Blood Transfusions and Advance Directives

A harsh reality is that any of us could find ourselves confined to a hospital bed after an accident. Often, the victim of a major accident will require blood transfusions as part of the treatment and recovery process. Not surprisingly, blood transfusions are an emergency procedure with a limited window of time, an invasive procedure, and one that can have long-lasting effects on the recipient. 

How can one go about planning for the potential of requiring a blood transfusion? What if religion or other personal preferences bar someone from receiving a blood transfusion? An advance directive is a viable solution. An advance directive is a way for someone to plan out how they want their health and treatment to be handled when they are unable to make the decisions for themselves. This is known as a durable power of attorney for healthcare, and it only grants decision-making authority over health-related decisions. 

Do you have a plan in place if you’re in need of an emergency blood transfusion? Unfortunately, many Americans do not, and often do not even understand that it’s possible to create a plan for this scenario. This article will go over the basics of advance directives, focusing on how they can be applied in preparation for an emergency blood transfusion.

What Is a Blood Transfusion?

A blood transfusion is a medical procedure that is performed when a patient has sustained life-threatening blood loss. The process takes blood gathered from a third party and often well in advance of the procedure and transfers it into the patient via a tube placed within a vein, typically located in the arm. 

A transfusion is typically carried out in the event of a physical accident resulting in major blood loss, or in the event of a disease or other disorder where the body cannot properly create its own blood cells. The primary components of blood include red cells, white cells, plasma, and platelets. Most transfusions focus on only supplying certain isolated elements of blood. However, while less common, some procedures require “whole blood” transfusions.

Blood transfusions are reliably safe, but complications can occur. A common complication is a blood borne infection, although blood that is set aside for transfusion is heavily tested and risk of a blood borne infection spreading during the procedure is very unlikely. Other complications include acute immune hemolytic reactions, where the immune system attacks the donated blood due to incompatibility, typically derived from an improper blood type being transfused. Another unfortunate scenario involves the white blood cells from the donated blood attacking the recipient’s bone marrow, although this is limited to those with very weak immune systems, such as those of leukemia or lymphoma patients.

What Is an Advance Directive? 

Advance directives consist of two types of documents. The first is a health care proxy, where a trusted health care agent – someone who has the power to make medical and treatment decisions when the creator of the advance directive is incapacitated – is assigned. Without an advance directive, health care decision-making power is deferred to a close family member or relative, who may not have the same interests as the incapacitated patient.

The living will is the other important piece of an advance directive. A living will carefully lays out instructions on how the subject wishes to be dealt with in the event of a medical emergency, including a blood transfusion. 

Living wills also allow for immense flexibility. Subjects can direct professionals to use certain treatments, or provide specific limitations on how they must perform a procedure. For example, Laura knows that being on a ventilator, while lifesaving, creates a very poor quality of life that she wishes to limit. Laura can create a section in her living will which limits doctors’ use of a ventilator for a maximum of three weeks, then requests to be taken off at the end of that time frame, regardless of the status of her recovery.

When Might Someone Refuse a Blood Transfusion?

Let’s turn back to blood transfusions specifically. There are a variety of personal, moral, medical, or religious reasons for one to decline or outline specific limitations on blood transfusions. For example, Jehovah’s Witnesses must refuse blood transfusions on religious grounds because they believe that no blood not produced within a person’s body should enter their system. Although Jehovah’s Witnesses have extremely strict religious requirements surrounding blood transfusion, most other religions allow it to varying degrees that can be outlined in an advance directive.

Others might refuse on the grounds of preexisting medical conditions, such as rare immune system disorders. If a transfusion is rushed due to an emergency, a doctor might not be able to make a correct judgment call if the patient suffers from a highly uncommon condition that could be adversely affected by a blood transfusion. 

Regardless of whether it is a religious, medical, or personal decision, a doctor does not have a right to force treatment upon someone who would otherwise refuse if they had the capacity to do so. An advance directive is a reliable way to assert refusal regardless of the state of consciousness of the patient at the time of the procedure. 

Advance Directive as a Solution to Blood Transfusion Instruction

A patient refusing a blood transfusion creates a very tricky legal and ethical situation for doctors. Doctors have a duty to provide the best care to patients under the circumstances. If the circumstances call for a blood transfusion, then it puts the doctor in a difficult situation where they need to decide to provide the best care to the patient or respect their personal wishes regarding treatment, which may lead to a negative health outcome. However, advance directives can provide a viable, legal path to ensuring that the wishes of the patient are carried out in the event of a blood transfusion. 

In designing the living will, one may include language such as, “I direct that no transfusions of whole blood, red cells, white cells, plasma, or platelets be given to me under any circumstances…” Although it can be helpful to include a specific reason, it is not necessary to include any explanation as to why a blood transfusion is being refused. 

Further, in assigning a health care proxy, it is typically recommended to select someone who is well-aware of the blood transfusion limitation. If due to religious reasons, a proxy who is a trusted family member or close friend who is of the same religious denomination can be helpful. An estate attorney can be helpful in screening and selecting an appropriate health care proxy.

Why Hire an Attorney?

Medical issues can arise at any moment and render you incapacitated, occasionally requiring a procedure like a blood transfusion. While it’s difficult to contemplate such things happening, it’s always best to plan for them before they occur, rather than leave the decision to one’s family during a stressful time. An experienced estate attorney is an invaluable asset when it comes to selecting a health care proxy and designing an effective living will. 

At Rosenblum Law, we guide our clients through every step of the process and create an advance directive for them that will ensure that their wishes are followed and their family is prepared for any future possibility. Call us now to get started with a free consultation.

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