• Adolescent Health
• Emergency Service, Hospital
• Paediatrics
• Intensive Care Units

The question of blood product transfusion arises for patients of any age. But for the clinicians involved, the outcome of the decision as to whether blood can be given is usually most anxious when the patient is unable to speak for themselves. Very frequently, even if the adult patient refusing blood is currently incapacitated, they will have made arrangements, prior to the loss of their capacity, which will alert the clinician to their advance refusal.

In a series of clinical legal enquiries since 2009,1 of eight adult (the ‘third age’) Jehovah’s Witnesses refusing blood, six were incapacitated, but had previously perpetuated their refusal using instruments provided by the Mental Capacity Act 2005 (MCA 2005). One capacitous young man maintained his refusal and died as a result; the eighth patient whose wounds were self-inflicted withdrew her refusal. Following transfusion, she was discharged. In each of the adult cases, the clinician has some reassurance that they are complying with a capacitous decision, although with moral trepidation throughout the progress of the transaction.

But it is upon children’s doctors, nurses and other clinicians that a rather heavier burden is placed, revealed as two clinically and legally distinct child phenotypes: the other two ages of Jehovah’s Witnesses.

The first age is of the children who are unquestionably incompetent to decide whether they wish to accept blood products. In the same series of enquiries, six cases of incompetent children on whose behalf parents …