Let me preface this thread by stating a few things:
1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views.
2. Whatever your belief, please respect the beliefs of others.
That said, I admit to not understanding how parents can stand by and watch their child bleed to death.
Teenager, throwing up blood for 2 days, H & H 6.1 and 17.0. Platelets 14. WBC 1.0. Pancytopenia. A religion that does not allow blood products or transfusions. Essentially we will be watching this patient die. As the majority of us know, some fresh frozen plasma, units of packed cells, the ability to SAFELY do an EGD and the patient would be discharged home in about 2 days.
Instead, in 4 hours when the next CBC was done, the Hgb was down to 5.8.
I overheard the attending doc asking the charge nurse to assign a "kind" nurse as this was a "difficult" case. I felt that was unnecessary, because as hard as it is for all of us to watch this, we still treat the patient and family with compassion.
My main point: I'm hoping someone could explain to me, how in the world can you stand by and allow your child to die?
Harsh question, and I'm sure an age-old question, but I do not and can not understand it.
Flynurse, I think I understand what you are saying... it's not my religious beliefs that makes this case difficult, it's being a mother and a human. The plain and simple truth that faces all the caregivers and health professionals on this case is that we are all parents who can not and do not understand allowing a child to die.
If your reason for not taking care of this patient is your a mother and a human, would you also refuse to care for a pediatric sickle cell patient. Their parents made a conscious decision to bring a child into a life of great pain and eventual early death. To refuse an asignment because you do not agree with the choosen treatment is forcing your beliefs upon others and telling them they cannot have the benifit of your education and experience because what they decided is wrong for you. Healthcare should be blind to race,creed,color,religious and cultural beliefs. We as nurses are there to help people in time of medical and emotional crisis. We offer our knowledge and try to teach people what the latest scientific treatments are available. It is up to the people to decide how that scientific knowledge is to be used. Refusual to treat a patient because you do not agree with a family, appears to atleast me as a form of bigotry( I dont say this to belittle), I dont like your beliefs so I am going to treat you different. Who gets to make these decisions? How would you feel if in a time of great family crisis, you had nurses refusing to care for your family member simply because they don't agree with your decsisions? I don't write this to flame anyone, but to simply ask the questions, Who has the right to change my beliefs because they don't like them? and What gives anyone the right to refuse me the choice of my or my family's healthcare?
I don't feel comfortable sharing too many details of this case - I don't want to tread on confidentiality issues, but at this time the patient has a new diagnosis and the physicians are discussing transferring the patient to a facility that is used to handling cases such as these. The Hgb is down to 5, petechiae is there, and now questioning intercranial hemorrage in addition to everything else.
I was involved in the physicians conference and all are extremely frustrated with this, but are handling it professionally (I really have to commend them). We have the house ethics nurse involved and I'll get started researching facilities. :stone
Vegas: It would make your search much easier if someone contacted one of the elders in the pts. congregation. We have a network set up to route people to appropriate facilities in this type of situation. Could save you some time.
Sorry...posted this before I saw that you'd already spoken with a rep. of HLC.
No problem! Just trying to do what I can under the circumstances.
Montroyal - No comparison to sickle cell. Those patients can and do receive treatment and live normal lives with their illness. You're comparing apples to oranges. Last I checked, all of us in the medical profession have a right to resign from a case that we are not comfortable with. It doesn't make us bigots, it doesn't make us unkind. Think of the female nurse assigned to a convicted rapist that reminds her of the man who raped her. Is she a bigot for not being comfortable with that assignment? I think not.
This is a case about CHOICE. You could ask the same question if some OB/GYN nurses could care for patients having elective abortions. Some do not participate in the procedure for personal reasons - they have that right.
I would not refuse to take care of the patient because I didn't agree with their decision. I don't think I COULD take care of the patient because I would be CRYING too much thinking that could be my child. So maybe in some instances I would be too sensitive, sorry. If though, I thought I could hold myself together I would be more than glad to care for that patient and try to do everything within my power to make him/her as comfortable as possible.
