Legal guardians and refusal of blood transfusion.

Abstract

A patient with k light chain multiple myeloma was sent by her General Practitioner to the Emergency Department because of severe anaemia (last haemoglobin 6.0 g/dL) and a fall to the ground that had caused trauma to the left knee and left periorbital ecchymosis. On entry to the Emergency Department the patient was found to have a haemoglobin concentration of 6.1 g/ dL. Being a Jehovah’s Witness, the patient refused a transfusion of red cell concentrates despite repeated discussion with the doctors in which the real and imminent risk of loss of consciousness and death was explained. Four days later, despite bone marrow stimulating treatment with high doses of erythropoietin (Eprex 10000 UI 3 times/week), there had been a progressive fall in the haemoglobin concentration (haemoglobin 4.4 g/dL). A person claiming to be the patient’s Guardian presented at the ward, giving the doctors an “application for the designation of temporary guardianship and emergency measures ex article 405 section 4 Civil Code” in order to safeguard, by confirming them, the wishes expressed by the patient who at that time was still conscious, lucid and demonstrated understanding of the risks related to her refusal of transfusions. Using the above case as a starting point, we, who were consulted about it in the quality of advisors for the University Hospital, analyse the medico-legal issues related to the powers of the new judicial figure introduced with Law 6/2004 of the Italian Civil Code.