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Ethical and Legal Issues in Obstetrics and Gynecology

Which of the following is not a requirement for hospitals according to the Federal Patient Self-Determination Act?

a. To provide all adults with information about their right to accept or refuse treatment in the event of life-threatening conditions

b. To state the institution's policy on advanced directives

c. To prohibit discrimination in care provided to a patient on the basis of the patient's advanced directive

d. To require donation of organs after death

e. To allow patients to decide who has the right to make decisions for them

The answer is d. The Patient Self-Determination Act (PSDA) took effect in 1991, and is intended to promote awareness and discussion to prepare for medical decisions at the end of life. It requires hospitals to inform patients upon admission of state laws concerning self-determination. Hospitals must inform patients about their rights to accept or refuse terminal care, and this information has to be documented in the patient's chart. The patient has the option to make a clear assignment of who can make medical decisions if the patient is unable. Patients are not required to allow organ donation.

A 31-year-old G3P3 Jehovah's Witness begins to bleed heavily 2 days after a cesarean delivery. She refuses blood transfusion, and says that she would rather die than receive any blood or blood products. You personally feel that you cannot do anything and watch her die. Appropriate actions that you can take under these circumstances include which of the following?

a. Tell the patient to find another physician who will care for her

b. Transfuse her forcibly

c. Only provide supportive care

d. Obtain a court order for a blood transfusion

e. Have the patient's husband sign a release to forcibly transfuse her

The answer is c. Determination of ethical conduct in doctor-patient relationships can sometimes be very difficult for the physician who is confronted with a patient's autonomy in making a decision that the physician finds incomprehensible. However, the autonomy of the patient who is oriented and alert must be respected even if it means that the patient is refusing potentially lifesaving therapy. Attempting to obtain a court order to transfuse an adult against his or her will is almost never an acceptable option, and leads to a tremendously slippery slope of the doctor's control of the patient's behavior. A patient's spouse also does not have legal authority to ...

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