Religious Decision-Making in a Teenager

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Editor’s Note:[1]

This column presents a problematic medical-surgical case that may pose a medical-ethical dilemma for patients, families, and healthcare professionals. As these cases are based on real medical situations, identifying features and facts have been altered to preserve anonymity and to conform to professional medical standards. In this case, the physician needs to ascertain whether or not a teenager’s statement of religious faith should be allowed to direct her life-sustaining medical treatment.

Question: May we accept this adolescent Jehovah’s Witness refusal of blood transfusion?

Story:

Debbi is a 13½-year-old girl who was well until two weeks ago when she developed knee pain without obvious trauma. She subsequently developed a fever and was admitted to the hospital with a septic knee found to be caused by Staphylococcus Aureus. She was started on appropriate antibiotics, but developed toxic shock and has subsequently been found to have staphylococcal sepsis,[2] osteomyelitis[3] of the femur and bilateral staphylococcal pneumonia with large pleural effusions.[4] Her osteomyelitis has been surgically drained. Her sepsis has come under control with the use of two antibiotics (Vancomycin & Cefotaxime). She is on supplemental oxygen and Total Parenteral Nutrition. The pneumonia is improving, but it has not been possible to relieve the pleural effusions with either needle aspiration or placement of chest tubes, and surgery was proposed for this afternoon.[5] Her Red Blood Cell count has dropped from normal level on admission (hemoglobin = 11.5) to a very low level (6.1). She was begun on erythropoietin (an enzyme to stimulate her bone marrow) several days ago.

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