THE JEHOVAH-WITNESS BLOOD REFUSAL CARD - ETHICAL AND MEDICOLEGAL CONSIDERATIONS FOR EMERGENCY PHYSICIANS

Jehovah's Witnesses are members of a Christian group that does not all ow blood transfusion. It is a general practice for adult Witnesses to carry on their person a wallet-sized advance directive card refusing b lood. The blood refusal card directs that no blood is to be given to t he owner under any circumstance, even if physicians believe transfusio n will be lifesaving. Although the card claims to refuse blood on a re ligious basis, it also states that there are various dangers associate d with blood. The possibility that in an emergency the dangers of bloo d may be relatively small, as compared with the likelihood of death du e to exsanguination without blood, is not noted on the card. Emergency physicians should look for evidence of an informed refusal when evalu ating these documents. Advance directives regarding life and death dec isions should be subject to scrutiny and not be automatically accepted at face value. A good-faith decision to transfuse the unconscious adu lt Jehovah's Witness, in emergent need of blood, is justified if the p atient does not have a blood refusal advance directive that is informe d and otherwise survives a high level of scrutiny. The ethical and med icolegal considerations upon which this thesis is based are discussed.