The development of physician norms in the United States. The treatment of Jehovah's Witness patients.

According to their religious dogma, Jehovah's Witnesses (JW) are unwilling to accept blood transfusions, even if their own lives are at stake. This belief puts physicians, who have no consistent legal norms to guide their behavior, in an ambiguous situation. To examine the socialization process regarding the development of norms under legal uncertainty, we asked medical students, house staff and faculty physicians to discuss their actions regarding each of four case simulations (one minor child, one incompetent adult, and two competent adults). In our sample, 84% of faculty and half of the respondents overall report having had personal experience with JWs. Despite patient or parental requests to the contrary, physicians were most likey to transfuse the child (80%), followed by the imcompetent adult (63%) and the two competent adults (25 and 15%). This ordering reflects the consistency of court decisions. In addition, the physicians' decisions regarding whether or not to transfuse did not vary with either their experience with JWs or level of training; however, experienced physicians appeared to learn to take precautions to protect themselves and their hospital from legal action. The study also indicates lack of formal medical education as an information source from which medical students learn about this ethical problem.