Who Approves Blood Transfusion?: On the Momentum of the "Guidelines for Refusal of Blood Transfusion on Religious Grounds"

  • AWAYA Tsuyoshi
    Department of Bioethics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University

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Other Title
  • 輸血の可否―「宗教的輸血拒否に関するガイドライン」 を契機として―

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Abstract

  Blood transfusion and other medical treatments require, in principle, approval from patients. Generally, medical treatment without a patient's approval is illegal and ethically inappropriate. Patients need to be competent in order to approve medical treatment. Competence is a necessary (although not a sufficient) condition for patients, approval to be legally and ethically effective. <br>  The legal and ethical rules about who approves and disallows a blood transfusion are quite simple and clear. If a patient is competent, he/she is the one who judges, or makes the decision to receive a blood transfusion by him-/herself. In this case no one else can make the proxy decision, representing him/her, and doctors cannot conduct medical treatment against the decision of a competent patient. <br>  If a patient is not competent, someone else needs to make the proxy decision, representing him/her. Doctors need, in principle, to follow the decision made by the proxy decision-maker. The proxy decision-maker is not supposed to make a decision that goes against the patient's interest. When doctors give a blood transfusion to a patient who is not competent, even though the person in his/her parental authority refuses it, it is a legal and appropriate action as long as the blood transfusion is beneficial to the patient or at least as long as the blood transfusion does not work against the patient.<br>  Accordingly, if a patient who is 15 years old or over but under 18 and is competent refuses a blood transfusion, doctors cannot conduct a blood transfusion against the decision of the patient. If a person in parental authority with respect to a patient who is under 15 and is not competent refuses the patient's blood transfusion, and if the refusal of a blood transfusion works against the patient, the person's proxy decision to refuse the blood transfusion is legally and ethically ineffective and it is legal and ethically appropriate for doctors to conduct the blood transfusion against the proxy decision of the person in parental authority. Here, there is no logical necessity of finding another person to represent the person in parental authority.

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