Ethical and Legal Implications of Bloodless Medicine and Surgery

Abstract

Transfusion medicine is in the midst of a “paradigm shift.” Multiple studies have documented new developments in our understanding of the risks of allogeneic blood and the benefits of bloodless alternatives. However, systematic attention has not yet been given to the ethical and legal implications of these changes. This article discusses the effect these changes have had on three ethical duties that physicians owe to their patients: (1) the obligation to respect a competent patient's right to refuse medical treatment in accordance with his/her own values and beliefs, (2) the obligation to examine current assumptions about the efficacy and safety of allogeneic blood, and (3) the obligation to engage in a process of communication that adequately prepares the patient to make an informed decision about the use of blood and blood derivatives. Physicians who neglect these duties not only fail their ethical obligation to respect patients' rights but also expose themselves to significant medicolegal risk. The discussion includes an explanation of the source and significance of each obligation, as well as an explication of the standard by which it is judged. The article concludes with a set of five practical recommendations for physicians seeking to provide ethically appropriate care.