SITUATION

Hospital X hired Nurse Y. Her first task was to attend to patient who was comatose. Dr.
T., the Attending Physician ordered her to administer blood transfusion to the patient.
However, the immediate relatives of the latter told her just to omit the transfusion and let
the patient die slowly and softly. The nurse turned down the request.
QUESTION #1.

What must be the basis of the nurse refusal?

The first consideration the Nurse look at is the principle of Stewardship. This principle
guides healthcare provider in their ethical management of life with others and clearly
demonstrates God as the giver of life and have no right to anothers life.
Another applicable Ethical principle is that of Paternalism in the part of the healthcare
provider. The Doctor here is literally taking the fatherly role of the patients care, given
the incompetency of the patient to make or give an informed consent or exercise
autonomy. Hence the decision of the Doctor is and should ethnically reflect the Patients
best interest which you, as a collaborative healthcare provision is obliged to follow.
The third Principle applicable here is the non- maleficence which simply says, do not
harm especially to the patient under your care as healthcare provider. By virtue of this
simple principle, the Nurse is obliged to give the blood transfusion as required because
that will be of beneficial to the helpless patient whose care is your paramount interest.
QUESTION #2.

What if she consented and followed the request, what is her

liability?

Ethical principles that may be applicable in the event that the Nurse is consented to the
relatives request to allow the patient die slowly are the principles of Beneficence, Nonmaleficence and the principle of Stewardship.
The Principle of Beneficence as applied in this case simply means that whatever care
provided should consider the welfare and Patients benefit. And so, care must be of
utmost patients benefit which is not respected here.
The next principle in question is that of non-Maleficence, which clearly says, do no
harm to your subjects. Not giving the blood transfusion will enviably endanger the
patients life. As healthcare worker, we are aware that blood supply to all parts of the

organs, cells, tissues and regions of the body especially the brain is an essential aspect
of living without which, damage and or even death may ensure.
Again I want to reiterate the principle of stewardship. Here it is said, that life comes from
divine and belongs to the divine function above. As healthcare worker, we are trained to
preserve this life which we even cannot give. A comatose patient is already on danger
line, and further deprivation of blood may cause increase level of such condition of
hypoxemia (decrease level of oxygen in the blood) and ultimately, patient can easily
proceed to brain death, irreversible damage or death within 10 minutes or more.
The nurse can be liable for misconduct and negligence. Misconduct in that sense that
she did not follow the rule as supposedly care provider, not only did she obey the
immediate authority of the doctor, she has breached the contract with the employer
(hospital) to give care at the optimum level.
By Negligence she has actually not done what she was supposed to do which is blood
transfusion and intentionally allowed the patient to go through pain and eventually
death. It is a punitive damage.
QUESTION #3.

What is the liability of the relative?

Following the principle of Justice which is simply Fairness on every party, Justice is
been delayed and denied the incapacitated or helpless Patient. Fairness is not given
consideration here rather it is one-sided.
Not unless the patient previously signed a Do Not Attempt Resuscitation or allow
speed death consent, the principle of patient is Autonomy is also breached in this case
by relatives.
It will be necessary for the health care provider to have existed all possible means of
lifes restoration without interference from fairly members before an alternative to life
may be sort.