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© Borgis - Postępy Nauk Medycznych 2/2020, s. 44-47 | DOI: 10.25121/PNM.2019.33.2.44
*Malgorzata Cyrych
Jehovah’s Witnesses, blood transfusions and judicial decision
Świadkowie Jehowy, przetaczanie krwi a orzecznictwo sądowe
Varna Free University, Varna, Bulgary
Streszczenie
Każdy pacjent ma prawo i możliwość decydowania o sobie, w tym o przyjęciu leczenia, nawet jeśli odmowa może grozić trwałym uszczerbkiem na zdrowiu lub doprowadzić do przedwczesnej śmierci. Niezależnie od tego, czy odmowa była racjonalna czy irracjonalna, jej przyczyna nieznana lub nieistniejąca, jeżeli zdolność pacjenta do podejmowania decyzji została zaburzona przez niewłaściwy wpływ osób trzecich, obowiązkiem lekarzy jest leczenie pacjenta w sposób, który uznają za najbardziej optymalny w aspekcie postępowania terapeutycznego. Niebezpieczna praktyka odmowy terapii z różnych powodów religijnych dotyczy prawie wszystkich sekt religijnych oraz w niewielkim stopniu innych grup wyznaniowych. Świadkowie Jehowy uważają, że przyjęcie obcej krwi zamyka drogę do zbawienia. Wyrażają jedynie zgodę na udzielenie świadczenia medycznego przy użyciu środków niekrwiopochodnych. Leczenie takiego pacjenta bywa więc niezwykle trudne dla lekarzy. W związku z powyższym pojawia się pytanie, czy prawa matki odmawiającej leczenia mogą przeważać nad prawami jej nienarodzonego dziecka, podczas gdy potencjalne ograniczenie bezwzględnego prawa kompetentnej osoby dorosłej do przyjęcia leczenia zostało uznane przez sądy amerykańskie czy też angielskie.
Summary
Every patient has the right and capacity to decide on accepting medical treatment, even if a refusal might risk permanent injury to his/her health or even lead to premature death, and regardless of whether the reasons for the refusal were rational or irrational, unknown or even non-existent, if a patient’s capacity to make a decision had been overborne by the undue influence of others, it is the duty of the doctors to treat her/him in whatever way they considered, in the exercise of their clinical judgement, to be in his best interests. The dangerous practice of denial of therapy for various religious reasons affects almost all religious sects and, to a small extent, other religious groups. Jehovah’s Witnesses believe that accepting foreign blood blocks the way to salvation. They only agree to provide a medical service with the use of non-blood products. Therefore, treatment of such a patient can be extremely difficult for doctors. In other words, the arise is whether the rights of a mother refusing to have treatment can prevail against those of her unborn child, whereas potential limit to the absolute right of a competent adult to accept or reject treatment was recognized by English and American courts.
This short paper argues that even though that every patient has the right and capacity to decide on accepting medical treatment, even if a refusal might risk permanent injury to his/her health or even lead to premature death, and regardless of whether the reasons for the refusal were rational or irrational, unknown or even non-existent, if a patient’s capacity to make a decision had been overborne by the undue influence of others, it is the duty of the doctors to treat her/him in whatever way they considered, in the exercise of their clinical judgement, to be in his best interests. In other words, the arise is whether the rights of a mother refusing to have treatment can prevail against those of her unborn child, whereas potential limit to the absolute right of a competent adult to accept or reject treatment was recognized by English and American courts.
Furthermore if, in a potentially life-threatening situation or one in which irreparable damage to the patient’s health can be anticipated, doctors or hospital authorities are faced with a refusal of an adult patient to accept essential treatment and they have real doubts as to the validity of that refusal, they should both in the public and the patient’s interest at once seek a declaration from the courts as to the lawfulness of the proposed treatment and it should not be left to the patient’s family to take action (1, 2). As for example, the case in France of a young Jehovah’s Witness who suffered a serious post-partum hemorrhage received wide attention: the woman was given a transfusion of four units of blood against her will. In giving judgement, the Administrative Court of Lille noted that the Public Health Code states that no medical intervention can be performed without the consent of the patient, but also recognized that it was the physicians’ duty not to respect the patient’s will when her life was in imminent danger (3). In order that a physician should not be indictable for the death of the patient he cannot merely desist from administering a therapeutic procedure. The patient’s wish (autonomy) not to receive treatment with a transfusion should lead to his/her leaving the healthcare facility either on his/her own initiative or on that of his/her relatives, as logically, so long as he/she remains there, the physician has a duty to save his/her life. In many instances’ parents had refused to permit a blood transfusion to be administered to their infant child due to their religious beliefs and concern about contamination. It is postulate that that in an emergency situation where a parent of young children is refusing medical treatment, a court can legitimately consider the best interests of the children as a factor in its decision as to whether life-saving medical treatment should be administered to a patient without his or her consent (4).
We can analyze the situation where the woman who upon admission, signed a standard consent form agreeing to the infusion of blood if it were to become necessary but later might chose not to receive a blood transfusion for religious reasons. To be clear, patient directs that no blood transfusions or blood products should be administered to her person under any (including life-threatening) circumstances (5). She gives no one, including her health-care agent, the authority to disregard such direction. saving patient’s life by way of the administration of a blood transfusion would immeasurably benefit the child and the family. Blood transfusions, including transfusions of whole blood, red cells, white cells, platelets, or plasma, should be given to the patient under any circumstances, even in the event of refusal based their refusal on their religious beliefs as Jehovah’s Witnesses the teachings of which sect, according to their interpretation, prohibited the injection of blood into the body (6).
The question therefore arises whether could she be compelled to receive medical treatment because her death would cause the abandonment of her child? In hypothetical situation physicians determines that the patient is ready to deliver her child and that a Caesarean section delivery would be appropriate (7). Further amuse, that she consented to the Caesarean section, but not withstanding the routine consent form she had signed, she withheld consent to the transfusion of blood on the basis of her values and religious convictions as a Jehovah’s Witness (8, 9).

