While 17 states recognize the doctrine to varying degrees and in different settings, only a handful of the states have allowed an adolescent to refuse live-saving treatment (14). In a minority of states, a “mature minor” doctrine allows minors who demonstrate a requisite level of maturity the right to consent for, and potentially refuse, treatment (14). There is one notable exception for cases that involve adolescents. Some states even have specific laws that authorize a court to order treatment under certain circumstances, though such laws are not required since a court can make an independent determination based on the state’s inherent interest in protecting the child (11,12,13). Instead, courts confronted with the issue have upheld a hospital’s ability to provide blood even against a parent’s wishes (11). Constitution protects the freedom to practice religion, courts have not interpreted that freedom to include the right to refuse lifesaving treatment for a child on the basis of that religion (11). This principle is not absolute, as is the case when a JW parent refuses blood for their minor child. In the majority of cases, however, a parent must provide consent or refusal. States vary on exceptions to this rule ( e.g., many states carve out specific types of care that minors may consent to on their own-such as sexually transmitted infection treatment) (10).
Minors ( i.e., individuals under the state-specific age of consent, usually 18) generally cannot provide consent for or refuse medical treatment. HLCs also provide educational lectures to providers and staff on working with JW families. In this role, they may offer literature on bloodless techniques, assist with consulting providers experienced in bloodless care or help with arranging transfer to other facilities. HLCs, comprised of male elders, aid patients and families by providing spiritual and practical assistance in the hospital, as well as aiding healthcare providers. JW Hospital Liaison Committees (HLCs) operate in 110 countries around the world, including 1,700 chapters within the United States (9). Given the inherent challenges in obtaining bloodless care, the JW community has become sophisticated in healthcare matters. JW who accept blood may be subject to repercussions within their community, which reportedly can include shunning (8). This extends to their children who are aware of the prohibition (6,7). The JW community actively instills the importance of this prohibition, encouraging members to carry “blood refusal cards” and execute Advance Directives detailing their wishes regarding blood. The majority of JW interpret the Bible as prohibiting receiving whole blood products (5). There are an estimated 8.3 million JW in the world, primarily in the United States (1.2 million), Mexico (859,000) and Brazil (829,000) (3,4). This article provides background and practical tips for risk managers who may be asked to consult on cases involving the refusal of blood for minor patients from the JW community.
This may arise when working with families from the Jehovah’s Witness (JW) community, a group that largely rejects whole blood products, including transfusion. When the rationale for refusal is religion, and especially when the treatment being refused is potentially lifesaving, the situation becomes more complex. In most circumstances, this extends to a parent’s right to refuse treatment for their minor child (2). A fundamental right of modern healthcare is that a patient can refuse medical treatment (1).
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