Blood transfusion and Jehovah's Witnesses: the legal and ethical issues

Abstract

A critical incident is any event that had an effect, or could have had an effect, on the welfare of a patient. Patients must be treated with respect by staff who demonstrate that they are sensitive to individual needs, values, beliefs and cultural background. This article will examine the legal and ethical issues relevant to the right of an unconscious Jehovah's Witness in an intensive care unit (ICU) to refuse a blood transfusion. The concepts of consent, capacity to consent, necessity to act, advance directives, decision making, consequences of failing to obtain consent, ethical principles, human rights and the best interests of the patient will be explored, in the light of relevant statute and case law, in order to demonstrate some of the legal and ethical complexities within acute healthcare delivery.

Autotransfusion: Therapeutic Principles, Efficacy and Risks

“…Some contraindications may be relative in this situation when autotransfusion may increase survival (McInroy 2005, Van Wolfswinkel 2009, Wooley 2005. In the context of operative treatment of neoplasms, when irradiation of the washed blood product is not possible, the use of a leukocyte filter will provide a 1 log reduction of the tumour load.…”

Blood transfusion and Jehovah's Witnesses revisited: Implications for surgeons

“…Any violation of this right in the form of intervention on one's body, even as trivial as a mere touching, can amount to an assault or battery. Transfusion in the face of a clear refusal by the patient is thus both ethically and legally wrong . It could well be the basis of a damage action in tort.…”

Use of recombinant activated factor VII in Jehovah's Witness patients with critical bleeding

“…Transfusion of blood products may be crucial in such circumstances to address significant blood loss. However, given the majority of JW patients either refuse all blood products or only allow fractionated blood products, dealing with haemorrhage in these patients can be challenging. The use of alternative agents has potential to be ‘lifesaving’ in such situations.…”