Legal Blood Transfusion

The First Amendment guarantees the free exercise of religion, but debate over whether it prevails when doctors determine that conventional medical therapies are necessary, but individuals or their families object to them on grounds of conscience. The refusal of Jehovah`s Witnesses to accept blood transfusions is an example of this conflict. In this photo, Dr. Nicolas Jabbour, right, holds a model of a liver while showing Vicky Rush, left, which part of her liver was transplanted into her grandson Aiden Michael Rush, not seen, Wednesday, Feb. 21, 2001, at a press conference at Children`s Hospital in Los Angeles. In what is believed to be the first «bloodless» liver transplant, doctors at the hospital transplanted part of Vicky Rush`s liver into her seven-month-old grandson without the need for blood transfusions. This «bloodless» approach, which largely takes into account the religious beliefs of the family that is Jehovah`s Witness, could eventually become a routine protocol for pediatric liver transplants in the hospital. (AP Photo/Damian Dovarganes, used with permission from The Associated Press) Moreover, also with regard to future legislative interventions in this area, a possible provision on the acceptance of transfusions by Jehovah`s Witnesses would be unconstitutional by «contradicting not only freedom of conscience, but also the principle that compulsory health care is not intended solely to protect a person`s physical health and cannot be performed compulsorily in a particular form.»2 Legal issues play a crucial role in shaping the structure of blood transfusion services (BTS) in the country, and ethical issues play a more important role in determining the quality of transfusion services. Thanks to the 1993 Supreme Court directive that made the registration of blood banks mandatory in the country, all blood banks are now licensed. Licensing became mandatory following the landmark decision in the petition – «Common Cause vs. Union of India» in January 1992. [1] The honourable court also ordered that the National Blood Transfusion Board (NBTC) be established with the State Blood Transfusion Boards (SBTC) to oversee the activity of blood banks in India.

[2] In particular, the Court of Cassation, Criminal Chamber IV, 18 May 2006, No. 16995 condemns: «. Health workers must take into account a document in which a patient refuses transfusions, even in an emergency, for two reasons: first, because there is a state of necessity that would require transfusion to be performed; and because the refusal expressed above cannot in any event legally bind the doctor, since it is an expression of will made without the indispensable condition of speed … and in accordance with the foregoing, the Court of Cassation, Civil Chamber III, in its judgment No. 4211 of 23 February 2007, examined the issue in greater detail by emphasizing: «.. This is the problem to be solved: not on the absolute and final value of a refusal based on a particular ideological and religious conviction, but on the correctness of the reasoning. whereas the initial refusal should not be considered effective at a later stage, given a radically changed clinical situation and an imminent risk of death, and without the possibility of further consultation with this patient. That justification is not invalidated by errors of law, since it corresponds to Law No 145 of 28 March 2001, Article 9 of which provides that `the wishes relating to a medical intervention previously expressed by a patient who is unable to express his will at the time of the intervention shall be taken into account`. but not in the sense of discussing the legality of the right to refuse blood transfusions, even if it results in death, but to establish the legality of the behaviour of health workers who performed a transfusion on the reasonable assumption that the patient`s initial refusal was no longer valid and that in fact […] TTI tests alone cannot guarantee blood safety. The world has evolved from testing technologies to treatment technologies, but treatment technologies are not mentioned in Laws D and C. Although NACO/NBTC established guidelines for reducing leukoreduction and irradiation in 2007, many blood bankers and drug inspectors are ignorant. The punctum dolens of refusing to receive blood transfusions from Jehovah`s Witnesses was particularly relevant from a legal point of view, as it is a topic of great importance and still relevant arising from the link between vital health care and a patient`s religious beliefs. The confirmation that a guardian as an «ad acta representative» can be the guarantor of the refusal expressed by a patient «now for then» stems from a judgment of a guardianship judge of Modena of 5 November 2008, which stressed that «the appointed guardian […] refuse consent to certain treatments.

In the absence of revocation, and taking into account the contingencies set out in the written observations, the wishes expressed should be respected, since the objection of a possible change of mind not manifested at the time of slipping into the expected state of unconsciousness is legally incompatible with the principle enshrined in the legal order since time immemorial, according to which a freely determined will, if that is the case, and it is likely to produce legal effects, it shall remain constant until it is revoked`. Law D and C must be reviewed every 2 years to keep pace with the times and must be amended so that, in the case of a component or procedure that is not included in Law D and C, the blood bank can do the same according to the standards established by NACO / NABAH. NBTC should participate more actively in the licensing process. The dual licensing system by the State and the Centre should be abolished and the approval process simplified to grant/renew licences within a maximum period of 3 months. SBTCs must operate a large, state-of-the-art blood bank in each state to get an idea of the calculation of blood costs that can be used to set treatment fees for other blood banks.