Legal and Ethical Aspects of Transfusion
SANBS Guideline - Updated August 2023
Patients who refuse a blood transfusion
Blood transfusion is an integral part of modern medicine, often being a lifesaving intervention. All healthcare workers involved in the ordering and administration of blood products and in the monitoring of transfused patients must be aware of their legal obligations and ethical responsibilities.
Informed consent
The ethical principle of autonomy states that competent adults have the right to determine what will (and what will not) be done to their bodies. This includes the right to make decisions based on personal values, which may differ from societal norms.
Chapter 2 of the National Health Act (2003) stipulates that healthcare workers should take all possible measures to obtain and document informed consent prior to any intervention;
Chapter 8 stipulates that individuals have the right to participate in decisions regarding their health care. The National Patients’ Rights Charter (2008) specifies informed consent and informed refusal as basic patient rights.
Obtaining informed consent for all blood transfusions is therefore mandatory, not optional. The use of a separate transfusion consent form is advised. (Check whether your hospital uses a separate consent form for blood transfusions).
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Information should be given on:
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Exceptions to obtaining informed consent from the patient:
- Emergencies, e.g. A patient in a coma where the treating doctor may decide on the patients’ behalf (after considering all other options) to administer emergency treatment.
- Minors, where a parent or a legal guardian may give consent after completing the informed process.
- Mental illness, where the legal guardian may give consent if at the time of treatment the patient is incapable of doing so (incompetent).
- Where a court order is obtained to permit intervention / treatment of a patient.
Obtaining informed consent is the responsibility of the treating physician. Ideally, the doctor making the decision to transfuse should be the doctor administering the informed consent. The nurse’s responsibility is to ensure that voluntary consent has been obtained from the patient prior to the transfusion.
Informed consent must be a voluntary process. It should be administered in a language that the patient understands, at the patient’s level of understanding. A translator should be used if necessary and the use of medical terminology should be avoided.
Patients who refuse a blood transfusion
(e.g. Jehovah’s Witness)
Informed refusal of treatment is a basic patient right. Should a patient refuse the transfusion, there should be clear policies for managing this patient. The reasons for refusal should be stated and documented. All alternatives to a blood transfusion should be explored and explained to the patient.
Hospital liaison committees from the Jehovah’s Witness Society can provide information to physicians regarding transfusion alternatives or arrange consultations with physicians who have experience in the management of a patient without the use of blood transfusions. These committees comprises ministers from this religious group with specialised training and exist in most large cities.
Documentation
All documents pertaining to the informed consent process should be kept in the patient’s file indefinitely (these are legal documents) and must indicate the time and date of the proceedings. The following signatures should appear on the documentation:
- Physician.
- Patient / parent / guardian / mandated person.
- Witness to consent.
- Translator (if required). Specify the language used.
- Nurses role:
- Sign as a witness if the process has been witnessed.
- Translate (if you know the language).
- Ensure Informed Consent is signed before the transfusion.
- Document that consent has been obtained.
Navigation to a Safe Blood Transfusion - Updated August 2023