Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol / Dever ético e legal do anestesiologista frente ao paciente testemunha de Jeová: protocolo de atendimento

Abstract Background and objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. Conclusions: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.

Resumo Justificativa e objetivos: Os pacientes testemunhas de Jeová recusam transfusão sanguínea por motivos religiosos. O anestesiologista deve dominar conhecimentos jurídicos específicos para atender esses pacientes. Entender como o direito e o Conselho Federal de Medicina tratam essa questão é fundamental para saber agir dentro desse contexto. O objetivo deste artigo foi estabelecer um protocolo de atendimento do paciente testemunha de Jeová com ênfase no dever ético e legal do anestesiologista. Conteúdo: O artigo analisa a Constituição, o Código Penal, resoluções do Conselho Federal de Medicina (CFM), pareceres e jurisprudência para entender os limites do conflito entre a autonomia de vontade da testemunha de Jeová em recusar transfusão e a obrigação do médico em transfundir. Baseado nessas evidências um protocolo de atendimento é sugerido. Conclusões: A resolução do CFM 1021/1980, o Código Penal no artigo 135, que classifica como crime a omissão de socorro, e a decisão do Supremo Tribunal de Justiça sobre o processo HC 268.459/SP impõem ao médico a obrigação de transfusão quando houver risco de vida. Não é necessário concordância do paciente ou de seu responsável, pois não é proibida a manifestação de vontade do paciente testemunha de Jeová ao recusar transfusão sanguínea para si e seus dependentes, mesmo em emergências.

Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol.

BACKGROUND AND OBJECTIVES: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. CONTENT: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. CONCLUSIONS: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.

Are we doing enough to prevent patient injury caused by positioning for surgery?

Patient positioning is an integral part of perioperative care and yet it is an area of patient care which can easily be compromised as staff try to accommodate surgeons and work through busy operating lists. Inadequate padding and incorrect positioning can cause serious and long term injury and disability, and can result in litigation against perioperative nurses and ODPs.

[Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management]. / Fundamentos del rechazo a la transfusión sanguínea por los Testigos de Jehová. Aspectos etico-legales y consideraciones anestésicas en su tratamiento.

The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a genuine challenge for anesthesiologists and surgeons from technical, scientific, ethical, and legal perspectives. We review the reasons why Jehovah's Witnesses refuse transfusion and discuss the ethical, legal, and anesthetic aspects of their care. The literature up to August 2005 was reviewed by MEDLINE search. The following search terms were used: Jehovah's Witnesses, anesthesia (and anaesthesia), legislation and jurisprudence, ethics, blood transfusion, alternatives, anemia (and anaemia), erythropoietin, trigger, and critical care. To further cover ethical and legal aspects, we reviewed current laws in Spain and similar practice settings.

Fundamentos del rechazo a la transfusión sanguínea por los Testigos de Jehová. Aspectos ético-legales y consideraciones anestésicas en su tratamiento / Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management

Uno de los conflictos asistenciales que la medicinaactual afronta, consecuencia de la pluralidad ideológicay religiosa de nuestra sociedad, es el rechazo a la transfusiónde sangre y derivados sanguíneos por los Testigosde Jehová a causa de sus creencias religiosas. El tratamientoperioperatorio de estos pacientes supone un retopara anestesiólogos y cirujanos, tanto desde el punto devista técnico y científico, como ético y legal. Revisamoslos fundamentos del rechazo a la transfusión sanguíneapor los Testigos de Jehová, así como los aspectos éticos,legales y consideraciones anestésicas en su tratamientoPara ello hemos revisado la literatura médica existentehasta agosto de 2005 mediante búsqueda en MEDLINE,utilizando los términos de búsqueda "Jehovah’s Witnesses,anaesthesia, legislation and jurisprudence, ethics,blood transfusion, alternatives, anaemia, erythropoietin,trigger, critical care". Para cubrir los aspectos éticos ylegales se ha revisado la legislación vigente en España yen otros países de nuestro entorno

The refusal of Jehovah's Witnesses to agree to bloodor blood product transfusion based on religious beliefs isone of the most challenging conflictive issues health caregivers have to face today. Such conflict is a by product ofthe ideological and religious diversity in society today.The perioperative care of such patients constitutes agenuine challenge for anesthesiologists and surgeonsfrom technical, scientific, ethical, and legal perspectives.We review the reasons why Jehovah's Witnesses refusetransfusion and discuss the ethical, legal, and anestheticaspects of their care. The literature up to August 2005was reviewed by MEDLINE search. The followingsearch terms were used: Jehovah's Witnesses, anesthesia(and anaesthesia), legislation and jurisprudence, ethics,blood transfusion, alternatives, anemia (and anaemia),erythropoietin, trigger, and critical care. To furthercover ethical and legal aspects, we reviewed current lawsin Spain and similar practice settings