Refuse Blood Transfusion Research Articles

Legal considerations regarding the blood transfusion refusal in cases of minor patients

(1) Background: This study examines the issue of malpractice accusations related to medical procedures in case of minor patients belonging to specific religious sects, focusing on both legal and ethical perspectives. The analysis particularly addresses the consequences of disregarding the refusal of legal guardians to consent to blood transfusions. (2) Methods: The present study is analyzing the opinion of doctors that practie in various hospital units regarding a series of aspects related to the refusal of blood transfusions in the case of minor patients who belong to certain religious sect. These aspects mainly targeted their level of awareness regarding the relevant legislation, the incidence rate of such cases in practice, and the risk of malpractice accusations. For this observational-prospective study, a questionnaire consisting of ten closed-ended questions was delivered to fifty doctors. Before starting to complete the questionnaire, the doctors were asked for their consent to participate in the study, being informed about its purpose. Doctors answers were analysed and interpredeted in order to revel if doctors are informed about the legal aspects, thei protection offered by the law and their attitude regarding the boold transfusions for this cathegory of patients. (3) Results: The results of this study show that most doctors are aware of the Romanian legislation regarding the rules on the expression of consent to the medical act in the case of minor patients by the latter's legal representatives, but they feel threatened by the danger of being exposed to accusations of malpractice when they are put in the situation of providing medical care to minor patients who belong to a certain religious cult, because they are faced with the vehement refusal of their family members who do not accept the idea of medicine based on blood transfusions. Although there is this rule from which the legal representatives of minor patients belonging to a particular religious cult do not deviate, the results showed that doctors believe that the best interests of those seeking medical services must be emphasised, prioritising the fundamental values that protect life or health. (4) Conclusions: Protecting the best interest of minor patients by prioritizing their health should be the main guideline for any legal representative when they need to make a decision regarding the medical care. From a legal perspective, however, it must be accepted that there is no unified viewpoint on this extremely delicate and complex issue, with voices condemning the physician's attitude of violating the will of the legal representatives of minor patients, adherents of a certain religious sect, by applying blood transfusion-based treatments.

Enhancing bariatric surgery safety for patients refusing blood transfusions: a specialized protocol with comprehensive technical measures.

Bariatric surgery has become a leading treatment for obesity, with techniques such as Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) demonstrating notable success in sustained weight loss and improved quality of life. Technological advancements and improved techniques have enhanced the safety of these procedures. The surgical procedures of Jehovah's Witnesses, who refuse blood transfusions as part of their beliefs, pose unique challenges and have rarely been addressed in the context of bariatric surgery. This report aimed to investigate the safety of bariatric surgery in patients who refuse blood transfusion, with an established protocol to minimize the risk of bleeding. We examined the prospectively collected data of Jehovah's Witness patients who underwent bariatric surgery from 2019 to 2023. The surgeries were conducted following a protocol that included specific measures to prevent bleeding. Data were reviewed for demographics, anthropometrics, comorbidities, preoperative medications, operative time, blood loss, length of hospital stay, hemoglobin level, drainage volume, tranexamic acid use, and postoperative 30-day complications. Eleven Jehovah's Witness patients underwent bariatric surgery, including 10 LSG and 1 LRYGB. A patient with iron deficiency anemia underwent intravenous iron treatment before the surgery. There were no intraoperative complications or major postoperative complications. All patients maintained stable hemodynamics postoperatively. Only one patient encountered nausea-vomiting, classified as a minor complication. One patient experienced a small amount of hemorrhagic drainage, which transitioned to serous after tranexamic acid infusion. Bariatric surgery can be performed safely with established protocols in patients who refuse blood transfusions.

Bloodless Cardiac Surgery in Jehovah's Witness: A Comprehensive Review.

This article explores the major challenges and specialized strategies involved in managing cardiovascular surgery patients who are Jehovah's Witnesses and refuse blood transfusions due to their religious beliefs. It delves into preoperative, intraoperative, and postoperative approaches aimed at minimizing blood loss and optimizing patient outcomes while respecting their autonomy. Preoperative measures focus on correcting anemia and coagulopathy through targeted interventions, such as iron supplementation and erythropoietin therapy, and meticulous screening for bleeding disorders. Intraoperative techniques include the use of vasoconstrictors, hemostatic agents, and innovative blood conservation methods like acute normovolemic hemodilution and cell salvage. Postoperative care emphasizes infection control, hemostasis, and judicious monitoring to prevent anemia and facilitate recovery. Through a multidisciplinary approach and adherence to evidence-based practices, healthcare providers can effectively meet the needs of Jehovah's Witness patients, ensuring safe and successful cardiovascular surgery outcomes without the use of blood transfusions.

