Blood Refusal: Patient Refusal of Blood Products

Abstract

The paper is going to cover various issues that relate with blood transfusion and blood products. In this the paper will concentrate on why people resist transfusion or some of the products due to various beliefs that include opinion and religion. The paper is going to mainly concentrate on this kind of group, the Jehovah Witnesses. In this the paper will look at the products that they are allowed to be transfused according to the doctrines and those prohibited. Hence the paper will look at the best option in dealing with them in a medical situation and options available in handling their children if they are in danger. Why do patients have refusal towards blood transfusion and its products?

Introduction

There are instances that arise when an adult refuses to receive a blood transfusion that is based on beliefs that may be inclined to religion, personal beliefs and other issues. This can be life threatening depending on the situation of the personal. This is even grace in situations that involve injuries that result in excessive bleeding, cases of antepartum in low risk and high risk obstetric patients. The situation may also be aggravated in the case of gynaecological surgery if the patient refuses the action of blood transfusion as the situation may result in a loss of lots of blood. In religion some of the groups that have this kind of inclination include the followers of the Jehovah Witness group. Such groups tend to refuse such actions or any components of blood that may be derived from the transfused blood (Williams & Wilkins, 2005).

The refusal to use some of these products may not be advised due to their importance in treatment of some of the conditions that arise like acute loss of blood, acute anaemia and even in chronic situations. Besides this, the products cannot be replaced as there are no alternatives available. This is attributed to the functions of the components of blood that include carrying and provision of oxygen besides the ability to clot. Hence despite the quest to provide some alternatives their efficiency and use is limited depending on condition (Community Hospital, 2010).

Risks Involved in Blood Transfusion

If a person does refuse blood transfusion or any its products sometimes this may be substantiated as there are actual risks that are involved with the process. Some of the risks involved include the blood can lead to allergic reactions that will result in damage to the patients’ blood cells. In addition some infections like hepatitis and HIV virus can be acquired through this process of the blood or its products was not properly analysed.

Effects of Refusing Blood Transfusion or its products

According to Muramoto (1998), if a patient needs blood or a blood product and refuses to be administered one it may lead to organ damage that may be a result of lack of adequate oxygen. This can lead to conditions like heart attacks, strokes or in worse case scenario uncontrolled bleeding resulting in death if the appropriate measures are not taken.

Considering all the factors that are involved in the transfusion process, the physician attending the patient should be in a position to explain to the client why the process has to be undertaken and include the risks that are involved. However the physician should why the patient needs to have the transfusion and the risks involved in not undertaking the exercise to put the patient in a position to make a well-informed decision.  Furthermore to reduce the liability factor that may arise in such situations the patient should be presented a consent form to sign that includes all the stated factors that are relevant (Community Hospital, 2010).

Case of Jehovah Witness

According to Muramoto (1998), Jehovah Witness is one of the groups that refuse the transfusion of blood. Their main reason for this is based on the religious inclination and belief. Hence in the case of such incidents the refusal has to be officially being documented in the file of the patient. Included in the medical file is the alternative means of treatment that is acceptable to the patient should conditions that need the transfusion of blood arise. The best approach when dealing with such clients is the use of the specific refusal from that will be filled and filed. In the case of Jehovah Witnesses, there are products that are acceptable to them and there are those that they refuse.

Dilemmas Doctors Encounter

Most of the believers of Jehovah Witnesses may tend to refuse some life-saving interventions that may be needed resulting in doctors being in a dilemma on the best way to go about. The doctors may presume this opinion and decision to be misguided, misinformed and coerced due to the obligation to follow the teachings of the religious group. Due to this, the doctor is left in a dilemma of either trying to educate people who practice this faith or try to dissuade them.  Due to the inability to judge the validity of the teaching on the religious aspect, the doctors should try to concentrate viewing the whole issue on a rational and moral basis depending on the long-term effect of the patient (Muramoto, 1998).

The best approach in such situations is the treating physicians who are handling the patients to consult the church in companion of the hospital liaison committee on the blood doctrine and the way forward. The consultation is recommended to be established on guidelines that are used in the transfusion of blood. By doing this it will help reduce the biased opinion that may be forwarded towards the religious belief hence this may work in improving the patient’s health and life. However sometimes the patients may be coerced by the members of the church to conform to church policy, effectively this will result in reversal of the decision that had been made earlier. This results in criticism of whether the decision made was entirely autonomous (Williams & Wilkins, 2010).

