I recently had a patient referred to me with a partially obstructing sigmoid carcinoma. His HCT was 45 and a CT scan revealed a moderate sized sigmoid mass without invasion of adjacent organs, ureteral obstruction, visible lymphadenopathy or hepatic metastases. The patient is a Jehovah’s Witness and agreed to surgery on the condition that I would agree not to transfuse him.
I scheduled him for surgery, but our anesthesiologists informed him that they would not promise not to give him blood if, for some reason, his life depended upon it. Despite the negligible possibility that he would require intraoperative transfusion, the patient insisted upon a promise of no transfusion, and as this was not forthcoming, decided to seek care at a larger hospital about 50 miles away.
Needless to say, this is an ethical dilema. I am willing to operate on Jehovah’s Witnesses when there is a low risk they will require transfusion, and believe that a competent and fully informed adult patient has the right to decide what is to be done with his or her body. However, since I am in a small hospital with only two anesthesiologists, and since they refuse to promise these patients that they will not transfuse them, many Jehovah’s Witnesses will not agree to surgery in my hospital.
I considered the possibility of the cell saver, but to my knowledge, this is contraindicated in the case of both bowel surgery and cancer surgery.
Our anesthesiologists maintain that most of their colleagues will not agree to withold life-saving transfusion, but frankly, I doubt their veracity, considering the number of Jehovah’s Witness patients who do undergo surgery. At the same time, I am not comfortable forcing a physician to do something that he or she feels is ethically wrong.
What I am wondering is, how many anesthesiologists share these views, and how many are willing to comply with the wishes of a patient not to receive blood under any circumstance? In your institution, what percentage if any of your anesthesiologists are willing to provide anesthesia with these constraints? I am also curious as to how many members of this discussion group do and how many refuse to operate on patients who unequivocally refuse transfusion.