Caring for the Jehovahʼs Witness Parturient

C. Mason, C. Tran
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引用次数: 5

Abstract

A llogeneic blood transfusion is considered by Jehovah's Witnesses to be a violation of God's law, and this can present many ethical, legal, and health concerns when medical care is needed. Especially in cases dealing with childbirth, where substantial blood loss can occur, having an efficient and effective plan and line of communication between the parturient and her caregivers is crucial to ensure the most beneficial outcome for the patient while respecting her constitutionally protected right to make an informed choice about her medical treatment. The authors of this article reviewed concepts and care options as they related to the perioperative care of a Jehovah's Witness parturient. Courts have upheld that competent pregnant women have the right of bodily self-determination and therefore can refuse blood transfusion. This article established the importance of having a patient's care preferences and directives clearly expressed. For example, patients may do this in writing by using an advance health care directive, which would clearly delineate their personal decisions not only on blood transfusion but also in regard to derivatives of plasma or cellular blood components and autologous blood management, which are “conscience” items on which Witnessesmake individual decisions. Although patients have the right to decline treatments, the physician also has a duty to disclose any risks associated with refusing a treatment and to educate patients on alternative treatments. Communication between parturients and their medical caregivers is key throughout the entire treatment process. This article suggests using a perioperative surgical home model to coordinate care throughout the entire surgical experience as this model is fitting for the unique needs of the Jehovah's Witness population. The use of pharmacologic therapies is also recommended when alternatives to blood transfusion are needed. The authors of this article also suggest several options for reducing perioperative transfusion requirements and medical options for Jehovah's Witness patients who experience a massive hemorrhage. Blood conservation techniques should be considered as Jehovah's Witnesses have differing opinions about what treatments are allowed. Although some Jehovah's Witness parturients may consent to the use of acute normovolemic hemodilution and blood cell salvage, other Witnesses may have stricter specifications. Anesthetic and surgical techniques should be executed in a way that decreases blood loss. Again, the authors emphasize communication between patients and caregivers to expedite any necessary interventions in the threat or event of hemorrhage. The care of a Jehovah's Witness parturient must encompass all medical, ethical, and legal considerations. This article stresses the establishment of a communicative and comprehensive model early in the antepartum period that can be maintained throughout
照顾耶和华见证人的产妇
异基因输血被耶和华见证人认为是违反上帝的律法,当需要医疗护理时,这可能会带来许多伦理、法律和健康方面的问题。特别是在可能发生大量失血的分娩情况下,在产妇及其护理人员之间制定高效和有效的计划和沟通渠道至关重要,以确保患者获得最有利的结果,同时尊重受宪法保护的对其医疗作出知情选择的权利。这篇文章的作者回顾了概念和护理方案,因为他们涉及到围手术期护理耶和华见证人的产妇。法院坚持认为,有能力的孕妇有身体自决的权利,因此可以拒绝输血。这篇文章建立了病人的护理偏好和指示明确表达的重要性。例如,病人可以使用预先保健指示,以书面形式做到这一点,该指示将明确规定他们的个人决定,不仅是输血,而且还包括血浆或细胞血液成分的衍生物和自体血液管理,这些是证人作出个人决定的"良心"项目。虽然病人有权拒绝治疗,但医生也有责任告知病人拒绝治疗的任何风险,并教育病人选择其他治疗方法。在整个治疗过程中,患者和医疗护理人员之间的沟通是关键。这篇文章建议使用围手术期的家庭模式来协调整个手术过程中的护理,因为这种模式适合耶和华见证会人口的独特需求。当需要替代输血时,也建议使用药物治疗。这篇文章的作者还提出了减少围手术期输血需求的几种选择,以及对经历大出血的耶和华见证人患者的医疗选择。应该考虑血液保存技术,因为耶和华见证人对允许的治疗方法有不同的意见。虽然一些耶和华见证人的产妇可能同意使用急性等容血液稀释和血细胞回收,但其他见证人可能有更严格的规定。麻醉和手术技术应以减少失血的方式执行。再次,作者强调患者和护理人员之间的沟通,以加快任何必要的干预威胁或出血事件。耶和华见证人的产妇护理必须包括所有医疗、伦理和法律方面的考虑。本文强调在产前早期就建立一种可以贯穿始终的沟通和综合模式
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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