Mr. Martinson's Religious Rights Martin Martinson's Bad Day

My name is Martha Martinson, and this is my husband, Martin.

Martin and I met when I was 24 and I had just started my very first teaching job. He had moved to town recently and was working at the local insurance office. My friend Marla worked with him and she introduced us. He was handsome, smart, and incredibly kind. When he asked me on a date I couldn’t believe my luck! We dated for a year before he asked me to marry him and married the next summer.

We’ve a had good marriage, and we now live together in the home we bought 30 years ago. We both retired this year. We like to work in our garden, go on drives on the weekend, and Martin enjoys playing the piano. Since I retired, I volunteer at the school library a few days a week.

This year Martin and I also began studying the bible with our neighbors in the evenings. We attend meetings twice a week at our local Kingdom Hall, and two months ago we become Jehovah’s Witnesses. We spend time with our new friends, and help other people learn about the Bible and God’s Kingdom. It’s all still new, but we’re so grateful we’ve gotten here and we’re loving our life and our community.

Today Martin went to store, as he often does in the mornings. I was thinking he’d be back soon with the milk when I got a phone call. The nurse on other end told me that Martin had been in a car accident, and had just arrived at the hospital. She told me his condition was serious and that I should come. I could barely think. I grabbed my purse and my jacket and got in the car. I was so beside myself I hardly remember driving there.

11/14/16

Dear Diary,

Sheesh. Another day at Goody Gumdrops Hospital. It’s my second week working as a nurse in the ED and I feel like every day brings a new dilemma that I never thought of during nursing school. Today was no different.

Mr. Martinson came in like many of the patients I’ve seen in my short time here; battered and worse for the wear. He was unconscious because of a head injury, as he was the driver in a head-on collision. Fortunately he was the only person in the car, because judging by his condition, it looked like a quite a brutal accident.

His head was bleeding, his skin was cold and pale with glass shards still puncturing his arms, and he was barely breathing. Obviously, he needed some sort of surgical intervention.

That’s where Dr. Duchovny came in. He diagnosed Mr. Martinson as having a ruptured spleen, among several other complications. That’s where things got….messy.

I had the incredibly uncomfortable task of informing Mrs. Martinson of her husband’s condition, and explaining to her that, because of the severity of his ruptured spleen, Mr. Martinson would likely require a blood transfusion to ensure his survival after the trauma he had endured. With other patients I’ve seen in the ED, more often than not, the family will agree to anything that could potentially save the loved one’s life.

But Mrs Martinson did something I didn’t expect: she refused the transfusion for her husband. I stood, dumbfounded, when she wouldn’t sign the consent to agree to this potentially life-saving intervention we needed so desperately to initiate.

She explained that she and her husband were recent converts to Jehovah’s Witness, and with that spiritual framework, blood transfusions were prohibited.

I couldn’t believe what I was hearing.

If I listen to the wife, I would be upholding patient autonomy, but Mr. Martinson may die. Sure, Mrs. Martinson is the next of kin, but how do I know that his religious wishes are the same as hers?

Not to get too technical, but the second provision in The ANA Code of Ethics says that it is my responsibility as a nurse to respect patients’ wishes, regardless of my own views and the consequences.

But, here’s the thing: the guilt of not saving a patient would weigh on me in the long-term. I became a nurse to help people – I value beneficence just as much as I value autonomy.

Is this even upholding autonomy? I don’t even know what Mr. Martinson’s wishes are, they could believe different things about the religion. They are new converts, after all. Mrs. Martinson may not even understand the nature of a blood transfusion. It seems so strange that Jehovah witnesses wouldn’t want life-saving treatment – it’s just blood!

Not to get too technical, but the second provision in The ANA Code of Ethics says that it is my responsibility as a nurse to respect patients’ wishes, regardless of my own views and the consequences.

But, here’s the thing: the guilt of not saving a patient would weigh on me in the long-term. I became a nurse to help people – I value beneficence just as much as I value autonomy.