Abstract PO5-19-09: Trial in progress: A prospective randomized, controlled study to evaluate device efficacy for cutting and/or coagulation of tissue during mastectomy procedures

Abstract Background/Purpose: The ConMed HelixAR Electrosurgical Generator with Argon Beam Coagulation Technology (CHEST) trial aims to focus on patients undergoing mastectomy, either unilateral or bilateral, with immediate breast reconstruction including breast implants, tissue expander placement, or autologous flap. The study design follows the standard of care procedure with device efficacy being measured between two devices regularly used in the operative setting: the HelixAR Electrosurgical Generator (HEG) and the Conventional Electrosurgical Coagulation (CEC) systems. The need for safe alternative surgical tools is increasing as the number of women needing surgical treatment increases. Allowing for the test and comparison of these standardized devices gives an extent to the advantages of using one over the other. To evaluate the device effectiveness between the HelixAR Electrosurgical Generator and Conventional Electrosurgical Coagulation systems for cutting and/or coagulation of tissue during mastectomy and reconstruction surgery, we report the implementation in a randomized clinical trial. The study is powered to show superiority of the HEG to the CEC as it relates to the primary objective of time from post-mastectomy to hemostasis. The HEG is designed to deliver argon gas and high frequency electrical current compared to the CEC delivering high frequency electrical current only. The primary efficacy measure is the time it takes from post-mastectomy to hemostasis with the secondary effectiveness endpoints being infection, drain duration, total drain output, blood loss and device related adverse events. The study hypothesizes that the time for post-mastectomy hemostasis is significantly less for the HEG than the CEC. Additional hypotheses include overall less device related adverse events, lower blood loss, and reduced operative time in favor of the HEG. Methods: This is a prospective 1:1 randomized controlled study of the HEG versus the CEC for patients undergoing a mastectomy with reconstruction procedure. 82 patients will be enrolled and distributed in two arms of 41 patients with a primary objective to assess the device efficacy for cutting and coagulation. The subject population includes patients with breast cancer or high risk from genetic mutations and/or family history. Exclusion factors include known history of bleeding diathesis or coagulopathy, advanced refusal of blood transfusion, active systemic or cutaneous infection or inflammation. The enrolled patients will be followed for 2 months post-operatively. Results: The study is open with 53/82 (65%) patients enrolled at the time of the abstract submission. Of those, 26 subjects were randomized to the CEC and 27 to the HEG. 27 subjects have experienced an adverse or serious adverse event including bruising, infections, and wound dehiscence, none determined to be related to the device use. For the study, analysis will focus on the primary endpoint comparing post–mastectomy procedure time to hemostasis between the two devices. Conclusion: The CHEST trial demonstrates the feasibility of conducting a randomized controlled trial at a single center in a complex operative setting comparing two surgical modalities. The testing of these surgical devices provides rationale for the implementation of safe and regulated clinical trials. While both devices are FDA approved and regularly used, the standardization of device efficacy is becoming more prevalent as new innovations get introduced into the surgical setting. Citation Format: Jessica Montalvan, Ivan Marin, Logan Healy, Margarita Riojas-Barrett, Mary Bajomo, Elizabeth Bonefas, Alastair Thompson, Marco Maricevich, Sebastian Winocour, Stacey Carter. Trial in progress: A prospective randomized, controlled study to evaluate device efficacy for cutting and/or coagulation of tissue during mastectomy procedures [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-19-09.

Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery.

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.

Jehovah's Witnesses and the Normative Function of Indirect Consent.

