Written advance directives refusing blood transfusion: ethical and legal considerations

A patient's automony and right to determine his or her treatment is widely recognized in current ethical theory and medical practice. However, conflicts between the desire to respect a competent patient's religious conviction not to be violated and society's interest in preserving life do arise. This paper examines two cases involving Jehovah's Witnesses who signed cards refusing blood transfusions and who were subsequently transfused. In the Canadian case, the physician was found liable for battery. In the American case, the courts upheld the appointment of a guardian who authorized the transfusion. In the emergency situation, if there is a reasonable doubt about the validity of a treatment refusal, the presumption must be to render life-saving treatment. The author believes, however, that a written advance directive could be developed that respects he religious convictions of Jehovah's Witnesses and the ethical and legal responsibilities of physicians.