Letters

Changes in policy of refusal of blood by Jehovah's Witnesses

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7294.1123 (Published 05 May 2001) Cite this as: BMJ 2001;322:1123

Refuse and decline have distinct meanings

  1. Graham Howarth (ghowarth@kalafong.up.ac.za), head of bioethics
  1. School of Medicine, University of Pretoria, Pretoria, Suite 21, P/Bag X 87, Bryanston, 2021, South Africa
  2. Department of Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne NE7 7DN
  3. Hospital Information Services (Britain), London NW7 1RN

    EDITOR—Muramoto discussed the bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses.1 Informed consent has now become ethically and legally ensconced as a patient's right. During the process of informed consent information is divulged to a patient, and this is often followed by a recommendation. The patient is then given the opportunity to accept or reject the recommendation in part or in its entirety. If the patient decides against the treatment, authorisation and, hence consent, is withheld. There is a tendency in the medical literature to refer to this rejection as refusal.

    Although the two words are used as synonyms, their meanings are distinct. Refuse is the stronger of the two and often emphasises firmness, at times rudeness—to refuse to obey an order, to refuse to lend somebody money. Decline means to reject politely or courteously and is applicable to social events or an offer to help—to decline a dinner invitation.

    The doctor-patient relationship is usually …

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