In New South Wales, a coronial inquest has found that 75-year-old Heather Winchester died as a result of multiple organ failure due to severe anaemia secondary to blood loss post elective surgery, in circumstances where there was confusion regarding whether she, as a Jehovah’s Witness, had consented to receiving blood transfusions during surgery.
While undergoing elective surgery, the medical teams involved had differing understandings of whether she would accept a transfusion if needed. Complications arose that required her to undergo a second and third surgery, during which she lost a significant amount of blood and required a life-saving transfusion.
Medical ethics and health policy require that practitioners obtain informed consent before providing treatment. In Ms Winchester’s case, the confusion stemmed from several factors:
When the situation became critical, and a transfusion was likely her only chance of survival, the hospital sought legal advice. The advice was not to proceed with the transfusion, and Ms Winchester subsequently passed away.
The inquest concluded (amongst other things) that the manner in which Ms Winchester’s refusal of treatment was communicated did not meet the standards required of an adequately informed decision. It criticised aspects on the Church’s influence on medical treatment decisions, without involving medical opinion. It stressed, amongst other things, the need for medical professionals to have clear, consistent, and well-documented procedures for informing a patient of risks of a procedure, in order to verify whether a patient’s consent or refusal is truly informed.
In this case, the coroner found that the surgeon had only discussed the general risks of the procedure recommended to Ms Winchester, and not the specific increased risks that the procedure carried in light of Ms Winchester’s expressed (to the surgeon) refusal of blood transfusions.
The coroner also made recommendations to the hospital to firm up its procedures to mandate that surgeons review pre-surgery anaesthetic clinic notes and to create a procedure requiring staff to provide certain information to patients who identify as Jehovah’s Witness to enable them to make clear, informed decisions about receipt of blood transfusions.
The coroner also recommended that local hospitals meet regularly with the Jehovah’s Witness hospital liaison committee to share knowledge and increase clinician’s understanding (And the Church’s understanding) of what treatment would be considered reasonable and compatible with Jehovah’s Witness beliefs.
It’s not uncommon for patients to decline certain medications or procedures based on religious beliefs or “their own research”. This case highlights how those views impact on a clinician’s ability to obtain truly informed consent from the patient.
Clinicians must carefully examine whether a patient has provided valid, informed consent to medical treatment – or has validly refused treatment - after being provided with adequate information about the specific risks of the treatment given the patient’s subject circumstances. General advice contained in a pamphlet, in and of itself, is unlikely to be sufficient to discharge duty of care, especially for these complex cases.
To read the full case, click here.
This article was written by Sydney Meville, Solicitor Insurance & Risk