Case Scenario: MOTHER REFUSES TREATMENT, SPOUSE AGREES

Vega, a Jehovah's Witness, executed a release requesting that no blood be administered to her during her hospitalization. Vega's husband also signed the release. She delivered a healthy baby. After the delivery, Vega bled heavily. Her obstetrician, Dr. Sood, recommended a dilation and curettage (D&C) to stop the bleeding. Although Vega agreed to permit Sood to perform the D&C, she refused to allow a blood transfusion. Before undergoing the procedure, she signed a second release refusing any transfusions and releasing the hospital from liability. Despite the D&C, Vega continued to hemorrhage. Because Sood and the other physicians involved in Vega's care believed that it was essential that she receive blood in order to survive, the hospital requested that the court issue an injunction that would permit the hospital to administer blood transfusions. The trial court convened an emergency hearing at the hospital and appointed Vega's husband as her guardian.

At the hearing testimony, Vega's husband testified that, on the basis of his religious beliefs as a Jehovah's Witness, he continued to support his wife's decision to refuse transfusions and believed that she would take the same position if she were able to participate in the hearing. The court, relying on the state's interests in preserving life and protecting innocent third parties, granted the hospital's request for an injunction permitting it to administer blood transfusions. Vega was given blood transfusions. She recovered and was discharged from the hospital. Vega sued, arguing that if her refusal of blood transfusions interfered with certain state interests, it should be the state itself, not a private hospital, that asserts state's interests. The hospital responded that because it was charged with Vega's care it had a direct stake in the outcome of the controversy and was a proper party to bring the action. The hospital had a legitimate interest in receiving official guidance in resolving the "ethical dilemma" it faced: whether to practice medicine by trying to save a patient's life despite that patient's refusal to consent to treatment or to practice medicine in accordance with the patient's wishes and likely watch the patient die, knowing nonetheless that it had the power to save her life. The hospital had conflicting interests and was in the role not of opposing its patient but of a party seeking the court's guidance in determining its obligations under the circumstances.

Vega claimed that the state's interest in the welfare of her child is not sufficiently compelling as to outweigh her interest in refusing blood transfusions. Vega maintained that the trial court's injunction, issued at the behest of the hospital, violated her commonlaw right of self-determination, her federal constitutional right to bodily selfdetermination, her federal constitutional right to free exercise of religion, and her state constitutional right of religious liberty. The court concluded that, under the circumstances of this case, the issuance of the injunction, followed by the administration of blood transfusions, violated Vega's common-law right of bodily self-determination. Although the hospital's interests are sufficient to confer standing on it in this case, they are not sufficient to take priority over Vega's common-law right to bodily integrity, even when the assertion of that right threatens her own life. The hospital had no common-law right or obligation to thrust unwanted medical care on a patient who, having been sufficiently informed of the consequences, competently and clearly declined that care. The hospital's interests were sufficiently protected by Vega's informed choice, and neither it nor the trial court was entitled to override that choice. Vega's common-law right of bodily self-determination was entitled to respect and protection.

Ethical and Legal Issues

1. What would you do if a patient refused a blood transfusion and the spouse agreed with her decision, knowing that a blood transfusion may be necessary to save her life?

2. Should a hospital challenge a patient's refusal of lifesaving blood transfusions?

3. Does the administration of a blood transfusion violate a patient's common-law right to bodily self-determination?