Wednesday, 22 September 2010

Exciting case at work which turned out not!

Having recently become the Director of Obstetric Anaesthesia at my hospital there was an interesting case on which had a lot of workup and preparation in the event of a disaster which fortunately turned out not to be a disaster!

We had a primiparous woman who had fertility issues having successfully conceived her first child with IVF, had an anterior Grade IV placenta praevia, who also happened to be a Jehovah's Witness.  ARGH!

(Translation: Woman who had difficulty falling pregnant but finally got conceived with IVF, turned out to have the placenta covering the cervix so the baby can't be born without bleeding to death, as well as being at the front of the uterus making it difficult to get to the baby out via caesarean because there is the risk of cutting the placenta as you go in to get the baby... complicated by the fact that she was a Jehovah's Witness who by their religion refuse blood transfusions or they go to hell)

So there was a lot of discussion about this lady and teams involved.  The patient agreed to cryoprecipitate, as well as the cell saver, and the Interventional Radiologists were involved and they put balloon catheters in place in her common iliac arteries so that in the event she did bleed, we could inflate them and stop the blood flow to the uterus so we wouldn't lose that much blood.  Everything was set up, teams were ready, and we were all prepared for an emergency.  Fortunately though she didn't end up bleeding much and we didn't need all our special fancy equipment but you can bet your bottom dollar that if we didn't have all that stuff set up she would have bled like buggery and probably died.

It's a bit strange I think, my colleague's attitudes to Jehovah's Witnesses.  Anaesthetists say that in the event that the patient was going to die that they would give a blood transfusion even though the patient specifically requested not to.  They say because they want to "Do no harm".  However, I am not sure that I would do the same, I don't see why they find it so difficult to accept that despite their best efforts the patient died because of blood loss.  I guess they feel that it was because it was a preventable death, that they could have done something to save the patient.  But if you give blood to these patients, they become unclean, and they basically think they'll not go to heaven.  Is it really up to us to disrupt someone's religious beliefs and life because we don't want to feel the guilt of someone dying under our care?  I know if someone died because of bleeding when I'd done their anaesthetic I'd feel terrible about it, but I at least take comfort in the fact that I didn't do anything to their religious beliefs or faith.  I wonder if that makes me a worse doctor?  I don't think so, I think that if I had some special wish that I would like people to respect it.  It bothers me when people say "oh these stupid people and their religions, wrecking our lives making us stressed because of their stupid beliefs".  I just keep quiet but inside I'm thinking "How would you like it if someone told you that you had to do something against your beliefs because they thought it was stupid?"


  1. I suspect you're over simplifying the other doctor's views a little there. The problem is that the patients faith comes into conflict with the doctor's beliefs - that a physician's duty is to preserve life over respecting faith.

    In the circumstances, exactly the same standards that apply to abortion should apply here. Where it goes against the doctor's beliefs to not provide such treatment when required to save the life of a patient or patients (including the baby for the case you mentioned), they should inform the patient and be willing to refer them on to another doctor who is willing to work with the restrictions of the patients faith.

  2. Ah yes :p

    Life is short, and Art long;
    the crisis fleeting; experience perilous, and decision difficult.
    The physician must not only be prepared to do what is right himself,
    but also to make the patient, the attendants, and externals cooperate.
    - First aphorism of Hippocrates