Professionalism in Hematology
Core concepts
Professionalism encompasses integrity, accountability, respect, and patient-centeredness. In hematology, ethical tensions arise around transfusion refusal (Jehovah's Witness), rationing scarce resources (stem cell transplant, CAR-T slots), conflicts of interest with industry, and end-of-life decisions. Candidates should understand informed refusal, capacity assessment, and the duty to advocate for patients while respecting autonomy.
Traps
- Assuming a patient lacks capacity because their choice seems unwise.
- Overriding a competent refusal of blood products.
- Failing to disclose a conflict of interest.
- Breaching confidentiality in discussions with family without consent.
- Treating a colleague's impairment or error with silence rather than reporting through appropriate channels.
Worked example
A competent adult Jehovah's Witness refuses transfusion during a bleeding episode. Capacity requires understanding, appreciation, reasoning, and communication of choice. If capacity is intact, honor the refusal and document it; explore alternatives (iron, erythropoietin, cell salvage) within the patient's stated limits.
Rule of thumb
Capacity is decision-specific and independent of the "wisdom" of the choice; document discussions and honor competent refusals.