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Jehovah's Witnesses

Blood Transfusions

What obligations and liabilities of a
are the legal a member of the Christian Science church, refused to com¬
physician when a patient, in anticipation of medi- ply. The court quoted the material portion of the First
cal or treatment, demands that he not be given a
surgical Amendment to the Constitution of the United States, "Con¬
blood transfusion ? In an elective procedure, where no gress shall make no law respecting the establishment of a
emergency exists and the patient is an adult in possession religion or prohibiting the free exercise thereof." It then
of his faculties, the patient would have a lawful right to pointed out that religious freedom embraces two concepts,
impose this condition. The physician in turn, in these cir- freedom to believe and freedom to act. The first, according
cumstances, could elect to accept or refuse the patient for to the court, is absolute, but not the second. Conduct re¬
care and treatment. Should the condition be imposed after mains subject to regulation for society's protection. This
the physician-patient relationship is established, the physi- freedom, said the court, can be restricted to prevent grave
cian may lawfully withdraw from the case, providing he and immediate danger to interests that the state may law¬
advises the patient of his intention to do so and affords the fully protect. Because the public interest threatened was the
patient an opportunity to obtain the services of another health of all students and employees of the university, the
physician. court held that the school requirement was necessary and
Emergencies valid for the protection of others (State vs Armstrong, 239
P2d 545, Wash, 1952).
In anemergency, when the patient or the person legally
responsible for him, demands that no blood be adminis- Refusal of Blood When Infant Is Involved
tered, a more difficult situation exists. There may be no This of
time to discuss the medical implications of the demand or
matter refusing
blood transfusions for religious
to withdraw from the case without prejudicing the pa¬
reasons poses intricate
some problems. If an 80-year-old
man refuses a transfusion, one can weigh the matter more
tient's welfare.
In the vast majority of cases in which blood is refused, impersonally than if a parent refuses a transfusion for an
a religious belief motivates the patient. Jehovah's Wit¬ 8-day-old child. The refusal of a transfusion by a 28-year-
old mother of small children differs from the refusal of a
nesses uniformly insist that they not be transfused because
it is contrary to their religious principles. 28-year-old bachelor.
Courts have been called on rather frequently to interpret Society has responded where infants are concerned.
Where an infant is involved and a transfusion has been
the "freedom of religion" concept of our federal and state
constitutions. In these cases the issue was personal versus objected to, courts have seen fit to declare the infant a
collective rights. In a case decided by the Supreme Court ward of the court, appoint a guardian, and authorize him
to consent to the transfusion. Some years ago, an Illinois
of the state of Washington, it was contended that the
district attorney brought an action to determine the fitness
board of regents of a state college was without authority to
of the parents of an 8-day-old child suffering from erythro-
require that all students undergo x-ray examination of the blastosis fetalis. On proper petition and hearing, the par¬
chest for the purpose of discovering possible tuberculous
infection as a condition precedent to admission. A student, ents, Jehovah's Witnesses, who refused to permit medical
treatment, which included transfusions, were declared to be
Prepared by the AMA Law Department. unfit and the court appointed a guardian for the child. The
Reprint requests to Law Department, American Medical Association,
535 N Dearborn St, Chicago 60610. guardian authorized treatment. The child was given a trans-

