Managing patients who refuse blood transfusions: an ethical dilemma: Major trauma in two patients refusing blood transfusion

BMJ 1994;308:1423-26 (28 May)

Education and debate

Managing patients who refuse blood transfusions: an ethical dilemma: Major trauma in two patients refusing blood transfusion

S Finfer, ,^a S Howell, J Miller, K Willett, J Wilson-MacDonald

^a John Radcliffe Hospital, Oxford OX3 9DU Intensive Therepy Unit, Royal North SHORE Hospital, St Leonards NSW 2065 Australia Correspondence to: Dr

Patients who refuse blood transfusions after severe blood losshave a poor prognosis but survival is possible. Below SimonFinfer and colleagues describe how they managed two patientswho presented after a car crash. We asked an ethical expert,a former pathologist who is a Jehovah's Witness, and a lawyerto comment on the issues that these cases raised.

Patients with severe injuries who refuse blood transfusion presentcomplex medical, legal, and moral problems. In many cases treatmentmay seem futile but occasionally patients will survive despitesevere haemodilution. We report the cases of two men who werebadly injured when their car was impaled on a motorway crashbarrier.

Case reports

The front seat passenger was a 29 year old man. He had an openfracture of the left femur, laceration of the left femoral artery,and a closed fracture of the right . . . [Full text of this article]

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