An HIV-positive Jehovah's Witness who is pregnant needs a transfusion to live and have a healthy baby. She categorically refuses. She is not depressed and is fully alert. What do you tell her?

• A. Administer the transfusion anyway
• B. You must honor her wishes
• C. Seek a court order to override
• D. Overrule due to maternal/fetal health

Answer: (B)

The key concept is that competent adults have the right to refuse medical treatment. If a patient is fully alert, not depressed or impaired, and understands the consequences, her autonomous decision must be respected—even when that decision could jeopardize her health or that of the fetus.

Here, the pregnant patient has religious beliefs that reject blood transfusions. Because she is capable of making her own decisions, you should honor her wishes after ensuring she is fully informed about the risks of refusing a transfusion and about any feasible alternatives that align with her beliefs (such as non-blood conservation methods, iron therapy, or other supportive options). Your role is to provide clear information, answer questions, and document her capacity and refusal.

Administering the transfusion against her will would violate autonomy, seeking a court order is not appropriate when the patient is competent, and overruling for maternal/fetal health would also undermine her decision.