[Death after refusing treatment--causality assessment using the example of a Jehovah's Witness]

A 39-year-old man and Jehova's Witness suffered a complex pelvic fracture in an accident at work. He died 17 days later from fulminant pulmonary embolism. For religious reasons he had refused blood transfusions which would have been necessary for an early surgical stabilization of the pelvic fracture. Alternatively, the clinicians initiated a therapy with recombinant human erythropoetin (EPO) to increase haemoglobin and postponed the surgical stabilization of the pelvic fracture to a later date. Shortly before the planned operation, the patient suddenly died. The forensic autopsy confirmed the suspected diagnosis of pulmonary embolism as the cause of death; the manner of death was classified as an accident. Because of the preceding refusal of treatment the causality between the refused blood transfusion with the subsequent alternative therapy and the patient's death had to be assessed.