Presentation: Blood Transfusion and Patient Essay

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The aim of this essay is to analyse the legal and ethical dilemmas doctors and other healthcare workers may encounter in the working theatre environment. The essay will explore the concept of ‘Autonomy’ and ‘Paternalism’ and how these apply to health care in a given case scenario. Standards set out by the Health Professionals Council for Operating Department Practitioners will be discussed with regards to the patient scenario

The case scenario for this essay is a forty seven year old lady who will be known as Mrs Jones she has been involved in an accident. She is transferred to hospital by a paramedic ambulance due to severe injuries sustained. Mrs Jones demonstrates signs of shock, including significantly low blood pressure. She has received treatment for this however a blood transfusion is needed to prevent death. The doctors treating her explain the seriousness of her injuries and the need for surgery. Mrs Jones is conscious in spite of her injuries and comprehends the seriousness of her condition. However, she refuses the blood transfusion due to her religious objections since she is a Jehovah’s Witness. The doctor now has the ethical dilemma whether to treat her and give her the blood transfusion against her will or to honour her religious beliefs and allow her to die.

Jehovah’s Witnesses with a signed blood refusal cards, which is a form of advance directive, create medical, ethical and legal dilemmas for all healthcare professionals (Woolley, 2005). Mrs Jones had refused to consent to treatment on her religious beliefs ‘no blood’ and appears to be deemed capable of understanding the proposed treatment on offer. A Jehovah’s Witness usually carry an advanced directive; an advanced directive may allow an individual to specify in advance that under certain circumstances can withdraw consent for life supporting interventions (Watchtower, 1990). It is important to realise that individual Jehovah’s Witnesses may have different views about blood transfusions and the doctor’s obligation is to respect the wishes of the individual’s beliefs. (AAGBI, 2005). To administer blood to a patient who has refused to accept it by an advance directive or through expressing their refusal through a consent form is ethically unacceptable. The HPC (2008) expect that all Operating Department Practitioners should understand the importance of and be able to obtain informed consent. Relying, on such cards to refuse a blood transfusion is controversial for reasons to do with ‘informed consent’. Firstly, it is not always clear that Jehovah’s Witnesses who have signed cards were provided with adequate information about their options, including risks, benefits and alternative therapies. Also Jehovah’s Witnesses usually sign the cards during a religious meeting under the guidance of a group leader (Watchtower, 1990). Therefore an individual could have been subjected to pressure that would violate their autonomy. Beauchamp and Childress (2001) recommend that to protect personal autonomy an individual must be free from both controlling interference by others. Where a competent adult refuses a blood transfusion on religious grounds, the courts cannot be dictated by its view of what would be in the best interests of the patient but must look to the validity of the refusal in terms of the capacity of the patient. (Kee, 1995). Few doctors would argue that they should override the adequately autonomous decisions of Jehovah’s Witnesses to refuse blood transfusions even if they are likely to die as a result of such transfusions (Maylon, 1998).

Autonomy is described as the capacity to think, decide and act on the basis of such thought and decision freely and independently it also takes into account, the individual’s moral values and beliefs (Kennedy, 2004). Jehovah’s Witnesses are usually well informed regarding the right to treatment. The doctor should discuss with Mrs Jones the medical consequences of non-transfusions and provide an evaluative
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