A woman who is a Jehovah's Witness is in a car accident and requires a life-saving blood transfusion. She is unconscious, but a card in her wallet explicitly refuses transfusions. What is the appropriate course of action?

Where answers to this question lose points

Our scorer marks every answer on three parts. For each of the 81 applicants who finished this question on Confetto, we took their first scored answer and counted the part that scored lowest.

• Structure: a clear order and a clear point35 of 81

Confetto data as of November 8, 2026. A part is shown only when 20 or more applicants share it. Answers where two parts tied are not counted toward either. We never show anyone's answers or details.

What this question tests

• Cultural humility
• Patient care
• Medical ethics

How to structure your answer

1. Ask questions (25 seconds). The opening identifies the problem: an unconscious woman needs life-saving treatment but has explicitly refused transfusions. To fit this part more closely, it should ask the medical team about urgency and the card’s validity and applicability, rather than opening only with concern.
2. Who is affected (20 seconds). The patient comes first, including both her survival and her right to have her expressed wishes respected while unconscious. The answer also considers the medical team’s responsibility and emotional difficulty, followed by family members and her religious community as potential sources of understanding and support.
3. The conflict (20 seconds). The conflict is between saving the woman’s life through a transfusion and respecting her explicit refusal of that treatment. The answer makes this personal by acknowledging how strongly the applicant wants to save her while recognizing that unwanted treatment could violate her consent and dignity.
4. Options (40 seconds). Transfusing could save her life but would override her expressed refusal, while withholding blood would respect her wishes but could result in death. The answer develops a third option, urgently pursuing acceptable alternatives, although these may not achieve the same outcome as transfusion.
5. Choose (30 seconds). The answer chooses to honor the written refusal while pursuing every available acceptable alternative, rather than stopping at uncertainty. Its main reason is that unconsciousness does not erase a decision expressed when competent, and respecting the patient means respecting her values as well as treating her injuries.
6. What next (20 seconds). The next steps are to work urgently with the medical team, consult physicians experienced in bloodless care, and use relevant hospital protocols. The answer also proposes contacting family or her religious community to clarify individual preferences and obtain support, not to override her refusal.

Example answer from Confetto

Example answer from Confetto. Not a real applicant's answer.

My immediate reaction would be deep concern for this woman's life while recognizing the profound ethical dilemma the team is facing. I see two fundamental principles in direct conflict: the duty to preserve life and the obligation to respect patient autonomy, even when she cannot currently voice her wishes.

I believe the wallet card represents a clear expression of her autonomous decision made when she was competent. As a Jehovah's Witness, she likely made this choice after careful consideration of her religious beliefs and personal values. Even though she's unconscious, I think we must honor what she explicitly stated about her own care. Ignoring her written directive would essentially be forcing treatment she specifically refused, which violates the principle of informed consent.

However, I would immediately explore every possible alternative. I'd work with the medical team to identify non-blood volume expanders, consider bloodless surgical techniques if applicable, and consult with physicians experienced in treating Jehovah's Witness patients. Many hospitals have protocols specifically for these situations that can sometimes achieve similar outcomes without transfusion.

I would also try to contact any family members or her religious community if possible, not to override her decision, but to better understand her specific beliefs and potentially access additional support or alternative treatment options they might know about.

This situation would weigh heavily on me, because so much of what draws me to medicine is wanting to save a life like hers by the most effective means available. But what I've seen in clinical settings, and read about cases like this, has taught me that good care means respecting patients as whole people with deeply held values, not just treating their medical conditions. Even if the outcome is tragic, I believe respecting her autonomy honors her dignity as a person. The most ethical action is pursuing every alternative while honoring her clearly expressed wishes.

Use it for its structure. Interviewers can tell a memorized script, so tell your own story.

Keep going

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