Healthcare ethics involves making well researched and considerate decisions about medical treatments, while taking into consideration a patient’s beliefs and wishes regarding all aspects of their health. The healthcare industry, above any other, has a high regard for the issues surrounding the welfare of their patients. This power over a patient’s wellbeing creates a mandatory need for all healthcare organizations to develop an ethics committee. The committee’s goal is to establish a written code of ethics that details the policies and procedures that determine proper conduct for all employees.

There are many ethical issues that may arise in regards to a patient’s healthcare.

Treating patients with certain religious beliefs pose important ethical issues in the field of healthcare. This paper will describe an ethical health care issue concerning refusal of care, such as a blood transfusion. It will cover the four ethical principles as they apply to healthcare providers and patients’ rights. It is important that health care workers have a rudimentary understanding of Jehovah’s Witnesses philosophy about blood transfusion so that as professionals we can be proactive in their management.

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Ethical Health Care Issue

In all areas of practice, physicians come into contact with Jehovah’s Witnesses and their refusal to accept blood transfusion, even when it means saving their lives. The Jehovah’s Witness faith creates some challenges for physicians caring for its members. The ethical principles of autonomy versus beneficence come into conflict when a physician believes a transfusion is in the best interest of the patient, but the patient refuses.

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Legal precedence provides a backdrop. In addition, Panico, Jenq, & Brewster (2011) article states, there was a case involving a woman who had consented for examination of a fibroid tumor under anesthesia, but withheld consent for removal of the tumor. While sedated, she underwent resection of the tumor that led to complications. She sued and the judge ruled in her favor, establishing the notion that every human being should have the right to decide what is done with his or her own body. Moreover, this premise gave any individual the right to refuse treatment if he or she understands the risks; a Jehovah’s Witness has the right to refuse a blood transfusion.

This ruling set a precedent for informed consent. In 1990, the Canadian case of Malette v Shulman described an emergency department physician who gave a blood transfusion to an unconscious patient who was in hypovolemic shock. Per report, the patient had a signed wallet card that identified her as a Jehovah’s Witness, although it was undated and unwitnessed. The wallet card, is considered a legal document which, stated that she did not want to receive a blood transfusion under any circumstances (Lantos, Matlock, & Wendler, 2011). Furthermore, when the patient’s daughter arrived and asked that the transfusion be stopped, the physician did not comply. The physician argued that there was no way of knowing if the patient had changed her mind in the minutes before the car accident and thus he was duty bound to save her life (Lantos, Matlock, & Wendler, 2011). The court found the physician guilty of battery.

Although it is easy to draw on emotion to argue against the ruling in this case, the verdict has not been overturned. This case illustrates the current teaching to today’s physicians, who are taught to respect patient’s autonomy and preferences for their own bodies (Lantos, Matlock, & Wendler, 2011). Jehovah’s Witness have been known to refuse transfusions with packed red blood cells to treat their life-threatening diseases. Medical professionals must consider patient has autonomy of thought, intention, and action when making decisions regarding health care procedures. To comply with patient’s wishes medical professionals could offer fresh frozen plasma and platelets as an alternative. Furthermore, Jehovah’s Witnesses number over one million in the United States and at least six million worldwide. Witnesses believe in strict and literal interpretation of the Bible, which leads them to reject some aspects of modern medical care (Doyle, 2002).

Medical professionals have discussed in open forums ethical decisions they are required to make while taking care of a dying patient who refused to accept a blood transfusion. Data suggests they struggled to relate to someone who would take some blood products, but not others, and who are willing to risk death over a red blood cell transfusion. Refusal of blood transfusions became common practice only after a 1945 church decision (Mann, Votto, & Kambe, 1992). Indeed, Jehovah’s Witnesses interpret these sections of the Bible differently and if a member accepts blood into their veins, they are shunned and forfeit their membership in the faith community and eternal life. The society had enforced shunning and social isolation by Witnesses’ own family members, relatives, and friends, ultimately leading to expulsion from the religion (Doyle, 2002).

