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A medico-legal approach to developing a structured decision-making process for patients refusing blood transfusions
Lucia Tattoli1, Davide Santovito2
1Section of Legal Medicine, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
Frontiers in Public Health
|October 29, 2025
Summary
Respecting patient autonomy in refusing blood transfusions requires clear communication and informed consent. A structured process enhances safety and mitigates medico-legal risks for healthcare providers.
Area of Science:
- Medical Ethics
- Healthcare Law
- Patient Safety
Background:
- Patient autonomy is paramount in healthcare decisions, including treatment refusal.
- Refusing life-saving treatments like blood transfusions presents ethical and legal challenges.
- Balancing patient autonomy with the physician's duty of care is crucial.
Purpose of the Study:
- To explore communication and information processes for adult patients refusing blood transfusions.
- To analyze legal frameworks, clinical practices, and medico-legal risk management in such cases.
- To evaluate a structured protocol for medico-legal consultations regarding transfusion refusal.
Main Methods:
- Retrospective analysis of 16 medico-legal consultations from 2017-2021.
- Utilized PROSA risk assessment software for analyzing consultation phases.
- Conducted a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of the consultation protocol.
Main Results:
- High-risk sub-phases identified: medical record analysis, care pathway selection, alternative therapy, and communication about transfusion/Patient Blood Management.
- SWOT analysis revealed the informed consent process had 74% advantages versus 26% disadvantages.
- The structured consultation protocol showed potential efficacy in clinical applications.
Conclusions:
- Healthcare professionals need predictable, transparent, and traceable guidelines for managing patients refusing blood transfusions.
- A structured communication process within informed consent provides a replicable framework for high-stakes decisions.
- This approach supports safety, transparency, and continuous improvement while mitigating medico-legal risks.
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