferring therapy, which, in this case, is death. Even if he was a Jehovah’s Witness, you cannot be certain he would refuse the blood. You cannot say, “Well every other Jehovah’s Witness refuses blood, so would he.” The refusal must be individual. He, this individual patient, must specifically say he doesn’t want the blood in the specific situation. Otherwise it is like going to a restaurant where all the residents always order pizza. You walk into the restaurant and you are a resident. Should the restaurant automatically serve you pizza? Maybe you want chicken. Shouldn’t they ask you what you want? How would you feel if you have on a shirt that says, “Kiss me, I’m a resident” and the waiter brings you pizza saying, “Well, everyone else in your group eats pizza.” You must get individual informed consent or refusal, maybe the patient will consent, and maybe he will not. A shirt is not sufficient evidence of a choice of food or blood transfusion.