The St. Fleur family is well respected in the Haitian community because they are religious, faithfully practice Jehovah's Witness, and have great moral values. Rhonda, the youngest daughter of this family, is 17 years-old and lives at home with her mother and father. Recently, she began having fevers and subsequently developed severe abdominal pain. She was admitted to the hospital, where laboratory tests were hCG and COVID-19 positive. Rhonda was in shock when the doctor informed her that she was pregnant and COVID-19 positive. She confessed to the doctor that she has been sneaking out during the Pandemic to see her boyfriend, but swears that she uses sexual prevention techniques. However, as her symptoms have de-compensated, she is rushed to the OR with a diagnosis of Ectopic Pregnancy. The family is at the bedside and reminds the surgical team that Rhonda's faith prevents her from receiving any blood products due to her religion and cultural beliefs.
What are Haitian's views on unplanned pregnancy and viral infections?
What are Haitian's views on blood transfusions?
What are your procedures/responsibilities as a Nurse Anesthetist if the family refuses blood products for Rhonda's emergency surgery?
Sample Answer
This is a complex scenario involving clinical emergency, adolescent privacy, cultural values, and religious freedom. As a Nurse Anesthetist (CRNA), your immediate priority is patient safety and ethical decision-making within the legal framework of consent.
Haitian Views on Unplanned Pregnancy and Viral Infections
Haitian culture is often deeply rooted in Catholicism and Protestantism (including Jehovah's Witnesses, as in this family's case), which heavily influence views on sexuality and health.
Unplanned Pregnancy: Unplanned pregnancy outside of marriage, especially for a minor, is generally viewed with shame and disappointment by the family and community due to the strong emphasis on moral values, virginity, and religious adherence. For the St. Fleur family, who are highly respected and devout Jehovah's Witnesses, this discovery would be a source of significant distress, potentially leading to social isolation for Rhonda and intense family crisis.
Viral Infections (COVID-19): Views on viral infections vary based on education and access to information. While the medical reality of COVID-19 is acknowledged, some traditional or spiritual beliefs may influence how illness is perceived (e.g., as punishment or fate). However, the immediate concern for this family is the critical medical emergency (ectopic pregnancy) and the religious constraint on treatment (blood).
Haitian Views on Blood Transfusions
The St. Fleur family's refusal of blood products is primarily driven by their religious faith (Jehovah's Witness), not general Haitian cultural beliefs.
Jehovah's Witness Doctrine: Jehovah's Witnesses believe that the Bible prohibits the ingestion of blood (Acts 15:28, 29). They interpret this command to mean they must not accept whole blood or the primary components (red cells, white cells, platelets, or plasma), even in life-saving situations. They are prepared to accept the risk of death rather than violate their religious conscience.
Haitian Cultural Views: General Haitian culture does not prohibit blood transfusions. In fact, due to high rates of conditions like sickle cell disease and trauma, blood transfusions are a recognized and accepted medical treatment. In this specific case, the religious belief overrides the general cultural norm.
Procedures/Responsibilities as a Nurse Anesthetist (CRNA)
As a CRNA, your responsibilities in an emergency where a life-saving treatment (blood transfusion) is refused due to religious beliefs are critical and must balance ethics, law, and clinical necessity.
1. Immediate Clinical and Documentation Responsibilities
Confirm Capacity and Consent: Though Rhonda is 17, she is a minor. The CRNA must confirm that the parents/guardians have the authority to refuse this treatment based on their religious beliefs for their minor child.
Note: Legally, the status is complex. In many states, courts can override parental refusal of life-saving treatment for a minor. However, in an immediate emergency, time is the primary factor.
Acknowledge and Respect the Refusal: Verbally acknowledge the family's refusal and document it meticulously in the chart, including who made the decision (parents), the reason (Jehovah's Witness faith), and the specific products refused.