Treatment of Jehovah Witness

According to Muramoto (1998), most cases the action to be especially in Jehovah Witnesses may vary depending on the whether the patient is an adult or a child and furthermore if they are willing to consider the action of transfusion. The physician in such cases must look at the non-blood alternatives and treat them without the use of alogeneic blood. The acceptable alternatives in the treatment may also involve non-blood volume expanders. The physician may also take the action of consultation with haematologists and transfusion experts in trying to discuss the best possible alternative to allogenic blood. In the process included is a pre-operative stage that involves assessment for the elective surgery. In the case of obstetric women who may in the ward and refusing a transfusion a different approach will be applied that follows a fore stated care plan. However, this has to be in line with the wishes of the patient as stated in the hospital liaison committee. In the case of an emergency that is life threatening the medical staff has to honour the plan

According to Barking Havering & Redbridge University Hospitals (2010), in the case of children the position that us taken may be slightly different; the case of a child who is assumed to have attained the age to fully understand the implications involved in the process will be treated as an adult. However if the child has not attained such a level of understanding the medical staff needs to give some emergency aid then the following needs to be addressed:-

  • Are the risks involved in suing blood been considered?
  • Have all other options that may be of non-medical nature been considered?
  • Did the Hospital Liaison Committee been considered and asked for guidance?

Besides this, assistance on legal regulations has been set up for Acts of Children. In such a precedent the parents should be notified and invited to any case that may be related to the issue. The legal action that will be sought must relate to the immediate medical attention that was required. However in the exceptional circumstances where the delay is believed that it may result in death a decision will have to make that will decide on the action to be followed that will be against the wishes of the parents. In such cases the decision will have to be made by at least two doctors who are of consultancy status (Djupe & Olson, 2003).

According to the PMH Transfusion Committee (2007), some of the accepted products include Dextrose, Gelofusine, Haemaccel, Dextran, Normal Saline and Recombinant Erythropoietin among others. On the other hand there are products the religion prohibits as a whole on a belief status. These include blood, red blood cells, platelets, Fresh frozen plasma and white blood cells. However some of the products of blood transfusion may be accepted on an individual basis unlike the above that are listed by the group as a whole. These entail immunoglobins, Clotting Factors, Cryoprecipitate, Haemodilution, Intraoperative Cell Salvage and Post-Operative Reinfusion. Despite the grouping when a physician is dealing a patient, they should treat him or her on an individual basis on a grouping note. This is because each individual will have his or her preferences on the blood products to be used or not used. After the discussion process with the physician is completed the conclusion has to be put down in the file containing the patient medical records.

In recent times due to the belief by the Jehovah Witness of receiving the modern medical care and full use of the modern technology some of the members have opted to receive the appropriate medical but in silence. In doing this they avoid the religious punishment they would otherwise have received for breaching the policies of the church. This will come into play as there is the doctor patient confidentiality that has to be maintained hence the physician may not divulge any details on the medical process that the patient undertook while under treatment. In this however some of the closest practices that can be related to blood transfusion are that of intra-operative transfusion in which the circuit will be linked to the patient’s circulatory system but without any storage mechanism. Hence many of the Jehovah Witnesses may accept processes like intra-operative haemodilution when the equipment is arranged so as to keep the blood in a constant link to the patient’s circulatory system. Most of the options that may seem acceptable will have to be discussed first with the Transfusion Practitioners (Walsh & Crumbie, 2007).

Conclusion

The issue of whether to accept blood transfusion or not may vary depending on the beliefs of a person on an individual basis or religion. In the case of an individual this may be related to some of the risks that are involved in the transfusion and its products like the resultant infections that include HIV and hepatitis. This can present a dilemma to the physicians as they may have of look for alternative means of treatment. This is because the wishes have to be respected by the physician. However in the situation of life threatening conditions and it involves a child legal mandate for child protection may be used to ensure they get the proper treatment. Jehovah Witness are the group that mostly has this problem hence mainly covered as they accept some blood transfusion  products and reject others especially those associated with blood directly.