USMLE Step 1 Question 341

Question:

A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

Correct Answer: D.  Transfuse blood as needed, explaining the situation to the parents

In this emergent situation, the patient requires urgent blood transfusion. As a general ethical and legal rule, parents cannot withhold life- or limb-saving treatment from their children, even for religious reasons. This fact should be quickly explained to the parents, and the patient treated appropriately.

Administer blood without delay and contact child protective services (choice A) is incorrect because there is no indication that the patient has been abused. Although the parents’ request to avoid blood cannot be followed, making the request is not grounds to contact authorities.

Convene an urgent meeting of the hospital ethics board (choice B) is incorrect because a legal and ethical standard has been set for this type of situation, as described above. Further, this choice is logistically unfeasible; the patient’s condition requires immediate action.

Engage the parents in a discussion of why they hold these beliefs (choice C) may be appropriate in a non-emergent situation, but not at this point.

Treat the patient without using blood products, per the request of her parents (choice E) is incorrect. As a general rule, parents cannot withhold life- or limb-saving treatment from their children, even for religious reasons. If the patient were conscious and made the same request, it still would not be honored, as she is a minor and therefore legally incompetent.