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護理師正在為一位最近剛接受甲狀腺全切除術的42歲女性病患提供出院衛教。這位病患是一名虔誠的耶和華見證人,在手術期間經歷了嚴重的失血,其血紅素掉到了 6.8 g/dL。目前她的生命徵象穩定。醫療提供者已經開立了口服鐵劑與每週施打的紅血球生成素 (Epoetin alfa) 注射。病患詢問:『在法律與宗教上,我可以接受這些注射嗎?』護理師最恰當的回應為何?

A nurse is providing discharge instructions to a 42-year-old female client who recently underwent a total thyroidectomy. The client is a devout Jehovah's Witness and experienced significant blood loss during surgery, dropping her Hemoglobin to 6.8 g/dL. Currently, her vital signs are stable. The healthcare provider has prescribed oral iron supplements and weekly Epoetin alfa injections. The client asks, 'Can I legally and religiously accept these injections?' What is the most appropriate response by the nurse?

  • A“I will immediately call the hospital chaplain to explain the medication contents to you to avoid any institutional liability.”
    我會立即聯絡醫院牧師,向您說明藥物成分,以避免任何機構責任。
  • B“Epoetin alfa is a synthetically manufactured growth factor, not a blood product, making it completely acceptable and religiously compliant for you.”✓ 正解
    紅血球生成素是一種合成製造的生長因子,並非血液製品,因此完全可接受且符合您的宗教規範。
  • C“You cannot receive this injection because all injectable medications are strictly forbidden by Jehovah's Witness doctrines.”
    您不能接受此注射,因為耶和華見證人的教義嚴格禁止所有注射用藥物。
  • D“Because Epoetin alfa is a minor blood derivative extracted from human plasma, it fundamentally violates your religion's ban on blood products.”
    由於紅血球生成素是從人類血漿中提取的微量血液衍生物,它根本上違反了您宗教對血液製品的禁令。
Explanation · 中文詳解

本題測驗文化倫理與護理管理 (Cultural/Ethical Care)。耶和華見證人 (Jehovah's Witnesses) 的核心宗教教義是「絕對禁止全血 (Whole blood) 與其四大主要成分(紅血球、白血球、血小板、血漿)的輸注」。這名病患因嚴重貧血 (Hb 6.8),傳統療法是輸血,但她必然會拒絕。此時,醫療團隊最常開立的黃金替代療法是『紅血球生成素 (Epoetin alfa / Epogen)』。護理師必須清楚向病患衛教,Epoetin alfa 是在實驗室透過重組 DNA 技術「合成製造 (Synthetic)」的生長因子激素,它用來刺激骨髓自行製造紅血球。因為它『並非來自於人類血液的萃取物 (Not a blood product)』,所以在耶和華見證人的宗教規範下是完全可以被合法且安心接受的(選項 B 正確)。選項 D 錯誤,它不是任何人類血液的衍生物。選項 C 錯誤,該宗教只拒絕血液,並沒有拒絕注射針劑或現代醫療。選項 A,護理師具有解釋藥物成分的專業與法定責任,這不是牧師的專長工作。

Epoetin alfa is a synthetically manufactured growth factor produced via recombinant DNA technology, not a human blood product. This makes it fully compliant with Jehovah's Witness beliefs, which prohibit whole blood and its four major components but generally accept non-blood fraction therapies.

✦ 台美臨床差異

台美皆面臨耶和華見證人拒絕輸血的醫療倫理困境。在國考中,替代輸血的黃金標準答案就是:「給予 Epoetin alfa (EPO) 與體液擴充劑 (Normal Saline/Lactated Ringer's)」。

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