Is this even upholding autonomy? I don’t even know what Mr. Martinson’s wishes are, they could believe different things about the religion. They are new converts, after all. Mrs. Martinson may not even understand the nature of a blood transfusion. It seems so strange that Jehovah witnesses wouldn’t want life-saving treatment – it’s just blood!

I know my job is to be a patient advocate above all else, and it would be an incredible difficult and presumptuous decision to blatantly disregard his wife’s refusal of the transfusion, but giving Mr. Martinson blood would greatly increase his likelihood to survive.

I’m so torn. I want to save his life, but if the Martinsons don’t agree with my decision to continue with the transfusion, they could sue the hospital for the medical staff undermining their rights.

I have so many unanswered questions. Yes, a lawsuit may be filed if the transfusion is completed, but if it saves a life, isn’t that worth the risk? I adhere to a Code of Ethics that required me to serve all patients with the highest quality of care, I’m just not sure in this situation if the highest quality of care means respecting his wife’s wishes and his spiritual beliefs, or forging forward and giving a transfusion that ultimately saves his life.

I just wish I wrote a paper about this in nursing school so I could have some clarity.

Until next time,

Joy

MARTHA,

The inside of hospital is like a maze and I kept having to ask directions. I was worried and scared and all I wanted was to see Martin. When I was able to visit him, he was unconscious and he looked terrible. He still had blood on his skin and face. He looked pale, and cold and had cuts on his arms. He was connected to machines and wires. When Martin left the house this morning he was his cheerful, healthy self. Suddenly he looked so small and fragile.

The nurse asked me lots of questions about Martin, his medications, and his medical history. She asked me if there were any religious or cultural consideration they needed to know about and I told her that we’re Jehovah’s Witnesses. She asked me if Martin had an advanced directive. And I told her he doesn’t. We joined so recently and we’ve been meaning to sit down and put one together for each of us. But we’ve been healthy it didn’t seem urgent, so we hadn’t gotten around to it yet.

The nurses and doctors explained to me that Martin had internal injuries, and would need surgery. They told me there was some damage to his spleen. A nurse came and talked with me and told me that Martin would probably need a blood transfusion to survive. I told her again that we’re Jehovah’s Witnesses and that we can’t have blood transfusions.

As Jehovah’s Witnesses, Martin and I turn to the bible for answers to hard questions. It teaches us that we’re not to consume blood. We’ve learned that avoiding taking blood is an act of obedience to God, out of respect for Him as giver of life.

The nurse asked again if Martin had an advanced directive and I told them he didn’t. But I’m his wife, and I know what he would want. The bible is clear. The teachings are clear. I can’t imagine losing my husband, but the choices they’re giving me are no choices at all.

Could survive without the blood? Usually people don’t need blood transfusions. I’ve been told that often patients do better without them, even in surgery. Surely there is another way?

Patient's rights should always be upheld to the full extent possible by healthcare professionals. Religious freedom and patient autonomy are important considerations when caring for patients.
In times when patient wishes are unclear, it is the nurse's duty to advocate for most appropriate action. When these decisions are unclear, legal intervention may be necessary. team care conferences with family members and all medical professionals are integral in planning appropriate care - but remember time is of the essence.
Good clinical judgment and patient advocacy is a cornerstone of nursing.

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Created with images by TusitaStudio - "hospice caring elderly" • NGDPhotoworks - "ring wedding detail" • Catedrales e Iglesias - "Templo San Francisco de Asís,Telchac Pueblo,Telchac Puebla,Estado de Yucatan,México" • Tobyotter - "Old Cross" • Unsplash - "book bible bible study" • Sean MacEntee - "irish road" • Daigo Tanaka - "thought-bubble" • bigblockbobber - "tablets pills medicine" • Mr Moss - "The Good Book - 125/365" • tpsdave - "doctor physician surgery" • qimono - "blood cells red"

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