Similarly, research suggest that the health care provider must consider four main areas when evaluating justice and the four areas are fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation (Gillon, 1994). In considering the many ethical dilemmas associated with Jehovah’s Witnesses and their refusal to accept blood transfusion have medical professionals focusing on the ways in which treatments or interventions violates accepted norms of conduct of social science research. Physicians must be aware of the growing diversity of values and beliefs among Jehovah’s Witnesses. Some of the most intractable ethical problems arise from conflicts among principles and the necessity of trading one off against the other. The balancing of such principles in concrete situations is the ultimate ethical act (House, 1993, p. 168).

Evaluation involves at least four levels of social-political interaction- with government and other agency policy makers who commission evaluation. Evaluation has to operate in this multilayered context of different interests, providing information to inform decisions while remaining independent of the policies and programs themselves (House, 1993, p. 170). More importantly, the weight of ethical judgment is thus put on experimental research to justify meeting ethical standards (Panico, Jenq, & Brewster, 2011). Resource allocation is a major issue that physicians are confronted with when dealing with Jehovah’s Witness allocation. Beneficence requires that the procedure be provided with the intent of doing good for the patient involved. As described above if a patient refuses a blood transfusion and opt for an alternative procedure that costs more it can prove problematic (Panico, Jenq, & Brewster, 2011).

When society thinks of the greater good, this argument poses a challenge to the principles of patient autonomy that we also value. In a society in which medical resources are costly, benefits will always need to be weighed against the potential cost to both the patient and society thus creating ethical challenges. Finally, the care of a Jehovah’s Witness with life threatening illnesses requires a multidisciplinary and planned approach. These patients suffer with certain diseases and are often anemic and must be prepared to deal with this issue in both outpatient settings and during an acute crisis. Clinicians must view each patient as an individual who may have varying thoughts about transfusions of the multiple different blood products that are available. Therefore, medical practices today need to continue to open early lines of communication with these patients.

Providing adequate information and educating the patient about realities and obtaining informed consent before subjecting a patient to any test, procedure, or surgery is very essential. It is vital to the optimal care of a Jehovah’s Witness patient. It is necessary that dialysis unit nurses and social workers have conversations with patients about their beliefs on blood products. Discussing a patient’s wishes, understanding their basis for these decisions, and discussing risks, benefits, and alternatives that can be used in both emergent and non-emergent situations is crucial to preparing for more urgent situations, when these conversations often are not possible.

Setting of Guidelines

The settings of guidelines differ from facility to facility, but the core values are the same. “Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the US Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines.” (Guidelines & recommendations, n.d.) “Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” (Institute of Medicine, 1990). Such documents have been in use for thousands of years during the entire history of medicine. (Wikipedia) Clinical protocol is a predefined written procedural method in the design and implementation of experiments.”

Protocols are written whenever it is desirable to standardize a laboratory method to ensure successful replication of results by others in the same laboratory or by other laboratories. Detailed protocols also facilitate the assessment of results through peer review. In addition to detailed procedures and lists of required equipment and instruments, protocols often include information on safety precautions, the calculation of results and reporting standards, including statistical analysis and rules for predefining and documenting excluded data to avoid bias.”(Wikipedia) All aspects of guidelines all have a form of ethics that follow.

Ethics Groups

There are many different ethics groups in healthcare. Ethics groups improve patient care and the health of the public by examining and promoting physician professionalism. The Ethics groups are organized into three parts: as stated by (AMA) Council on Ethical and Judicial Affairs (CEJA), which promotes adherence to the professional ethical standards set out in the Code through its judicial function, Ethics Resource Center, which provides students and physicians with the essential tools and skills to address ethical challenges in a changing health care environment, and the Institute for Ethics which is an academic research center uniquely situated in the nation’s largest professional association of physicians. All these different groups listed above, promote ethics in healthcare. Another ethic that effect patients is the Health Insurance Portability and Accountability Act (HIPPA). As stated by (AMA) “Created in 1996 (HIPPA) provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs; Reduces health care fraud and abuse; mandates industry-wide standards for health care information on electronic billing and other processes; and requires the protection and confidential handling of protected health information.”

So many different parts of ethics that effect patients seem never-ending but all these things are set in place to help patients, but when do these ethics go too far? When do they become legal issues? Ethics codes and policies of facilities can turn wrong fast and one person’s view change others as things go awry and it becomes a legal issue. An example of ethics becoming a legal issue is a Texas law that says life-sustaining treatment cannot be withdrawn from a pregnant patient, regardless of her end-of-life wishes.

