Overriding the Jehovah's Witness Patient's Refusal of Blood: A Reply to Cahana, Weibel, and Hurst

Abstract

This article is a response to a survey on moral reasoning among Swiss health professionals that appeared in a recent issue of this journal. The authors of that survey inquired whether or not their respondents would give a blood transfusion to a Jehovah's Witness patient who clearly refused it. A substantial number of the respondents answered that they would override the patient's refusal and give the transfusion. The present article examines the two ethical rationales that were offered to explain the overriding respondents' answers and argues that neither one is ethically acceptable. It concludes with an account of the phenomenon of "motivated reasoning" that, so it is argued, better explains why the overriders would refuse to honor the Jehovah's Witness patient's transfusion refusal.

Transfusão de sangue e hemocomponentes para as Testemunhas de Jeová: revisão de escopo

“…Outra intervenção muito citada pelos autores é o uso de expansores de volume sem sangue (cristaloides e coloides), porém também podem ser empregadas tecnologias mais avançadas, como bypass cardiopulmonar, oxigenação por membrana extracorpórea (ECMO), hipotensão controlada, entre outros. Vale destacar a importância de a equipe multidisciplinar atuar de forma conjunta, prestando um cuidado humanizado e integral, além de oportunizar a troca de saberes interprofissionais, a fim de melhorar os resultados da assistência 15,16,19,21,22,24,26,30,31,33,35 . Evidenciou-se, nos achados, que todos os autores estudados concordam entre si que, de fato, existe um dilema ético quando o paciente seguidor da comunidade Testemunha de Jeová não aceita ser transfundido.…”

Refusal of treatment and decision-making capacity

“…Conversely, it could be argued that the resulting consequences of her refusal were so harmful that it would have been morally right to override her decision, as implied by some of the media coverage of the events surrounding her death. 1 However, Banja 20 argues that it is not ethically acceptable for health professionals to override a competent patient’s refusal based on their own personal values and beliefs. Moreover, Beauchamp and Childress 9 state that acknowledging the right of patients to act based on their personal values and beliefs is part of respecting autonomy.…”

Respecting the Will of the Patient: Between Illusions and Realities: Table 1

“…That means taking into account the patient's existential needs that therefore prevent him from "obeying" the patient's choice, and all the more so as it is the anesthesiologists, from among all the medical team members, who have to render an account to the institution regarding the negative consequences, which could be brought about by the patient's choice. 3…”

“…We would like to offer the reader a reality check, especially in the light of a critical commentary written by an American ethicist in answer to that study, and published in the same journal [3] (II).…”