[Patients refusal to be treated, the problem of Jehovah's witnesses]

The principle of respecting the patient's wishes is an international medical principle, found in several texts. In France, it was recalled in the 1994 Civil Code concerning bioethical laws and has recently been included in the Public health Code (law concerning patient's rights dated March 4, 2002). According to these various texts, the patient's wishes must always be respected, even in life threatening cases, so long as the patient has been informed of the risk. The refusal by Jehovah's witnesses to receive blood transfusion is always a problem. When, in full consciousness, a patient refuses a blood transfusion that his life depends on, what should the physician do? In June 1998, the Paris Court of Appeal ruled on this case. The judges found that "the obligation of the physician to always respect the wishes of the patient.is limited by the other obligation of the physician (the basis of a physician's activity) which is to protect the health and life of that same patient". In October 2001, the State Council ruling on this particular case found that, given the critical conditions of this case and the absence of a therapeutic alternative, the physicians had not committed an error. But it was also clearly underlined that a physician must respect the wishes of the patient and that this obligation must not be superseded by the duty of saving a life, thus disputing the judges of the Court of Appeal. Two questions. Two emergency interim rulings confirmed the position of the judges: the non-respect of the patient's wishes is an infringement of individual freedom. It is only in extreme and clearly defined circumstances that the physician will not be punished for this offence. This raises two questions: can a physician treat a patient against his/her wishes? And what risks does the physician take when respecting the patient's wishes when his/her life is at stake?