• Children's Rights
• Ethics
• General Paediatrics
• Paediatric Surgery
• Adolescent Health

While many citizens may view an adult Jehovah's Witness’ refusal of the blood transfusion that might otherwise save her life as irrational, the refusal alone does not lead the courts in England and Wales to conclude that she lacks competence. Her refusal will be considered competent, provided that she comprehends, believes and is able to weigh the information which is relevant to her decision and that she makes her choice free from coercion. The decision of a competent adult to refuse blood is legally binding on doctors.1 ‘English law could not be clearer. A competent adult patient, once properly informed has the unassailable legal right to refuse any or all medical treatment or care’.2 This was amply demonstrated in the recent case of a 23-year-old3 who had slashed his brachial artery. He was detained under the Mental Health Act 1983, and the court found that the artery could be repaired under the Act. However, he remained at risk of reopening his own wound. The court found that it would be ‘…an abuse of power …to even think about imposing a blood transfusion…’ on a man with capacity to refuse blood products. The court also held that were his capacity to disappear, he had provided a valid advance decision to refuse blood transfusion.

This legal approach can be explained in part since the decision to refuse blood is not founded on any mental disability or dysfunction on the patient's behalf. Moreover, in more general policy terms, it would be unjust for the state to interfere in decisions based upon religious belief, since there is no reason why citizens should be deprived of their power to make decisions concerning only their own lives.4

This principle of self-determination extends into decision-making in pregnancy. The competent and pregnant Jehovah's Witness …