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Ethical dilemma · Cultural humility · Intermediate2
Clear filtersCompeting duties with no perfect answer: consent, confidentiality, fairness.
- Practice this question nowEthicsIntermediateMMI station MD, DO, PA, Nursing, Residency
A Jehovah's Witness patient refuses a blood transfusion they need to survive. What do you do?
Autonomy and consent · Cultural humility · Communication
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Sample answer outline
- A competent adult can refuse even life-saving treatment. Your job is to make sure the refusal is informed, voluntary and consistent with their values.
- Talk with them privately to check for pressure from family or community.
- Explore what they will accept: bloodless surgery techniques, cell salvage, iron, medicines that boost blood production.
- Document the conversation and their decision clearly, and keep caring for them fully.
- Note how it differs for a child or for an unconscious patient without an advance directive.
What makes it work
- It respects autonomy while doing everything else possible.
- Showing the contrast with a child proves you understand the limits.
Avoid
- Trying to persuade them out of their faith.
- Treating the refusal as a reason to step back from their care.
- Practice this question nowEthicsIntermediateMMI station MD, DO, PA
A family begs you not to tell their grandmother she has cancer because "it'll kill her faster." What do you do?
Autonomy and consent · Cultural humility · Communication
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Sample answer outline
- Listen to the family first: their fear and any cultural norms around sharing bad news.
- Explain that the information belongs to the patient, and that you won't lie to her.
- Ask the grandmother how much she wants to know and who she wants involved. Some people choose to let family decide.
- Share news at her pace, with the family present if she wishes, and plan support together.
What makes it work
- Asking the patient what she wants resolves the dilemma respectfully.
- It honors culture without giving up honesty.
Avoid
- Telling her bluntly against the family's wishes without asking her first.
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