A landslide occurred in the middle of the night on 20th July, 2023 in a remote mountain hamlet, approximately 60 kilometres from Uttarkashi. The landslide was caused by torrential rains and has resulted in large-scale destruction of property and life. You, as District Magistrate of that area, have rushed to the spot with a team of doctors, NGOs, media and police along with numerous support staff to oversee the rescue operations.
A man came running to you with a request for urgent medical help for his pregnant wife who is in labour and is losing blood. You directed your medical team to examine his wife. They return and convey to you that this woman needs blood transfusion immediately. Upon enquiry, you come to know that a few blood collection bags and blood group test kits are available in the ambulance accompanying your team. Few people of your team have already volunteered to donate blood.
Being a physician who has graduated from AIIMS, you know that blood for transfusion needs to be procured only through a recognized blood bank. Your team members are divided on this issue; some favour transfusion, while some others oppose it. The doctors in the team are ready to facilitate the delivery provided they are not penalized for transfusion. Now you are in a dilemma. Your professional training emphasizes on prioritising service to humanity and saving lives of individuals.
(a) What are the ethical issues involved in this case?
(b) Evaluate the options available to you, being District Magistrate of the area.
The case presents conflict between procedural integrity and the moral obligation to save a critical patient’s life in an emergency.
- Procedural compliance – There is a duty to provide urgent medical care to the pregnant woman in need, but proper procedures should be followed for blood transfusion.
- Beneficence vs. non-maleficence – Transfusing blood could save the woman’s life (beneficence), but improperly tested blood could harm her (non-maleficence).
- Rule utilitarianism – Whether strictly following protocols supersedes the specific need in this emergency situation.
- Justice and fairness – The woman should receive equitable and timely treatment like any other patient.
- Truthfulness – Whether to accurately report the emergency transfusion if done or conceal it.
- Integrity and ethics – Upholding professional ethics and integrity while addressing the moral dilemma.
Evaluation of the available options:
- Follow protocol and do not allow transfusion
- Merit – fails beneficence, violates duty of care
- Demerit – upholds regulations, avoids non-maleficence
- Allow emergency transfusion
- Merit – upholds beneficence, duty of care
- Demerit – violates regulations, non-maleficence risk
- Rush patient to hospital
- Merit – proper facilities, reduces non-maleficence risk
- Demerit – delay risks life, fails beneficence)
- Airlift certified blood
- Merit – avoids non-maleficence
- Demerit – weather delays could fail beneficence)
- Doctors decide
- Merit – expertise-based decision, considered decision
- Demerit – abdicates responsibility
- Do nothing
- Merit – upholds regulations
- Demerit – utterly fails beneficence and duty of care
Evaluating these options through the lenses of key ethical principles of beneficence, non-maleficence, justice and accountability, I would responsibly order the emergency transfusion based on duty of care and beneficence while minimising harm.
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