Religious practice, blood transfusion, and major medical procedures.

In this debate, we explore the dilemmas between the law, the ethical issues, the good clinical practice, and the wishes of the family. In the scenario chosen, the issues center around not only the senior family members but also of an older child with some rights to self-determination. There are no absolute rights or wrongs to this case, which is based on a synthesis of other actual clinical scenarios. The maze of considerations are not easy to negotiate, and in the final analysis, the surgeon and the anesthetist must also be comfortable with the decisions as they are the active elements that have to practically manage a clinical crisis should it occur. The participants in this debate are all UK based, and as such the legal standpoint reflects UK legislation, and the ethical and clinical reviews are strongly influenced by current attitudes within UK and Europe that may not be exactly mirrored in different cultural frameworks. However, in this article, it is the broad principles behind the differing responses that are important, which it is hoped will stimulate reflection of attitudes and management in different cultural frameworks.