BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?/by J. Lowell Dixon, M.D.

PHYSICIANS are committed to applying their knowledge, skills, and experience in fighting disease and death. Yet, what if a patients  refuses a  recommended treatment?  This will likely occur if the patient is a Jehovah's Witness and the treatment is blood, packed red blood cells, plasma, or platelets.

When it comes to the use of blood, a physician may feel that a patient's choice of non-blood treatment will tie the hands of dedicated  medical personnel. Still, one must  not forget that patients other than Jehovah's Witnesses often choose not to follow their doctor's  recommendations. According to Appelbaum and Roth, 19% of patients at teaching hospitals refused at lease one treatment or procedure, even though 15% of such refusals "were potentially life endangering." 

The general view that "the doctor knows best" causes most patients to defer to their doctor's skill and knowledge. But how subtly dangerous it would be for a physician to proceed as if this phrase were a scientific fact and to treat patients accordingly. True, our medical training, licensing, and experience give us noteworthy privileges in the medical arena. Our patients, though have rights. And, as we are likely aware, the law (even the Constitution) gives greater weight to rights.  

On the walls of most hospitals, one sees displayed the "Patients Bill of Rights."  One of these rights if informed consent, which might more accurately be called informed choice. After the patient is informed of the potential  result of various treatments (or of non-treatment), it is  his choice what will submit to.  At Albert Einstein Hospital in the Bronx, New York, a draft policy on blood transfusion and Jehovah's Witnesses stated:  "Any adult patient who is not incapacitated has the right to refuse treatment no matter how detrimental such a refusal may be to his health."  

Next time: BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE? 

From the Watchtower magazine