Problem: PATIENT AND PROVIDER OBLIGATIONS

Any glimmer of uncertainty as to a patient's desires in an emergency situation should be resolved "in favor of preserving life." The patient in Matter of Hughes 5 signed a standard blank hospital form entitled "Refusal to Permit Blood Transfusion." There was no indication on the form that the consequences of her refusal had been explained to her in the context of the elective surgical procedure she was about to undergo. The form should have contained an unequivocal statement that under any and all circumstances blood is not to be used and an acknowledgment that the consequences of the refusal were fully explained. The form should fully release the physician, all medical personnel, and the hospital from liability should complications arise from the failure to administer blood, thereby resolving any doubt as to the physician's responsibility to his patient.

If Hughes had refused to sign such a form, her physician could then have decided whether to continue with Hughes's treatment or to aid her in finding a physician who would carry out her wishes. The court emphasized that this case arose in the context of elective surgery. This was not an emergency situation where the physician and patient did not have time to discuss fully the potential risks, benefits, and alternatives of the planned surgery and the conflict arising over the patient's religious beliefs. Patients have an obligation to make medical preferences known to the treating physician, including the course to follow if life threatening complications should arise. This protects the patient's right to freedom of religion and self-determination. In addition, it is helpful to the hospital when faced with the dilemma of trying to preserve life whenever possible and honoring the patient's wishes to forgo sustaining treatment.

Ethical and Legal Issues

1. Describe the relevant ethical principles violated in this case.

2. Describe the relevant legal issues in this case. What actions could the parties to this lawsuit have taken beforehand to prevent this case from becoming a legal issue?