Migden D R, Braen G R
Emergency Department, Group Health Cooperative of Puget Sound/Virginia Mason Medical Center, Seattle, WA 98111, USA.
Acad Emerg Med. 1998 Aug;5(8):815-24. doi: 10.1111/j.1553-2712.1998.tb02510.x.
Jehovah's Witnesses are members of a Christian group that does not allow blood transfusion. It is a general practice for adult Witnesses to carry on their person a wallet-sized advance directive card refusing blood. The blood refusal card directs that no blood is to be given to the owner under any circumstance, even if physicians believe transfusion will be lifesaving. Although the card claims to refuse blood on a religious basis, it also states that there are various dangers associated with blood. The possibility that in an emergency the dangers of blood may be relatively small, as compared with the likelihood of death due to exsanguination without blood, is not noted on the card. Emergency physicians should look for evidence of an informed refusal when evaluating these documents. Advance directives regarding life and death decisions should be subject to scrutiny and not be automatically accepted at face value. A goodfaith decision to transfuse the unconscious adult Jehovah's Witness, in emergent need of blood, is justified if the patient does not have a blood refusal advance directive that is informed and otherwise survives a high level of scrutiny. The ethical and medicolegal considerations upon which this thesis is based are discussed.
耶和华见证人是一个不允许输血的基督教团体的成员。成年见证人通常会随身携带一张钱包大小的预先指示卡，拒绝接受输血。这张拒绝输血卡规定，在任何情况下都不得给卡的主人输血，即使医生认为输血将挽救生命。尽管这张卡声称基于宗教原因拒绝输血，但它也指出输血存在各种风险。然而，卡片上并未提及在紧急情况下，与因不输血而失血过多导致死亡的可能性相比，输血的风险可能相对较小。急诊医生在评估这些文件时应寻找知情拒绝的证据。关于生死决定的预先指示应受到审查，而不应仅凭表面价值就自动接受。如果患者没有经过充分告知且经过严格审查的拒绝输血预先指示，那么在紧急情况下为急需输血的昏迷成年耶和华见证人进行输血的善意决定是合理的。本文将讨论这一论点所基于的伦理和法医学考量。
