- Can you determine what that treatment was?
The RBC histogram demonstrates a dual population of RBC's
following transfusion.
- What issues arise when the patient refuses this therapy? What if the patient is a child and parents refuse therapy?
The one example that always gets discussed is the Jehovah's Witness. The lesson to be learned from the Witnesses is not exactly what most people think. It has something to do with religious freedom, but it really is much broader than that, and has to do with informed consent and the right to refuse treatment, even very obviously beneficial treatment (to health care professionals). One can, to put it harshly, make scientifically bad or 'irrational' decisions. And it does not have to be based on any particular religious beliefs. But religious beliefs are probably the single biggest source of values and beliefs that are not based on any empirical data or 'rational' reasoning. (That need not be an insult: it is a common part of the definition of religious belief that there is a 'test of faith' based upon accepting some unprovable claims about supernatural things. Those are all by a scientific definition non-rational topics.) Life and society are more than the sum of biochemical reactions.
It just happens that the Jehovah's Witness religion has chosen, as one of its central tenets, to challenge a widely used and beneficial medical intervention. Thus its notoriety. Remember that this religion predated transfusion therapy. But other people make other choices for other reasons that are just as frustrating to physicians, and just as deserving of respect. Neither doctors nor judges have the right to force people to accept someone else's definition of rational behavior, or to accept medical treatment they don't want.
When discussing this, someone will inevitably ask about the children of parents who are Witnesses. Note how that was stated: we did NOT say Jehovah's Witness children. That is a hint as to why we treat them differently. The children of Witness parents are treated the same as all other children: they are protected by the state from what society as a whole considers bad decisions made by their parents. Thus if the child of a Witness needs a transfusion, there are always judges on call 24/7 who will give authorization to transfuse without the parents' consent (or over the parents' protest). In the best one-liner ever written in health care law, by the great jurist Benjamin Cardozo (he became a U.S. Supreme Court Justice): 'Parents can make martyrs of themselves, but not of their children.'
