Legal and Ethical Challenges
The key ethical principles which underpin medical practice are
non-maleficence, beneficence, autonomy and justice and their utilisation
applies to care of any patient undergoing cardiac surgery, including
Witnesses11,12,22,24. This is outlined, along with
core legal principles, within existing clinical guidelines, as well as
case reports, with one notable example by Papalexopoulou et
al .12. This case helps to demonstrate the ethical
principles of beneficence and non-maleficence, as it presents a complex
case in which the risk-to-benefit of treatment was vital to
assess12. It discusses that it can be deemed
inappropriate for clinicians to refuse to treat a patient based on such
factors as high risk12. A clinicians choice to treat
Witness patients is further noted in guidance by RCS
England22. Doctors do have a choice about whether to
treat patients who refuse blood transfusion, as the clinicians may deem
this a conflict to their role as a doctor, especially in life-saving
situations. If so, the refusing clinician must refer the patient to a
doctor who is prepared to perform treatment with knowledge of the
patients views. This must be recorded adequately to prevent claims of
misconduct22. Furthermore, the concept of adequate
note-taking and record keeping is also considered within guidelines with
regards to discussions about treatment options and eventual decision
making with patients, allowing for autonomy10,22.
Patients with mental capacity have the right to refuse treatment, and
this is upheld in both ethical and legal respects, making administration
of blood products against the patients will potentially
unlawful22. It is imperative that alternative
treatments are made available to Witness patients, with a number having
been developed over the years.