In this case study, I consider Mr. A, a Jehovah's Witness with chronic vertebral osteomyelitis in need of surgical debridement. Prior to proceeding to the OR, he was unwilling either to explicitly consent to or refuse blood transfusion, while indicating he was open to transfusion intraoperatively, if the team judged it necessary. Ethics was consulted to determine if it would be morally justifiable for the team to proceed with blood transfusion during the course of surgery without Mr. A's documented consent to being transfused. I argue that in this case, what might be termed indirect consent-namely, delegating decision-making regarding some possible course of action without explicitly consenting to the course of action itself-may be sufficient for discharging the clinician's ethical obligation to obtain consent. Identifying information has been changed or omitted to protect patient confidentiality.

Bloodless Treatment of Jehovah’s Witness Patients with Lymphoma and Multiple Myeloma

Background/Aims: Jehovah’s Witnesses refuse blood transfusions for religious reasons. Soonchunhyang University Hospital Seoul has operated a bloodless treatment center since 2000, and a database of bloodless treatment patients has been created. This study aimed to analyze the bloodless treatment outcomes of lymphoma and multiple myeloma patients.Methods: We retrospectively analyzed data of patients diagnosed with lymphoma (22 patients) or multiple myeloma (seven patients) who were treated bloodlessly at Soonchunhyang University Hospital Seoul from 2006 to 2021.Results: The 2-year survival rate for lymphoma patients was 66.6%, with 22.7% dying within 6 months of diagnosis. Those who died early (within 6 months) had a median hemoglobin level of 5.5 g/dL and a median platelet count of 50,142/µL. Dyspnea due to anemia was the most common symptom reported by patients at the end of life. Patients with multiple myeloma had a median survival of 60.3 months and a 2-year survival rate of 57.1%. Although three of the seven multiple myeloma patients were eligible for autologous stem cell transplantation, they were treated with chemotherapy only due to limitations of the bloodless treatment. The drug type and intensity were adjusted due to hematological toxicities in 71.4% of multiple myeloma patients.Conclusions: A significant proportion of patients completed their planned course of chemotherapy and achieved long-term survival. The treatments of some patients were adjusted due to the use of bloodless treatment at the initial chemotherapy session, which affected their response to treatment.

Identifying and Managing Patients with Life-Threatening Hematology Disorders By Doing Telemedicine Inpatient Hematology Consults in Underserved Hospitals

Background: Life-threatening hematology disorders require urgent intervention by expert hematologists. In many hospitals, there are no hematologists available to meet this need. This occurs in “underserved” hospitals, including many rural hospitals and many urban hospitals that do not have hospital-affiliated or hospital-employed hematologists on staff. Patients who present to these hospitals with life-threatening hematology conditions may have worse outcomes than those who present to hospitals that have hematologists on staff. The problem is created by the shortage of hematologists and the challenge of providing in-person consults in these hospitals. To address this problem, our telemedicine-based hematology practice joined the staffs of four underserved hospitals. We sought to identify and manage patients who require urgent hematology evaluation and intervention. Methods: We created telemedicine-based heme/onc consult services in four underserved hospitals that had little or no access to hematology experts. These facilities included one rural hospital, one critical access hospital (CAH), and two urban hospitals. In one urban site, we provided “hybrid” telemedicine-based service, in which we evaluated patients in-person alternating with telemedicine. Inpatients were seen on A/V devices with the help of the patient's nurse or with a “telepresenter” who brought the devices to the patients. Hospital EMR's were accessed by our hematology provider team. To identify patients who needed our services, we educated hospitalists about the need for urgent telemedicine heme/onc consults for select patients with clotting, bleeding, abnormal blood counts and emergency heme/onc conditions. Results: 3,202 patients were evaluated during a three-year period, including 180 patients in rural hospitals, 126 patients in a CAH, 349 patients in an urban hospital, and 2,547 patients in an urban “hybrid” hospital (mixed telemedicine and in-person consults). Consultations were mostly requested for non-malignant hematology patients, including those with bleeding, clotting, or abnormal blood count disorders. Heme malignancy and solid tumor patients were also referred. Several patients with life-threatening hematology or heme-malignancy conditions were identified, including 34 with acute life-threatening ITP, 23 with HIT, five with life-threatening high blood counts due to myeloproliferative disorder or newly diagnosed chronic myelogenous leukemia (CML), two with TTP, and two with atypical HUS. Two patients with acute promyelocytic leukemia (APL) were identified, stabilized, transferred to tertiary care hospitals, and ultimately cured of their conditions. Telemedicine enabled our hematology practice to provide same-day consults and weekend coverage for hospitals located far apart and outside our home region. Some patients were transferred to tertiary care hospitals more promptly because of our service, while others were deemed safe to avoid a hospital transfer that would otherwise have been requested. In some cases, we provided stewardship for blood transfusions and guidance for blood transfusion refusal. Finally, in some cases we enabled safe discharge by planning prompt telemedicine follow-up. Some of the challenges we faced included slow internet connections and less sophisticated EMR's in rural and CAH hospitals that required more time to complete a consult than would otherwise be needed. It was sometimes challenging to plan A/V televisits at convenient times. Sometimes we felt hindered by lack of in-person assessment. Some of the tests and interventions we would have requested in larger hospitals were not possible, resulting in delays of care or requiring transfers to tertiary care hospitals. Finally, some patients who may have otherwise received inpatient chemotherapy or radiation were discharged instead of being transferred. Conclusions: Telemedicine inpatient hematology consults for underserved hospitals are feasible, though challenging. It is possible to identify and manage patients who have life-threatening hematology disorders via telemedicine.

