Gouezec H, Lerenard I, Jan S, Bajeux E, Renaudier P, Mertes P M
Unité de sécurité transfusionnelle et d'hémovigilance, service d'épidémiologique et santé publique, CHU de Rennes, 35033 Rennes cedex, France.
Unité de sécurité transfusionnelle et d'hémovigilance, service d'épidémiologique et santé publique, CHU de Rennes, 35033 Rennes cedex, France.
Transfus Clin Biol. 2016 Nov;23(4):196-201. doi: 10.1016/j.tracli.2016.08.002. Epub 2016 Sep 12.
The goal of this study is to assess the physician's management of patients who refuse blood transfusion.
A questionnaire to assess the experience, the acceptance or refusal and the operating methods in case of vital risk has been realized and circulated at a national scale.
A total of 793 questionnaires were sent back and analysed according to 3 different categories: anesthesiologists, physicians and surgeons. Seventy-nine percent of total respondents and 90% of anesthesiologists had had to take care of a Jehovah's Witness. In 51% of all cases, it appears to be associated with mainly relational problems with the patient or his family. Nevertheless, 83% accept to take care a Jehovah witness, the most reluctant of them being anesthesiologists. A written confirmation of blood transfusion refusal even at vital risk and a piece of written evidence of belonging to Jehovah's Witnesses are not systematically required. For them, the impossibility to foresee with certainty the need for blood transfusion represents the main barrier to the medical care of a Jehovah's Witness. In case of imminent vital risk and if there are no available alternative procedures, 67% of respondents administer blood products (89% if the patient is unconscious).
This situation has nothing exceptional but the medical community does not seem to know all the regulatory requirements. Generally speaking, they do not oppose the medical care of a Jehovah's Witness, but remain committed to their primary focus: to save the patient, as long as it is not an end-of-life situation.
本研究的目标是评估医生对拒绝输血患者的管理情况。
已制定一份问卷，用于评估经验、接受或拒绝情况以及在生命危险情况下的操作方法，并在全国范围内分发。
共收回793份问卷，并根据麻醉医生、内科医生和外科医生这3个不同类别进行分析。79%的总受访者和90%的麻醉医生曾不得不照顾耶和华见证会成员。在所有病例的51%中，这似乎主要与患者或其家属的关系问题有关。然而，83%的人接受照顾耶和华见证会成员，其中最不情愿的是麻醉医生。即使在生命危险时，也没有系统地要求提供拒绝输血的书面确认以及属于耶和华见证会成员的书面证据。对他们来说，无法确切预见输血需求是耶和华见证会成员医疗护理的主要障碍。在面临迫在眉睫的生命危险且没有可用替代程序的情况下，67%的受访者会使用血液制品（如果患者失去意识，这一比例为89%）。
这种情况并无特殊之处，但医学界似乎并不了解所有的监管要求。一般来说，他们不反对为耶和华见证会成员提供医疗护理，但仍致力于他们的首要重点：拯救患者，只要不是临终情况即可。
