Ethical Issues of Patient’s Refusal of Blood Transfusion


The patient’s refusal of a blood transfusion procedure as the necessary treatment based on definite religious beliefs or personal visions should be discussed as an ethical issue that can be resolved while responding to the patient’s interests and viewpoints. The medical and nursing staff should follow the four major ethical principles of beneficence, non-maleficence, justice, and autonomy to respond to the problematic question adequately. Despite the possible physicians’ visions of the case which requires the blood transfusion treatment, the necessary care should be provided according to the patient’s decision.

The ethical and legal rights of a patient to refuse the healthcare treatment proposed by the medical and nursing staff are supported and approved with references to the legal rules and ethical standards followed by physicians and nurses in their practice. As a result, the medical and nursing staff can face different challenges during their everyday practice which are associated with such ethical issues as the refusal of blood transfusion. While refusing the proposed appropriate treatment based on the necessity of the blood transfusion procedure, patients need to act with references to their logic, values, and beliefs which should be accepted by the medical and nursing staff. Thus, the patient’s refusal of blood transfusion is often associated with personal religious beliefs and visions, and the medical staff’s responsibility is to respond to these visions because of following such ethical principles as beneficence, non-maleficence, justice, and autonomy.

Patients can refuse the healthcare treatment based on the blood transfusion procedure when this procedure is discussed by patients as risky in relation to their religious beliefs or shared ethical norms and values. From this point, it is important to refer to the example of the Jehovah’s Witnesses because they often refuse the blood transfusion as the appropriate treatment. The blood transfusion is discussed by the representatives of this religious movement as a violation of divine laws and prohibitions, and this treatment is morally wrong for the Jehovah’s Witnesses (Mann et al., 1992, p. 1043). Similar ethical and moral concerns are shared by the representatives of other religions or by the persons who focus on the negative consequences of the blood transfusion procedure because of the minimal percentage of the associated risks. To provide patients with the opportunity to make their choice, the medical and nursing staff should inform patients about the role of the procedure for the effectiveness of the treatment, consequences and potential or expected results and possible risks, elements of the procedure, and the appropriate non-blood medical alternatives.

It is important to note that a patient has the right to refuse the blood transfusion because of his or her ethical and religious visions even if this procedure is the only appropriate treatment to rely on in the patient’s case. Thus, the tasks of the medical and nursing staff are to completely inform patients about all the details and to accept the written refusal. Furthermore, the question of possible persuasion in the case is still the ethical dilemma because persuasion is discussed as the technique of influencing the patient’s autonomous decision. Even though a patient can refuse the blood transfusion as the most effective treatment, physicians and nurses should draw the patient’s attention to the other alternative non-blood techniques or stimulating treatment to contribute to the patient’s interests and wellbeing (Kepros, 2012, p. 11). Patients should also be informed about all the techniques which can be associated with the blood as their element or main component to avoid the violation of the patients’ religious beliefs and ethical visions.

The refusal of the blood transfusion can be discussed as a significant ethical issue which is associated with the challenge experienced by the medical and nursing staff when they can feel powerless to provide patients with the necessary care and treatment. Such situations as the lack of action to persuade patients to choose the blood transfusion and the focus of medical and nursing staff on describing the advantages of the non-blood alternative treatments are connected with the four major ethical principles followed in the healthcare industry. According to the first ethical principle of beneficence, the medical and nursing staff should concentrate on guaranteeing the treatment which is good or appropriate for the concrete case because the physician’s and nurses’ main task is to promote the wellbeing of patients (Huycke & All, 2000, p. 563). As a result, focusing on the principle of beneficence, the medical staff can face the ethical dilemma because physicians should provide the most effective care, but patients can refuse such treatments as the blood transfusion because of their personal visions (“General statement of ethical principles and guidelines”, 2010, p. 61). The problem is in the fact that physicians should act according to the patients’ decisions despite the ethical principle of beneficence and the medical staff’s vision of the issue. However, the minimal possible ethical requirements associated with the concept of beneficence should be followed while providing the alternative treatment.

The ethical principle of non-maleficence is based on the idea that physicians cannot cause any harm in relation to their patients. The medical and nursing staff can perform the activities which can cause any types of the physical, psychological, and social against the patients (“General statement”, 2010, p. 61). If the focus on the blood transfusion procedure cannot be discussed as the physical harm because it is the effective treatment, the ignorance of the patients’ refusal of the procedure and associated concerns is the example of the psychological and social harm because the patient’s religious, cultural, and personal visions and attitudes can be violated.

Following the third ethical principle of autonomy, the medical and nursing staff cannot persuade patients to choose the blood transfusion because of respecting the person’s right to decide individually. Patients’ autonomy in relation to making decisions about their health is protected not only with references to the ethical standards and norms but also legally. From this perspective, it is the physicians and nurses’ duty to respect the right for autonomy (“General statement”, 2010, p. 61; Harris, 2007, p. 191).

The next ethical principle connected with the situation of refusing the blood transfusion as the effective care and treatment is the principle of justice. Physicians and nurses have no right to ignore the patient’s decision to refuse the procedure in spite of the potential consequences because they should be tolerant and just in relation to all the cases without references to their complexity (“General statement”, 2010, p. 62). Moreover, the ignorance of the patients’ decisions to refuse the procedure because of the religious beliefs is the example of the direct discrimination which is prohibited in the health care industry with the ethical principle of justice.

Although the physicians’ decision to use the blood transfusion can be discussed as logical and effective in the majority of cases, the ethical issue can be developed with references to the fact that patients refuse the procedure because of the personal viewpoints. In this case, the patient’s important decision should be followed directly because of the major ethical principles and associated standards worked out for the medical and nursing staff.


General statement of ethical principles and guidelines. (2010). Journal of American College Health, 59(1), 61-64.

Harris, D. (2007). Contemporary issues in healthcare law and ethics. USA: Health Administration Press.

Huycke, L., & All, A. (2000). Quality in health care and ethical principles. Journal of Advanced Nursing, 32(3), 562-571.

Kepros, J. (2012). Refusal of transfusions for cardiac surgery was not associated with shorter long-term survival. Annals of Internal Medicine, 157(10), 11-12.

Mann, M., Votto, J., Kambe, & McNamee, M. (1992). Management of the severely anemic patient who refuses transfusion: Lessons learned during the care of a Jehovah’s Witnesses. Annals of Internal Medicine, 117(12), 1042-1048.

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