Case Report on Successful Treatment of Life-Threatening Anemia in ESRD Patient on Maintenance Hemodialysis Who Is a Jehovah Witness and Refusing Blood Transfusion

Case Report on Successful Treatment of Life-Threatening Anemia in ESRD Patient on Maintenance Hemodialysis Who Is a Jehovah Witness and Refusing Blood Transfusion

Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report.

BACKGROUND Surgical management in patients who undergo traumatic blood loss but who refuse blood transfusion can be challenging, but physicians and surgeons must comply with the wishes and beliefs of their patients. This report describes the management of severe anemia, with hemoglobin level of 2.5 g/dL, in a 71-year-old male Korean trauma patient who declined blood transfusion. CASE REPORT A 71-year-old man was admitted to hospital with severe blood loss following trauma. He declined blood transfusion due to his religious belief as a Jehovah's Witness. On day 4, the patient's hemoglobin level dropped from 7.7 to 3.9 g/dL. Despite the need for blood transfusion, the patient refused. Hence, therapeutic strategies, including crystalloid fluid resuscitation, bleeding control, vasopressor support, erythropoietin administration, supplementation with iron, folic acid, and vitamin B12, coagulopathy correction, oxygen consumption reduction, and mechanical ventilation were implemented. Following 16 days of supportive management, the hemoglobin reached 7.4 g/dL. However, it suddenly decreased on day 41 (2.5 g/dL) due to episodes of melena secondary to an actively bleeding gastric ulcer, which was successfully managed with endoscopic hemostasis. Despite increased vasopressor dosage and addition of vasopressin and hydrocortisone, the patient became unresponsive with persistent hypotension. Methylene blue was used as the final therapeutic agent. The patient responded well and subsequently recovered without blood transfusion. CONCLUSIONS This report has presented the clinical challenges of managing the case of a patient who requires but declines blood transfusion and has highlighted the approach to clinical care while respecting the wishes of the patient.

Is Head and Neck Free Flap Reconstruction Feasible in Jehovah’s Witness Patients?

Jehovah's Witnesses (JW) population are members of a religious group that refuses blood transfusion. This presents a dilemma for surgical teams when performing major surgical procedures on these patients. This study aimed to assess the safety and feasibility of undergoing microvascular free flaps for maxillofacial reconstruction in JW patients and whether the type of underlying pathology impacts outcomes. This was a multi-institutional retrospective cohort study. The sample consisted of all JW patients who have undergone microvascular free tissue transfer for maxillofacial pathology between January 2016 and January2021. The primary predictor variable was the underlying pathology for which patients underwent head and neck free flap reconstruction; this was benign versus malignant disease. The primary outcome variables were safety, defined as discharge from the hospital with no mortality, and feasibility defined as successful free flap reconstruction. Other variables included age, race, sex, length of surgery, length of hospital stay, and intraoperative use of vasopressors. Data analysis was performed utilizing t-tests for means and χ2 for proportions. Alpha was setat< 0.05. A total of 12 participants from 7 participating sites met the inclusion criteria. There were 9 males and 3 females with a mean age of 58.3±8.3years. There were no deaths in this cohort and all patients were discharged from the hospital. All 12 free flap reconstructions were successful with no incidents of free flap loss; none of the patients received any blood transfusions or any other blood products. Subgroup analysis showed that patients treated for malignant disease versus benign disease had longer operations (11.2±2.9 vs 6.3±0.2hours, P<.01) and a longer hospital length of stay (11.8±4.9 vs 5.3±0.5days, P=.04). Our series supports the safety and feasibility of maxillofacial free flap reconstruction in this challenging subset of patients. Microvascular reconstructive surgeries for malignant diseases often result in longer operative times and hospital stays.

