一名36歲耶和華見證人病患大出血送醫，血紅素降至 4.5 g/dL。她完全清醒並再三拒絕輸血。自主權原則指示何種行動？
A 36-year-old Jehovah's Witness arrives experiencing massive hemorrhage. Her hemoglobin plunges to a critical 4.5 g/dL. She is entirely alert and repeatedly refuses all blood transfusions. What action does the ethical principle of autonomy dictate?
- AQuietly heavily sedate the client to bypass her refusal via emergency consent rules.安靜地深度鎮靜病人以透過緊急同意規則規避其拒絕。
- BRespect the competent client's explicit autonomous refusal, document it, and use non-blood alternatives.✓ 正解尊重有判斷能力病人的明確自主拒絕，記錄該決定，並使用非血液替代品。
- CMandate her legally registered spouse provide a surrogate signature overriding her decision.依法登記的配偶強制提供代理人簽名以推翻其決定。
- DObtain an emergency court order forcefully overriding her choice.取得緊急法院命令強制推翻其選擇。
這道題目考驗護理師對醫療倫理原則中「自主權（autonomy）」的理解和應用，特別是在面對病患拒絕可能挽救生命的治療時。自主權是指有能力做決定的個體有權利掌控自己的醫療決策。當一位完全清醒、有判斷能力的成年病患，即使面臨生命危險，仍基於個人信仰（如耶和華見證人拒絕輸血）再三拒絕治療，醫療團隊必須尊重其知情拒絕權。護理師的職責是確保病患充分理解拒絕治療的潛在後果，並將其決策完整記錄，同時提供所有可行的非血品替代方案，以符合病患的意願和倫理原則。
This item tests the nurse's understanding and application of autonomy among the principles of medical ethics, particularly when a patient refuses potentially life-saving treatment. Autonomy means that a competent individual has the right to control his or her own medical decisions. When a fully alert, decisionally capable adult patient repeatedly refuses treatment on the basis of personal beliefs (such as a Jehovah's Witness refusing blood) despite the risk to life, the healthcare team must respect that informed refusal. The nurse's duty is to ensure that the patient fully understands the potential consequences of refusal, to thoroughly document the decision, and to offer all feasible non-blood alternatives in keeping with the patient's wishes and ethical principles.
在台灣和美國，病患自主權（autonomy）都是醫療倫理的核心原則。耶和華見證人因宗教信仰拒絕輸血的案例在兩地都經常出現，且醫療專業人員普遍被要求尊重病患的知情拒絕權。然而，在美國，對於清醒且有判斷能力的成年人，其拒絕輸血的法律保障可能更為明確和嚴格。台灣《醫療法》也保障病患的知情權與自主決定權，但有時在生命危急情況下，家屬的影響力仍可能較大。在NCLEX中，強調的是護理師必須堅定地捍衛病患的自主權，前提是病患具備判斷能力。