Recently there was a Texas woman who was brain dead and pregnant. She and her husband both paramedics, between each other, did not want to be kept alive by machines in this type of situation. The hospital applied the law cited above, but is this the correct type of ethics governing hospitals? Larry Thompson, a state’s attorney arguing on behalf of the hospital stated the hospital was trying to protect the rights of the fetus as it believed Texas law instructed it to do. (Urbanski, D. 2014) Keeping a dead body alive with a fetus that had slim to no chance at life, where do ethics come in? Are ethics more of a personal belief or opinion of some?

Ethical Codes

Ethics codes help standardize the quality of ethics in healthcare field. The Code of Medical Ethics made by the American Medical Association (AMA) which was founded in 1847 unanimously adopted the world’s first national code of professional ethics in medicine. Since that time it has been the authoritative ethics guide for practicing physicians. “The Code articulates the enduring values of medicine as a profession. As a statement of the values to which physicians commit themselves individually and collectively, the Code is a touchstone for medicine as a professional community. It defines medicine’s integrity and the source of the profession’s authority to self-regulate.” (AMA) This code has set the guidelines for the medical industry. The Hippocratic Oath also shows how guidelines are set in medicine.

Hippocratic Oath is an oath historically taken by doctors and other healthcare professionals swearing to practice medicine honestly. There have been ethical guidelines in medicine a long time, the “Hippocratic oath was written in 5th century BC.” (Tyson, 2001) Such documents have been in use for thousands of years during the entire history of medicine. Each medical facility has their own ethical guidelines to follow and it plays an important role in healthcare and plays a role on patients. The last code is the National Association for Healthcare Quality (NAHQ). NAHQ’s (2011)

Maintains active personal and professional development programs in the field of healthcare quality and exhibits a broad range of knowledge creates and supports an environment that fosters teamwork, emphasizes quality, recognizes the customer, and promotes learning maintains a commitment to the improvement of the professional through participation in, and active support of, the local, state, and national professional organizations addresses concerns and takes formal actions to resolve or report the unethical or questionable practices to the appropriate channels. (Code of Ethics for Healthcare Quality Professionals, n.d.)


To many Jehovah’s Witnesses, the consequences of accepting a blood transfusion can be worse than death itself. Not every Jehovah’s Witness patient abides by the same beliefs regarding the acceptance of blood products. These patients can be managed through careful planning and open lines of communication between physicians and patients. Understanding the premise behind the beliefs of patients who are Jehovah’s Witnesses is critical to beginning conversations and truly understanding the patient. Ultimately, when a patient establishes what they will accept, as clinicians, ethically we must optimize the care we provide within their wishes about blood products. Frequent and open dialogue is essential for enhancing care for a Jehovah’s Witness.

As an alternative to violating a patient’s autonomy some physicians and some hospitals are more comfortable with bloodless procedures and patients can be referred to these centers if necessary for specialty care. Overall, health care professionals should be able to provide ethical health care to patients who are Jehovah’s Witnesses at any hospital or community office, but must continue to be educated and aware of their beliefs and respect their wishes and the impact these may have on organizing and providing their care. If these considerations are neglected one can surely expect ethical breaches or dilemmas as inevitable.


  1. Doyle D. Blood transfusions and the Jehovah’s Witness patient. Am J Ther. 2002;9(5):417–424. Gillon, R. (1994). Informed consent: an ethical obligation or legal compulsion. Retrieved from
  2. House, R. (1993). Ethics in evaluation. Retrieved from
  3. Lantos J, Matlock A, Wendler D. Clinician integrity and limits to patient autonomy. JAMA.2011;305(5):495–499. (Lantos, Matlock, & Wendler, 2011).
  4. Mann M, Votto J, Kambe J, McNamee M. Management of the severely anemic patient who refuses transfusion: lessons learned during the care of the Jehovah’s Witness. Ann Intern Med. 1992;117(12):1042–1048.
  5. Panico, M. L., Jenq, G. Y., & Brewster, U. C. (2011). When a patient refuses life-saving care. American Journal of Kidney Diseases, 58(4), 647-653.

Cite this page

Ethical Health Care Issues. (2016, May 03). Retrieved from

Ethical Health Care Issues

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