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You are a medical student on an obstetric ward. The patient is alert and has a card in her purse stating she refuses blood products. Her husband is asking the team to 'do whatever it takes'.
Say your answer out loud first, then jot down the key points you made. Writing it helps you spot gaps — and it's what the AI feedback reads.
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Understanding of autonomy and capacity, the right of a capable adult to refuse life-saving treatment, and how to act compassionately within the law.
A structure to build your own answer on — not a script.
Identify
Tension between respecting a capable adult's refusal (autonomy) and preserving life (beneficence).
Capacity and voluntariness
Assess capacity for this decision (understand, retain, weigh, communicate). Check the decision is informed and free from undue pressure — ideally speak to her privately.
Information and alternatives
Ensure she understands the consequences. Offer every acceptable alternative: cell salvage, IV iron, erythropoietin, surgical control, fluids — and ask which products she will accept (some accept certain fractions).
Law and guidance
A capable adult may refuse any treatment, even if it leads to death (Mental Capacity Act principles; GMC guidance). Treating against her will would be assault. Check for an advance decision.
Family and staff
Explain to her husband compassionately that her decision stands, while supporting him. Involve seniors, document carefully, and support staff.
Conclude
Respect her informed, capable refusal while providing all other care, including palliative care if needed.
A strong but not perfect answer. Read the notes to see why it works — then make your own version with your experiences.
The central conflict here is between respecting her autonomy and the team's wish to save her life.
The first question is whether she has capacity to make this decision. The Mental Capacity Act says we should start by assuming she does, and consider whether she can understand the information, retain it, weigh it up and communicate a decision. Heavy blood loss could affect her thinking, so this needs careful assessment — but disagreeing with a decision is not evidence that someone lacks capacity1. I'd also want the team to speak to her privately2, away from family or members of her faith community, to make sure the choice is genuinely hers and not the result of pressure.
If she has capacity and understands that refusing may lead to her death, then the law and GMC guidance are clear: a capable adult can refuse any treatment, even life-saving treatment. Giving blood against her will would be a serious harm and legally an assault.
That doesn't mean the team stops caring. They should explore exactly which products she'd accept3, and use every alternative available — cell salvage, iron, drugs to stimulate blood production, surgical control of the bleeding — and involve senior obstetricians, anaesthetists and haematologists early.
Her husband is clearly frightened, and the team should explain gently that the decision is hers, while supporting him. Everything should be documented carefully.
It would be incredibly hard for the team4 if she died, and they'd need support afterwards. But I think respecting her decision is right, because the alternative is overriding a capable person's deeply held beliefs about her own body.
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