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Piśmiennictwo
1. Hoffman A: Jehovah’s Witness parents’ refusal of blood transfusions: Ethical considerations for psychologists. J Health Psychol 2016; 21(8): 1556-1565.
2. Sagy I, Jotkowitz A, Barski L: Reflections on Cultural Preferences and Internal Medicine: The Case of Jehovah’s Witnesses and the Changing Thresholds for Blood Transfusions. J Relig Health 2017; 56(2): 732-738.
3. Tribunal Administratif de Lille. Ordonnance n. 03-3138 du 25 ao?t 2002.
4. Ringnes HK, Hegstad H: Refusal of Medical Blood Transfusions Among Jehovah’s Witnesses: Emotion Regulation of the Dissonance of Saving and Sacrificing Life. J Relig Health 2016; 55(5): 1672-1687.
5. Bock GL: Jehovah’s Witnesses and autonomy: honouring the refusal of blood transfusions. J Med Ethics 2012; 38(11): 652-656.
6. Sarteschi LM: Jehovah’s witnesses, blood transfusions and transplantations. Transplant Proc 2004; 36(3): 499-501.
7. Groudine SB: The child Jehovah’s Witness patient: a legal and ethical dilemma. Surgery 1997; 121(3): 357-358.
8. Figueroa GR: The jurisprudence about blood transfusion and informed consent of Jehovah witnesses. Rev Med Chil 2018; 146(7): 914-917.
9. Conti A, Capasso E, Casella C et al.: Blood Transfusion in Children: The Refusal of Jehovah’s Witness Parents’. Open Med (Wars) 2018; 13: 101-104.
10. Elder L: Why some Jehovah’s Witnesses accept blood and conscientiously reject official Watchtower Society blood policy. J Med Ethics 2000; 26(5): 375-380.
11. Klein AA, Bailey CR, Charlton A et al.: Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah’s Witnesses and patients who refuse blood. Anaesthesia 2019; 74(1): 74-82.
12. Linacre Q: Professional Autonomy in Medicine: Defending the Right of Conscience in Health Care beyond the Right to Religious Freedom. Linacre Q 2012; 79(2): 155-168.
13. Marsh JC, Bevan DH: Haematological care of the Jehovah’s Witness patient. Br J Haematol 2002; 119(1): 25-37.
14. Great Britain. England. High Court of Justice, Family Division. Re S (A Minor) (Medical Treatment). Family Law 1992 [1993 Apr] 23: 215-216.
15. Michalowski S: Court-authorised caesarean sections – the end of a trend? Mod Law Rev 1999; 62(1): 115-127.
16. Grubb A: Medical treatment (child): parental refusal and role of the court – Re T (A Minor) (Wardship: Medical Treatment). Med Law Rev 1996; 4(3): 315-319.
17. Massachusetts Supreme Judicial Court judgment in the case of Northwood Hospital v Munoz 409 Maxx. 116 (1991); 564 NE 2d 1017 Norwood Hospital v. Munoz, 564 N.E.2d 1017 (Mass. 1991) 564 N.E.2d 1017, 409 Mass. 116.
18. Dyer C: Court says doctors were right to treat Jehovah’s Witness. BMJ 1992; 305(6848): 272.
19. Tribunale di Milano, V sezione civile. Sentenza n. 14883 del 16 dicembre 2008.
20. Petrini C: Ethical and legal aspects of refusal of blood transfusions by Jehovah’s Witnesses, with particular reference to Italy. Blood Transfusion 2014; 12 (suppl. 1): 395-s401.
otrzymano: 2020-04-16
zaakceptowano do druku: 2020-05-07

Adres do korespondencji:
*Malgorzata Cyrych
Varna Free University, Varna, Bulgary
src.emergency@gmail.com

Postępy Nauk Medycznych 2/2020
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