Downloaded From: by a Simon Fraser University User on 06/07/2015

She with her husband signed conceivable that on recovery gratitude will be expressed. 104 NE2d 769. according to reports reaching the patient despite her con¬ AMA Law Department. the judge The burden is on the physician to insure that evidence of pointed out that the patient. An order of a trial court was obtained. It may be reasonably concluded that an indi¬ for treatment of a rupturing ulcer. woman in the 32nd week of pregnancy. a patient was admitted to a hospital citizenship. the Anderson. 331 F2d 1000." may be found in Medicólegal to freedom of religious belief and the exercise thereof Forms With Legal Analysis. and neither would consent to the transfusion be¬ certain that the patient is in full possession of his faculties cause of religious beliefs. The attorney for the hospital or where the physician is uncertain that another has author¬ applied for an emergency writ before the US Court of ity to act for the patient. The In an elective procedure when the patient is a minor. late in the afternoon. the First Amendment. patient. This procedure. 205 NE2d 435. it would seem that the to save life. asking tion as time permits should be sought. not allow this ultimate of voluntary abandonment. describe the facts as they existed. Consulta¬ judges.jamanetwork. Complete records her if she would oppose the transfusion if he permitted it. The Supreme Court held this would be awarded for such an assault. incurred would have to be predicated on saving life! It nonetheless. One of the circuit from both the medical and legal points of view. his judgment and conscience. including a "Refusal to Per¬ 14th Amendment. did. 201 A2d 537. If this responsibility. The attending physician vidual may lawfully forego therapy that is contrary to his determined that patient would die if she did not receive religious principles as long as he does not thereby endan¬ transfusions but would have a 50-50 chance of living if she ger the health and welfare of others by his actions. 111. said the Supreme Court (In re necessary. it is reported. the physician may consider seeking community to care for her infant. hospitalized. responded favorably and lived the public health. 111. Refusal of Blood When Adult Is Involved Personal. In an opinion explaining his action. the patient was a 29-year-old cases. he should proceed with caution Appeals for the District of Columbia. to those in the Georgetown and Raleigh-Pitkin Hospital In a New Jersey case. a witness should be obtained who may ob¬ not in a mental condition to make a decision and signed serve and. If the patient died order of the trial court interfered with a basic constitu¬ as a result of the administration of blood. The court authorized the ad¬ sician to withdraw from the case or seek judicial interven¬ ministration of a blood transfusion if it became necessary tion without danger to the patient. appointing a conservator and authorizing him may be doubted that any more than nominal damages to consent to the transfusion. had a responsibility to the in the eyes of the law. 1964). A forceful dissenting the assistance of the state's attorney or a child welfare opinion was filed in which another judge asked where an agency who might apply to the appropriate court for a assumption of jurisdiction over matters such as this could proper review of the case. 1964). however. The Illinois court said of law relating to malpractice would govern. Delivery was com¬ In an emergency or where it is impossible for the phy¬ plicated by placenta previa. Brooks Estate. What was done here {People ex rel Wallace vs Labrenz. if necessary. the damages allegedly administer blood." The judge determined that the patient was is impossible. which does not affect the health or welfare of society and does Recently there has been a spate of cases involving adults. 1965). should be maintained. has been used in a number of trary views based on religious convictions. is a right of In one of these cases. He said that the state will not the demand not to give a blood transfusion was imposed allow the patient (parent) to abandon her child. a release absolving the hospital and physician from any It is. If during the procedure the ad¬ {Raleigh-Pitkin—Paul Morgan Memorial Hospital et al vs ministration of blood becomes necessary to save life. contrary to the demands of patient or parent. the usual rules tional right and must be reversed. prepared by the AMA Law except that the exercise thereof may be limited by govern¬ Department. the order. it is ulcer. by the trial court was a judicial attempt to decide what course of action was best for the 1952). according to the judge. protects every individual's absolute right mit Blood Transfusion. fusion and. as extended to the states by the Forms of use to physicians. refused a transfusion. Both patient and her husband were Jehovah's Wit¬ In case of emergency. physician is faced with a decision of his own. The court felt that the welfare of the unborn physician is obligated to respect the demands of the adult child and the patient were so intertwined and inseparable patient and the demands of the parents of a minor to the that it was impracticable to distinguish between them greatest extent possible. Holman Downloaded From: http://jama. or where the physician cannot be nesses. not disrupt society's machinery of government. lawful action based on religious belief. welfare.— Edwin J. and this is jurisdictions when the transfusion of infants is medically clearly unconstitutional. Copies of this booklet are available to mem- mental action if it constitutes a clear and present danger to bers on request. If this charge was sustained. was the mother the patieat's condition and the circumstances under which of a 7-month-old child. or morals. according to The Supreme Court of Illinois adopted a different view. just as possible that he may be sued for civil or criminal liability that might result from failure to assault. The refusal of the patient should be He said the patient indicated "it would not then be her reduced to writing and witnessed if at all possible. 24 years old. NJ. If he does give the trans¬ A married woman. Review by the courts might also lead us (Application of President and Directors of George¬ b¿ sought when an adult is involved if the facts are similar town by a Simon Fraser University User on 06/07/2015 . spoke to the patient. suffering from a peptic fusion. so it will are carefully made and preserved.