Patient autonomy is held to be sacrosanct. A doctor reconsiders this view.

The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be sacrosanct. My recent experiences, however, have led me to reconsider this view. A 21-year-old male of African-American descent, a Jehovah’s Witness, with a history of sickle cell anemia presents with diffuse pain and weakness. His admission hemoglobin is 6. His admitting diagnosis is sickle cell crisis. He is treated with fluids, IV opiates, and empiric antibiotics. His blood counts continue to fall. He is asked if he would accept transfusion. He seems uncertain, until his mother indicates the entire family are Jehovah’s witnesses and under no circumstances would any of the family accept blood. The patient quietly refuses transfusion. Church officials start to spend a considerable amount of time in the room and waiting area. They approach multiple health professionals and attempt to hand them literature with recommendations for care of patients without transfusion. The president of the hospital is called when the recommendations are not hewed to. His hemoglobin continues to fall and reaches a nadir of 4. He becomes more tachycardic and tach...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Hematology Intensive care Source Type: blogs