Patient’s Rights and Ethics

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BLOOD REFUSED WAS ADMINISTERED
Mrs. Hughes, a 39-year-old Jehovah’s Witness, was admitted to the hospital to undergo a hysterectomy. At the
time of her admission to the hospital, Mrs. Hughes signed forms expressing her desire not to receive any blood
or blood products. She also verbally expressed this intention to her treating physician, Dr. Ances. Unanticipated
problems arose during surgery that, in Dr. Ances’ opinion, required blood transfusions to save Mrs. Hughes’
life. Dr. Ances contacted Mr. Hughes, Mrs. Hughes’ husband, to discuss the emergency situation and his wife’s
need for blood. While on the phone, Mr. Hughes, also a Jehovah’s Witness, authorized transfusions.
On May 14, 1991, the hospital initiated an emergency hearing before a judge for the purpose of having a
temporary guardian appointed for Mrs. Hughes to allow additional transfusions after the surgery. She was
unconscious and incapable of expressing her desires at the time.
Dr. Ances testified that Mrs. Hughes, who had been his patient for 6 weeks, told him she did not want blood
products. He informed her that a time could arise when blood might be needed to save her life. He also told her
that, given the procedure and the size of the uterus, it was unlikely that she would need blood during the
surgery. Dr. Ances was aware that Mrs. Hughes had signed hospital forms refusing blood. Dr. Ances told the
judge that he assumed Mrs. Hughes was aware of the ramifications of refusing the blood and therefore did not
specifically discuss them with her. After hearing testimony from Dr. Ances and Mrs. Hughes’ family, the judge
found that the evidence was unclear as to whether she would want blood or blood products if it meant saving
her life. As a result, the judge appointed the hospital’s risk manager as temporary guardian for the limited
purpose of giving consent to the administration of blood and blood products. The order explicitly extended only
until Mrs. Hughes regained consciousness and became competent to make her own decisions.
Mrs. Hughes received blood transfusions during the time she was unconscious. She later filed a lawsuit
claiming she was administered blood transfusions contrary to her written instructions. Did the court err in
making a temporary emergency decision to appoint a medical guardian? Why or why not? Were ethics placed
above the patient’s rights and wants? Why or why not? What is the role of the Court?

 

Sample Solution

hemselves been educated. The School of Jurisprudence mainly served the lesser nobility and would prepare Tchaikovsky for a career as a civil servant. As the minimum age for acceptance was 12 and Tchaikovsky was only 10 at the time, he was required to spend two years boarding at the Imperial School of Jurisprudence\’s preparatory school, 1300 km from his family. Once those two years had passed, Tchaikovsky transferred to the Imperial School of Jurisprudence to begin a seven-year course of studies. Tchaikovsky\’s separation from his mother to attend boarding school caused an emotional trauma that tormented him throughout his life.
On June 25, 1854, when he was 14 Tchaikovsky suffered the shock of his mother\’s death from cholera. His parting from his mother was painful – an event that may have stimulated him to compose. Tchaikovsky bemoaned the loss of his mother for the rest of his life, and admitted that it had \”a huge influence on the way things turned out for me”. He was so affected that he was unable to inform Fanny Dürbach, until two years after the fact.
Tchaikovsky\’s father, who also became sick with cholera at this time but made a full recovery, immediately sent the boy back to St. Petersburg school in hope that the class work would occupy his mind.
At the age of 40, approximately 26 years after his mother\’s death, Tchaikovsky wrote to his patroness, Nadezhda von Meck \”Every moment of that appalling day is as vivid to me as though it were yesterday.\” However, within a month of his mother\’s death he was making his first serious efforts at composition, a waltz in her memory.
Teenage Years
Young Tchaikovsky
To make up for his sense of isolation and to compensate for the loss in his family formed important friendships with fellow students, such as those with Aleksey Apukhtin and Vladimir Gerard, which lasted the rest of his life. He may have also been exposed to the allegedly widespread homosexual practices at the school. Whether these were formative experiences or practices toward which the composer would have gravitated normally, biographers agree that he may have discovered his sexual orientation at this time.

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