A moral dilemma - If you are a surgeon, and you are treating a patient who tells you, no blood transfusions?

I am a surgeon, and the answer is straightforward: the patient signs a waiver declaring their understanding and wish that no blood be transfused under any circumstances. If the surgeon feels personally comfortable operating, he or she may do so with impunity should a vascular/hemotological emergency arise. If the artery bursts, you do what you can, but if the patient dies, he dies. This is not applicable to the minor-aged children of Jehovah's witnesses: the court intervenes to ensure they receive whatever blood products are necessary to sustain life.

I would not give that patient a blood transfusion, if I were that surgeon, because the last thing I would do is to go against another person's religious beliefs. That person could turn around and sue you if they found about the blood transfusion, which would show up on the final bill.

prsnl hstry: grew up Jehovah's Witness now pratice free from spirituality. Been on the operating table and father is currently getting a new pacemaker.

Always respect the patient’s wishes. They know their own body better than anyone else. Plus no offense, but mixing relatively unknown bodily fluids with someone who has a compromised immune system is risky. That’s why scientists are coming out/came out with alternatives.

Patients usually do not have a choice in blood donors. Doctors just grab what is available and since I do not live in Utopia (I live in Sin city) I really don't trust the blood donors.

Excellent question.

Sometimes, rules just NEED to be broken. Life is paramount in many religions, and if I were in the surgeon's position, I would never be able to live down the fact that a person died and that I was unable to do anything to get them to live, even though the answer was right in front of me, and I turned it away. You might make an enemy, then, and you know what? It really doesn't matter here. This person is dying, and their religion would most likely forgive them for breaking a law in their religion, if they never do that again. Sometimes, you are allowed to break rules in religion if your life is at stake, and it is an undeniable emergency. Besides, even if the person hates you so much after saving your life, to me, it proves two things : One - this person is not grateful for having their life saved, and Two - They really shouldn't have need to hate you because they are still alive; they should be thanking you instead. It's a tough ethical question, but life is paramount.

Only if you were married to him and he had not signed the medical directive all JWs are supposed to carry with them (forbidding whole blood transfusions), could you give permission (if he was unconscious). Any adult who takes a decision on such matters has to have his wishes respected by the medical profession. It is only in the case of minors that others have to take decisions, and parental refusal can be over-ruled by the Courts. It sounds as if his mother would do everything possible to prevent him getting one, probably by saying she knew his wishes and that he would not want one. If nothing is stated in writing by him, it will be a messy muddle. But if he still wants to refuse blood when he is NOT a practicing JW, you can be sure that the religion has a firm hold on him. He is quite likely to re-join them at a later stage in his life. That would make your position extremely difficult. The best thing you could do would be to find out the biblical reasons as to why God does not require martyrs to the blood transfusion 'cause', and show him from the Bible. After all, the JW stance is purely theological and actually is not based on any medical reasons at all. Email me if you want details.

I would give the person a transfusion in a heartbeat.

Chances are that their reluctance to be transfused results from faith or misinformation. To let either of these things kill a person under these circumstances is (in my opinion) profoundly stupid, and I would not let it happen.

Let the lawsuits come, but I would happily juice the patient with type O-negative.

Dr. Cox encountered this exact dilemma on a recent episode of Scrubs. He first refused to treat the patient, but then he transferred the patient so that Carla would not find out he was treating her. Carla would have given him the business.

The surgeon needs to operate without his hands tied. Either the patient agrees to avail himself of all lifesaving procedures available, or find another doctor.