One of the cardinal principles that govern the relationship between the doctor and the patient is that of consent and informed decision-making. This principle is based on the foundation that every human being of adult age and sound mind has a right to determine what shall be done with their own body. This is autonomy, self-rule and it means no health worker can interfere with another person without valid consent.
Autonomous actions, understood literally, are self-regulated actions. And consent must be voluntary. A consent forced by threats, fraud or misrepresentation is no consent at all. Such consent does not respect the person’s dignity and may not reflect the person’s wishes. The question that may arise is whether a choice is forced or voluntary if in a particular case, there is only one treatment option.
Nothing perhaps influences many people’s lives and everyday decisions more than their religious beliefs, medical decisions notwithstanding.
To Jehovah’s Witnesses, blood transfusion is a religious issue rather than a medical one. To them, the Bible clearly commands them to abstain from blood transfusions. The basis of this belief is in the book of Genesis 9:5: “You must not eat flesh with life, that is to say blood in it” and Leviticus 17:10: “If any member…consumes blood of any kind, I shall set my face against that individual.” The Jehovah’s Witness church’s absolute ban on blood transfusions was at the centre of one medico-legal case.
When a young Jehovah’s Witness couple had their first baby, they encountered a mega temptation. After delivery, the mother continued to bleed profusely. The woman had issued an advance medical directive before entering hospital, refusing blood transfusion and did so in writing. Her views were clear and widely known. The doctors, however, gave the couple the better of two evils to choose from; removal of the uterus to stop the bleeding or a blood transfusion. The couple agreed that if the removal of the uterus could save the mother’s life, so be it but under no circumstances did the wife agree to a blood transfusion. The operation was performed but the mother continued to bleed. She was transferred to the intensive care unit, where she kept drifting in and out of consciousness. Her husband was at her bedside and kept telling her that she was in a bad state and that the doctors had to give her a blood transfusion or she would die. She consistently replied with gestures indicating she did not want to receive a blood transfusion.
The doctors requested for legal advice. The legal advice was “continue with supportive measures but under no means should you give a blood transfusion unless at the direction of court.” The husband became desperate. He sought the services of another lawyer, who had an urgent hearing fixed at the Supreme Court. At the hearing, the woman’s religious objections to blood were not apparently discussed. The court was told of her medical state: unconscious, on ventilation and not far away from irreversible brain damage. The husband in court was in an extremely distressed state, weeping and tired. The tribunal declared the husband his wife’s legal guardian and he signed an order that his wife be given blood, which was sent to the hospital.
The woman was given blood, quickly recovered and was discharged a week later. The husband was later to say that although he felt guilty about the transfusion, he could not bring up the child on his own. However, the woman, very furious, took action against the Supreme Court, attacking the legality of the tribunal’s decision and that of the blood transfusion. She also considered suing the hospital, doctors, nurses and lawyers involved in giving her blood.
In one of the court documents, she stated: “I view the blood transfusion that was forced on me …as equivalent of rape. To me, it feels as if someone forced an abortion on me while under sedation. I am angry about what has happened and I have cried about it a number of times.”
She said the blood was someone else’s bodily fluid and she had a terrible fear she had contracted an infectious disease. She said she would have screamed and fought against the sedation had she not been sedated.
This is the catch-22 situation; doctors are familiar with the Jehovah’s Witnesses’ blood stance and at that time, the lady said no but her husband said yes. Should she have been given the transfusion?