Ethics in Healthcare Administration

A 35 yr old woman with chronic disease is admitted to your long term care facility. She has developed a problem requiring a transfusion, and if she does not receive one, she will die. Her religious beliefs preclude her from receiving blood products. After a thorough explanation by the physician, she understands that she is likely to suffer permanent physical injury and possibly die if she refuses to accept the transfusion. Her family, which shares the same religious affiliation, supports her decision. The physician refers the matter to the healthcare ethics committee on which you sit as the healthcare administrator. The committee members all agree that the law permits a competent adult to refuse medical care.

1. Is it ethical to speak to this patient in private, away from her family, and offer he the option of a secret transfusion so that nobody knows of it, or is this coercion into sinful behavior?

2. Is it ethical to meet with the family and patient to attempt to convince them to change their minds regarding the transfusion? What can and should be said to them ? What should not be said?

3. How does this discussion change if the patient is a child or a ward of the state?

4. What are the legal facts of which the healthcare administrator must be aware in such a case?