CASE STUDY

Blood Transfusion-Legal, Ethical & Professional Implications

Blood Transfusion-Legal, Ethical & Professional Implications

Introduction

This case is based on a scenario in which an old patient is refusing to blood transfusion treatment. On the other nurses are trying to persuade him. This paper explores the knowledge and understanding of ethical issues in health and social care practice in relation to blood transfusion. The practice of transfusion medicine involves a number of ethical issues because blood comes from human beings and is a precious resource with a limited shelf life. In 1980 the International Society of Blood Transfusion endorsed its first formal code of ethics, which was adopted by the World Health Organisation and the League of Red Crescent Societies. (Beauchamp & Childress, 2009) A revised code of ethics for donation and transfusion was endorsed in 2000. Blood donation as a gift, donor confidentiality, donor notification and donor consent, consent for transfusion, the right to refuse blood transfusion, the right to be informed if harmed, and ethical principles for establishments, are discussed in the international and Indian contexts. (Schwartz et al., 2002)

Ethics is basically a set of moral values or a code of conduct. The role of ethics in developing clinical practice guidelines and recommendations for health-care providers is to ensure that values that may not be adequately incorporated into the law are given reasonable consideration. The framers and the users of guidelines must be aware of the potential ethical conflicts inherent in many medical decisions, and the guidelines must reflect a thoughtful consideration and balancing of issues. (Hope et al., 2008)

The practice of transfusion medicine involves a number of ethical issues because blood comes from human beings and is a precious resource with a limited shelf life. It involves a moral responsibility towards both donors and patients. Decisions must be based on four principles: respect for individuals and their worth, protection of individuals' rights and well being, avoidance of exploitation, and the Hippocratic principle of primum non nocere or "first do no harm". (Schwartz et al., 2002)

Ethics is a dynamic process in relation to the state of scientific knowledge, public awareness and the local laws, at any given time and place. This is clear when we review the history of transfusion ethics. The earliest mention of human transfusion, in 1492, describes efforts to save the life of Pope Innocent VIII. Blood was extracted from three 10-year-old boys and transfused to the Pope. All three boys and the Pope died. Some two centuries later transfusion was attempted again. In 1667, Dr Richard Lower transfused sheep's blood to a mentally-ill man to cure him. The patient was given 20 shillings to undergo this experiment. The same year a 34-year-old man underwent repeat transfusions of calf's blood. This resulted in a classical haemolytic transfusion reaction and the court banned future transfusions. (Rumbold, 1999)

Human-to-human transfusion was resurrected by James Blundell, a London obstetrician, to save the lives of women with obstetric haemorrhage. By the early twentieth century, a number of advances had been made in transfusion medicine, in the ...