An 18-year-old female arrives in the emergency department with a profound nosebleed. She is in a coma from blood loss and will die without a transfusion. A recent signed card from Jehovah’s Witnesses refuses blood products under any circumstance found in her purse. What is the most appropriate course of action?

An 18-year-old female arrives in the emergency department with a profound nosebleed. She is in a coma from blood loss and will die without a transfusion. A recent signed card from Jehovah’s Witnesses refuses blood products under any circumstance found in her purse. What is the most appropriate course of action?

• A. Override the patient’s wishes to transfuse to save her life.
• B. Respect the patient’s autonomy because she is incapable of decision making at the time.
• C. Transfuse if absolutely necessary without considering her advance directive.
• D. Seek a court order before any transfusion.

Answer: (B)

Respect for patient autonomy through an advance directive guides care when the patient cannot decide for themselves. Here, the patient is in a coma and lacks decision-making capacity, but she has a recent, explicit refusal of blood products documented in her purse. That advance directive expresses her seriously held wishes and should govern treatment in emergencies. Transfusing would violate her beliefs and autonomy, and seeking a court order would delay necessary care without changing the directive. Therefore, the most appropriate action is to honor the advance directive and refrain from transfusion.

Respect for patient autonomy through an advance directive guides care when the patient cannot decide for themselves. Here, the patient is in a coma and lacks decision-making capacity, but she has a recent, explicit refusal of blood products documented in her purse. That advance directive expresses her seriously held wishes and should govern treatment in emergencies. Transfusing would violate her beliefs and autonomy, and seeking a court order would delay necessary care without changing the directive. Therefore, the most appropriate action is to honor the advance directive and refrain from transfusion.