A few readers asked if we could have more frequent ethical discussions. That seems like a good idea. Here's a new case.
You are a family physician practicing in a busy urban area where you take care of hundreds of families from diverse backgrounds. You care from them from birth to death, both in the office and in the hospital. One evening, the emergency department calls you. Mr. F., a Jehovah's Witness, is in the ED feeling weak and short of breath. He's a 40 year-old single father of four kids. You've cared for him since he was a young man, through his marriage, the birth of his kids (whom you delivered and continue to care for), and the death of his wife. Lately, he has had terrible back pain from his job at the plant and has been taking a lot of "pain pills". He has always made it clear to you that his religious beliefs are central to his life, and among these beliefs is an abhorrence of blood transfusions. He will never accept one, no matter the circumstance.
The ED doctor is frustrated on the phone. Mr. F.'s blood count is dangerously low. It looks like he's been bleeding, perhaps from an ulcer. They are giving him IV fluids, and may consider taking him to the OR, but they are afraid he won't last long. His kids are in the waiting room with their elderly, infirm grandmother, also your patient. The ED doc wants to wait until he passes out, then give him an "emergency" transfusion with the patients "presumed" consent. The ED doc sounds afraid and frustrated and is wondering what you can add to the patient's care.