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UWHC,UWMF,

Policies,Clinical,UW Health Clinical,General Care and Procedures,Blood Products

Caring for Patients Who Refuse Blood Transfusions (2.2.1)

Caring for Patients Who Refuse Blood Transfusions (2.2.1) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Blood Products

2.2.1


UW HEALTH CLINICAL POLICY 1
Policy Title: Caring for Patients Who Refuse Blood Transfusions
Policy Number: 2.2.1
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: June 11, 2015

I. PURPOSE

To establish a policy for obtaining informed consent and caring for patients w ho refuse blood transfusions.
To establish procedures for implementing a decision to give blood transfusions to, or w ithhold blood
transfusions from, a patient w ho refuses blood transfusions. This policy applies to any UW Health facility that
transfuses blood products.

II. POLICY ELEMENTS

It is the policy of UW Health to respect the rights of adults w ith decision-making capacity to refuse blood
products. In cases w here the patient is a minor, the parents or other authorized representative may not
refuse blood products on the minor’s behalf w hen the blood is clearly necessary medical treatment.

III. OVERVIEW

A. The Adult Patient With Decision-Making Capacity.
The adult patient w ith decision-making capacity has the right to refuse blood transfusions. Courts throughout
the country have upheld this right on the basis of religious freedom and of a privacy right to make decisions
concerning one's ow n body and life. The issue of capacity turns on the patient's ability to understand the
procedure to be performed, the alternatives available, the risks and benefits involved in the procedure and in
receiving or not receiving blood.
B. Patients Lacking Decision-Making Capacity.
i. In cases w here the patient is a minor (under 18), the parents may generally not refuse blood on the
minor's behalf w here the blood is clearly necessary medical treatment. Hospitals routinely seek a
court order to protect the minor's health. (The policy in this regard should be clearly explained to
patients in cases of elective surgery.) There may be exceptions to this general rule in appropriate
cases; how ever, the appropriate legal department should be consulted before any exception is
made.
ii. In cases w here the patient is an adult w ho does not have decision-making capacity and there is no
reliable evidence of the patient's w ishes regarding the use of blood products, the patient's
authorized representative does not have authority to act for the patient w here that decision w ould
be against the patient's interest.
iii. In cases w here an incapacitated patient's authorized representative refuses to allow blood
products, staff should seek consultation w ith the Ethics Committee to determine if there is reliable
evidence of the patient's w ishes or w hether a court order should be sought. Court orders are
typically sought in the follow ing situations:
a. Non-emergency situations w here the adult patient does not possess decision-making
capacity and there is no reliable evidence of the patient’s w ishes.
b. When parents of a minor refuse blood products for their child.
C. In all emergency situations (adults or minors) w here the patient is unable to give consent, a life or health
threatening situation is presented, and the patient has not made a prior, clear unequivocal w ritten
declaration w hile possessing decision-making capacity, the law presumes consent and blood may be
administered. (See paragraph IV.B. below .) No family member or other person, other than one acting under
a court order, can refuse blood transfusions for the patient in this situation. (A family member has authority
to act for an adult w ithout decision-making capacity or minor patient only w here the family member is clearly
acting in the patient's best interest. Since refusal of a blood transfusion w hich is recommended by the
physician is not in the interest of the patient's physical health, the family member does not have authority to
refuse for the patient.)
For purposes of this policy, a medical emergency is defined as a situation in w hich: 1) the patient is
incapacitated and cannot make an informed choice, and 2) a life or health-threatening disease or injury
requiring immediate treatment is present and delay could cause death or serious impairment.

IV. PROCEDURE




UW HEALTH CLINICAL POLICY 2
Policy Title: Caring for Patients Who Refuse Blood Transfusions
Policy Number: 2.2.1

A. Non-emergent Cases With an Adult Patient With Decisional Capacity Who May Refuse Blood Transfusions.
i. The physician explaining the procedure or treatment to the patient shall inform the patient w hether
the procedure or treatment w ill or may require the transfusion of blood. If the patient agrees to the
transfusion or agrees to allow the physician to decide about the need for blood, the procedure or
treatment may proceed w ithout the physician contacting other physicians to be involved in the care.
The physician w ill record in the medical record the essence of the discussion pursuant to the
hospital policy on informed consent and the patient's consent to the procedure (UWHC Po licy
#4.17).
ii. If the patient requests the procedure or treatment but refuses the blood transfusions, the physician
may agree to treat the patient under these circumstances or may decline. If the physician declines,
he/she should refer the patient to another physician at UW Health w ho is know n to be w illing to
treat under these circumstances, if any. When the procedure or treatment w ill involve physicians in
more than one department (e.g., surgeons and anesthesiologists), and the intention is to w ithhold
blood, the physician communicating initially w ith the patient (e.g., surgeon) MUST notify the
chairman of the other department (e.g., anesthesiology) of the medical facts of the patient's case,
so that a determination can be made w hether a physician from the second department (e.g.,
anesthesiology) is w illing to provide care in the circumstances of this patient's case, w here no blood
w ill be transfused.
iii. If no physician is w illing to provide care from the second department, then the patient may have to
be referred to another health care facility.
iv. It is recognized that the w illingness of physicians from other departments to participate in the
procedure may depend on the risk factors for the particular patient in having the particular
procedure w ithout blood transfusions.
v. All staff physicians directly involved in the procedure or treatment of the patient w ithout blood
transfusions must agree to accept the patient's restrictions.
vi. Where the adult patient w ith decisional-making capacity w ishes the procedure or treatment but
declines blood transfusions, he/she should execute the "Refusal to Permit Blood Transfusions"
form or the “Jehovah Witness Questionnaire”.
B. Emergency Cases.
i. Where an emergency situation exists as defined above in paragraph III.C., the patient is unable to
make an informed decision, and there exists no reliable evidence of the patient's w ishes, the
physician may give blood w ithout a court order despite the know ledge that the patient is a
Jehovah's Witness or despite family objections. Family members w ho refuse blood transfusions
cannot act for the incompetent patient in this situation. The physician should document both the
patient's lack of capacity and the existence of the medical emergency in the medical record. Once
the patient regains consciousness and is capable of making an informed choice, then the patient's
w ishes must be respected.
ii. If an adult patient has a Jehovah's Witness Medical Directive "No Blood" card (or other advance
directive regarding no blood), the reliability of such document shall be treated as an informal (or
oral) advance directive. Its reliability must be evaluated under all circumstances according to
UWHC Policy #4.37 (Advance Directives).
V. FORMS

Refusal to Permit Blood Transfusion UWH 809
UWHC #301301-DT “Jehovah Witness Questionnaire (301301-DT)”

VI. COORDINATION

Author(s): UWHC Legal Department, UWMF Legal Department
Senior Management Sponsor: SVP/General Counsel
Approval committees: Ethics Committee; UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: March 16, 2015

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is



UW HEALTH CLINICAL POLICY 3
Policy Title: Caring for Patients Who Refuse Blood Transfusions
Policy Number: 2.2.1

responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VII. APPROVAL

Peter New comer, MD
CAMO

Christopher Green, MD
SVP Medical Affairs and CMO

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VIII. REFERENCES

UWHC Policy #4.17 Informed Consent
UWHC Policy #4.37 Advanced Directives

IX. REVIEW DETAILS
Version: Revision
Next Revision Due: June 11, 2018
Formerly Know n as: Hospital Administrative Policy 4.32