Between Autonomy and Paternalism: Attitudes of Nursing Personnel Towards Jehovah's Witnesses' Refusal of Blood Transfusion.

Objectives: The study describes the attitudes of Polish nursing personnel towards Jehovah's Witnesses' (JWs') refusal to receive blood and blood products. Methods: We developed an online survey assessing nurses' knowledge and attitudes towards JWs' refusal of blood transfusion in a life-threatening condition. It also examined nurses' attitudes towards ethical and legal issues associated with JWs' refusal of blood transfusions. These questions were explored using a sample of 202 Polish nurses. Results: Nurses' knowledge of JWs' stance towards blood transfusions is inadequate and they tended to be ill-disposed towards JWs' refusal of blood transfusions. Although most nurses respected adult JW patients' autonomy and supported their right to refuse blood, in the case of JW children they are guided by paternalism. Nurses' attitudes were affected by whether they had children, whether they declared themselves religious, their level of education and prior experience with patients who had refused a blood transfusion. Conclusion: Since most nurses felt unprepared to care for JW patients, this study reveals an urgent need to train nurses in transcultural nursing and increase nurses' cultural competencies, and that this should be incorporated into medical curricula .

Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.

Ethics in transfusion medicine: Are the intricate layers of ethics all universal? A global view.

Ethical principles have been considered, and in several respects regulated, along the entire blood procurement chain from donor motivation to transfusion to the patient. Consent of donors and voluntary non-remunerated donation are fields which have been addressed by codes of ethics and legislation. Caring for donor health is an area of further development of ethical standards. In part, blood products have also become a market, where commercial principles may synergize, but also creating issues in equality and maintaining human dignity that challenge societal solutions. At the bedside, the main global challenge remains to procure enough blood products for each patient in medical need. Allocation of rare blood, ethical evaluation of transfusion triggers, attitudes towards refusing blood transfusion and provision of blood products to remote settings are areas which should receive consideration.

One of Jehovah’s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report

There are an increasing number of patients who are refusing blood transfusions for several reasons, the most widespread among them being Jehovah’s Witnesses. We present a case of a 66-year-old woman admited to the hospital with gangrene as a complication of the diabetic foot. The hemoglobin level was 4.8g/dl, hematocrit was 15.8% and mean corpuscular volume was 77.1 fL. She needed urgent surgery to amputate her foot. Being one of Jehovah’s Witnesses, she refused blood transfusions. A multimodal blood management approach was applied, and the patient underwent leg amputation without transfusion of any blood product. The treatment strategy is discussed.

P-018 ABDOMINAL WALL REPAIR IN JEHOVA´S WITNESSES. PRE, INTRA AND POSTOPERATIVE MANAGEMENT

Abstract Aim Abdominal Wall Repair (AWR) is a surgical procedure with a risk of bleeding during and after its performance. Patients who reject blood transfusion require strategies to avoid bleeding or to increase the margin of indication for transfusion. Materials and methods We analyzed the Jehovah's Witnesses patients who underwent AWR in our hospital and the perioperative management aiming to prevent fatal anemia and allow the performance of the surgery in this group of patients. Results We present three Jehovah's Witnesses patients undergoing AWR for multirecurrent midline incisional hernias. All of them attended hematology consultation prior to surgery to improve their situation at the time of surgery. During surgery, hemostatic material was used in areas at risk of subsequent bleeding. All received iron after surgery and, prior to hospital discharge, a dose of erythropoietin if needed. Patient characteristics are presented in the table. No bleeding requiring blood transfusion or other complications occurred. Follow-up in outpatient clinics showed a correct evolution. Conclusions Multidisciplinary care and particular attention to avoid bleeding and improve the condition of patients with refusal of blood transfusion makes complex abdominal wall surgery feasible and safer.