Originally posted by montroyal ....Refusual to treat a patient because you do not agree with a family, appears to atleast me as a form of bigotry( I dont say this to belittle), I dont like your beliefs so I am going to treat you different. Who gets to make these decisions? How would you feel if in a time of great family crisis, you had nurses refusing to care for your family member simply because they don't agree with your decsisions? I don't write this to flame anyone, but to simply ask the questions, Who has the right to change my beliefs because they don't like them? and What gives anyone the right to refuse me the choice of my or my family's healthcare?...
I responded to the first point about refusing a patient assignment.
Next point: The patient is not being treated any different because of their decision. As the case manager on this case I DO not have the ability to just resign as the bedside nurse would have the right to do. I have to deal with it. So, in order to deal with it, I have done the following:
- Called in the house nurse ethicist
- Contacted and am working with the JW hospital liason
- Consulted with the physicians on this case who want to make sure this patient can be treated by a facility who deals with "bloodless" patients all the time.
The ethicist helps in making sure we are not doing anything that would be construed as being wrong and that we are following ethical practices given the situation.
The JW liason is working with me to get in touch with the facilities nearby AND a physician specialist who can conference with our phsycians on the management of this case. Not only that, this person can provide additional spiritual support to the family.
If there is anything else I could think of to assist the patient and family, I would. I keep my comments, anger and frustration to myself.
Unfortunately, we are working against time and an eventual full blown DIC.
Vegas, glad to hear you are working with the JW liason and the ethics committee. (In our neuro case we didn't have that kind of time since he was bleeding way to fast for that).
Even though you said you don't understand are frustrated as a parent, you are stepping out of that box and caring for the patient, doing your job (even though you said you couldn't be his direct care provider, you still are being professional and doing his case management), and talking about it. That's admirable.
I think the DNR consideration is very appropriate. I think if he is refusing life saving treatment, someone should tell him "you are bleeding to death, and resusitating you will be futile."
If you don't believe in accepting a blood transfusion and you are an adult then you are making a informed decision and will suffer the consequences, however, a child can not make that decision which is why I don't understand why a court order for protective custody was not given, I have worked in a few hospitals where the children were given blood against the parents wishes.
Isn't is a shame that people must suffer and die in the name of religion? Why do people think that only their God is the real God and everyone else must die? Just some thoughts to ponder over.
Agree BadBird. The patient is 18, though and signed the consent themselves.
The JW liason did state our facility routinely obtains court orders on pediatric patients that require blood/blood products to preserve life, which is good to hear.
l'm so sick and tired of people making judgements on things they know nothing about.
First of all they do not sit back and allow their children to die, they are happy for docs to use alternative methods to help their children, like Ringers Lactate etc instead of blood. Docs prefer to use blood because its cheaper.
They believe in what the bible says, which states clearly that they are not to eat blood or blood products, they are to pour it on the ground. This includes taking blood via IV.
To get this in perspective just because you refuse blood it doesn't automatically mean you are going to die.
My sister in law hemorraged badly after giving birth, she refused blood. The docs and nurses put her and her husband under considerable pressure to accept blood. They stood their ground.
She was rushed to a Melbourne hospital, while being told that she will die unless she accepts blood constantly while in the ambulance. She still refused.
They decided to give her large quantities of iron, which she accepted and she is alive today, this happened abour 3 years ago.
So don't assume that they will die without blood.
You have to realise that you may consider that you are saving their life by forcing blood, but you don't realise the emotional damage you are doing, even to the point of breaking their spirit.
They are not brain washed into making this decision nor do they make this decision lightly, they are well informed before making their decision.
Think of how you would feel if someone tried to make you go against something you totally believe in.
Further, what's the point of bringing the patient to the hospital ANYWAY? If you are of a belief that doesn't believe in life saving measures - which is obvious here - why not just keep them at home? Sign up for Hospice?
This is such a stupid statement. Just because they don't accept blood doesn't mean that they won't accept alternative treatment.
I think there have been cases like this where the hospital can ask a judge to intervene.
My understanding of Jehovah's Witnesses is that if they accept blood or blood products, they will not get to heaven. So that means a great deal if you truly believe that. I believe it is a misinterpretation of the biblical injunction against eating an animal without draining it of its blood (a cleanliness issue rather than a "get to heaven" issue).
I agree . . . this is very difficult to understand. Hopefully someone can intervene legally.
Jehovah's Witnesses don't believe that they will go to heaven.
montroyal
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