Get Answer: Year With History Question Guide

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This question relates to year with history and requires a structured academic response.

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Key Explanation

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Original Question

A 76 year old man with a history of coronary artery disease, diabetes and hypertension was brought in by his wife with two days of lethargy, slurred speech and right arm weakness. On presentation, the patient was awake and intermittently involved in conversation. He was afebrile, with a pulse of 90 and blood pressure of 166/98 His exam was remarkable for dysarthria, orientation only to person, pinpoint pupils, left sided tongue deviation, 3/5 motor strength in the right upper extremity, 4/5 motor strength in the proximal right lower extremity and right sided hyperreflexia. A non-contrast head CT revealed an acute left thalamic hemorrhage with surrounding edema and midline shift. The patient was evaluated by neurosurgery, but given the location of the bleed, no surgery was indicated. Platelet transfusion was recommended, as the patient had medication induced platelet dysfunction. The patient’s wife refused platelet transfusion as the patient was a long-standing Jehovah’s Witness. She had a copy of his Advanced Directives in which she was appointed the health care proxy and it was clearly outlined that he would not accept any blood product transfusion. An ethics consultation was requested. Questions: 1. From an ethical and legal standpoint how should a physician handle these situations? 2. If the patient can indicate that he wishes to accept platelets at this time, should his Advanced Directives be disregarded? 3. Would the situation be different if the patient were a minor and the parent’s refused transfusion?

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