Ethical and legal implications of bloodless medicine and surgery

Transfusion medicine is in the midst of a "paradigm shift." Multiple studie s have documented new developments in our understanding of the risks of all ogeneic blood and the benefits of bloodless alternatives. However, systemat ic attention has not yet been given to the ethical and legal implications o f these changes. This article discusses the effect these changes have had o n three ethical duties that physicians owe to their patients: (1) the oblig ation to respect a competent patient's right to refuse medical treatment in accordance with his/her own values and beliefs, (2) the obligation to exam ine current assumptions about the efficacy and safety of allogeneic blood, and (3) the obligation to engage in a process of communication that adequat ely prepares the patient to make an informed decision about the use of bloo d and blood derivatives. Physicians who neglect these duties not only fail their ethical obligation to respect patients' rights but also expose themse lves to significant medicolegal risk. The discussion includes an explanatio n of the source and significance of each obligation, as well as an explicat ion of the standard by which it is judged. The article concludes with a set of five practical recommendations for physicians seeking to provide ethica lly appropriate care.