Negotiating a parental refusal of a blood transfusion — OSCE

Station brief (8–10 minutes)

You are called to the ward where the parents of a bleeding six-year-old refuse a life-saving blood transfusion on religious grounds. Explain the clinical situation and the ethical framework to the family, agree an immediate plan that protects the child, and arrange the appropriate escalation. Do not invent local statutory wording or specific court procedure. [2]

Tasks for the candidate

1. Assess the risk of serious harm and state the principle that sets the threshold for overriding the refusal. [1]
2. Acknowledge the family's values respectfully while being honest about the clinical need and the consequences of refusal. [2] [3]
3. Explain that the child will be treated in her best interests under emergency authority, and that the ongoing dispute will be taken to the court. [1] [3]
4. Continue to offer care and keep the relationship intact, arranging ethics consultation and senior escalation. [4]
5. Document the pathway factually and contemporaneously. [1]

Expected performance

Must hit. Risk of serious harm assessed and the harm-principle threshold named correctly; family's values acknowledged respectfully; honest explanation of the clinical need and consequences of refusal; clear statement that the child is treated in her best interests under emergency authority and the dispute taken to court; continued offer of care with ethics consultation and senior escalation arranged; factual and contemporaneous documentation. [1] [2]

Merit. Distinguishes the harm principle (threshold) from the best-interests standard (guide); explains why the clinician does not override alone once the emergency passes; explores blood-conserving alternatives where feasible; names that judicial review supports transfusion of a child against parental refusal where life is at stake; explicitly plans to preserve the therapeutic relationship. [3] [4]

Fail. Allows the child to deteriorate without treatment; dismisses or ridicules the family's faith; overrides the refusal indefinitely without seeking court authority; fails to document; or, conversely, treats the family's refusal as binding even where it risks the child's death. [1] [2]

Sample candidate structure

"Mrs —, thank you for speaking with me. I understand that receiving blood is against your faith, and I want you to know I respect how important that is to your family. I also need to be honest with you: your daughter is bleeding and, without a transfusion, she is likely to die today. Because I have a duty to protect her life, I am going to give her the blood she needs now, in her best interests. I am also going to ask my senior colleagues and our ethics team to help us, and we will ask the court to look at what should happen next. I will keep talking with you throughout, and we will keep caring for her and for you as a family." [2] [1] [3]