Education and debate

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

^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 loss have a poor prognosis but survival is possible. Below Simon Finfer and colleagues describe how they managed two patients who presented after a car crash. We asked an ethical expert, a former pathologist who is a Jehovah's Witness, and a lawyer to comment on the issues that these cases raised.

Patients with severe injuries who refuse blood transfusion present complex medical, legal, and moral problems. In many cases treatment may seem futile but occasionally patients will survive despite severe haemodilution. We report the cases of two men who were badly injured when their car was impaled on a motorway crash barrier.

Case reports

The front seat passenger was a 29 year old man. He had an open fracture 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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