Bloodless surgery in urologic oncology: A review of hematologic, anesthetic, and surgical considerations.

The urologic oncology patient who refuses blood transfusion can present unique challenges in perioperative blood management. Since blood loss and associated transfusion can be expected in many complex urologic oncology surgeries, a multidisciplinary approach may be required for optimal outcomes. Through collaboration with the hematologist, anesthesiologist, and urologist, various techniques can be employed in the perioperative phases to minimize blood loss and the need for transfusion. We review the risks and benefits of these techniques and offer recommendations specific to the urologic oncology patient.

Comparison of three antepartum risk assessment tools to predict significant postpartum hemorrhage in livebirths.

To adequately predict significant postpartum hemorrhage (PPH) at hospital admission, we evaluated and compared the accuracy of three risk assessment tools: 1. California Maternal Quality Care Collaborative (CMQCC), 2. American College of Obstetrics and Gynecology Safe Motherhood Initiative (ACOG SMI) and 3. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). This is a retrospective cohort study of people who delivered liveborn infants from January 2018 to June 2021 at our center. Patients with comorbidities necessitating higher hemoglobin values, those who refused blood transfusions, and missing pertinent data were excluded. Significant PPH was defined as a blood transfusion within 48 hours following delivery. Diagnostic statistics were calculated for each tool. Of the 11,679 included pregnancies, 232 (1.9%) people had significant PPH. Amongst those diagnosed as high-risk by the CMQCC tool, 67/1485 (4.5%) had significant PPH; 62/1672 (3.7%) by the ACOG SMI tool, and 85/1864 (4.6%) by the AWHONN tool had significant PPH. All tools have low sensitivity and high negative predictive values. The area under the receiver operating characteristics curve of the three tools is moderately poor (CMQCC: 0.58, ACOG SMI: 0.55, AWHONN:0.61). Upon admission to labor and delivery, all three studied tools are poor predictors of significant PPH. The development and validation of better PPH risk stratification tools are required with the inclusion of additional important variables.

DEVER ÉTICO E LEGAL DO MÉDICO FRENTE AO PACIENTE TESTEMUNHA DE JEOVÁ

Jehovah’s Witness patients, because of their religious beliefs, refuse blood transfusions. Thereby, these patients’ treatment is a medical challenge due to the ethical-legal dilemma. This article aims to explore the conflict between the physician’s duty and respect for the patient’s autonomy, relating to the ethical and legal aspect. Methodology: an integrative review was made on the PubMed, Scielo, Capes Periódicos and Lilacs databases. Furthermore, the Federal Constitution, the Penal Code and the resolutions of the Federal Council of Medicine (CFM) on the subject were analyzed. Review: Article 5, item VI, of the Constitution of the Federative Republic of Brazil guarantees Brazilians and foreigners residing in the country freedom of conscience and belief, while CFM Resolution N. 1,021 / 80 imposes that the doctor must transfuse blood into the adult Witness of Jehovah patient in cases of risk of death, even without consent. This resolution is in accordance with article 135 of the Penal Code, which states: “medical or surgical intervention, without the consent of the patient or his legal representative, if justified by an imminent danger of death”. Conclusion: the limit between the patient’s autonomy and the physician’s duty is the threat of death, therefore, the doctor has the obligation to transfuse blood in these cases, without the need for consent, whether from the patient or its guardian.

Jehovah’s Witnesses and the Normative Function of Indirect Consent

In this case study, I consider Mr. A, a Jehovah’s Witness with chronic vertebral osteomyelitis in need of surgical debridement. Prior to proceeding to the OR, he was unwilling either to explicitly consent to or refuse blood transfusion, while indicating he was open to transfusion intraoperatively, if the team judged it necessary. Ethics was consulted to determine if it would be morally justifiable for the team to proceed with blood transfusion during the course of surgery without Mr. A’s documented consent to being transfused. I argue that in this case, what might be termed indirect consent—namely, delegating decision-making regarding some possible course of action without explicitly consenting to the course of action itself—may be sufficient for discharging the clinician’s ethical obligation to obtain consent. Identifying information has been changed or omitted to protect patient confidentiality.