Kathleen asked:

I'm taking a course in philosophy of health care. One of thediscussion questions was: In severe pain
a patient refused the surgeons' offer to describe to the patient the nature and consequences of the
procedure. She said that she trusted his judgement. The surgeon went ahead with the surgery and
he gave her a blood transfusion that was necessary to save her life. It turned out that the patient was
a Jehovah witness. She now wants to sue the doctor for not asking her consent in the matter,Do
you think that she had in fact provided valid, informed consent?

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I am assuming that the surgeon did not know that the patient was a Jehovah's Witness. We have to
look at this question from two perspectives:

When the surgeon offered to describe the nature and consequences of the procedure, he assumed
that the patient's concern was merely about the consequences for their health, or the risks involved in
the operation. Had he considered the possibility that the patient might be a Jehovah's Witness, he
could not reasonably have taken the patient's refusal of his offer as consent to a blood transfusion,
given that he had not called the patient's attention to this matter. On the other hand, if the surgeon did
not consider the possibility that the patient might be a Jehovah's Witness, then that might be
considered negligence on his part.

Most people are not Jehovah's Witnesses. Therefore, given that the issue of blood transfusions is a
very important one for a Jehovah's Witness, the patient ought to have volunteered this information. It
is surely incumbent on any Jehovah's Witness going into an operation to request that they should not
be given a blood under any circumstances, without waiting to be asked.

If one is looking to apportion blame, I feel that some blame must fall on both sides.

However, the question is 'Did the patient provide valid, informed consent?' The patient did not provide
informed consent, because she declined the offer to be informed. It is a patient's right to be told the
nature and consequences of an operation. In this case, however, the patient waived that right. It is
irrelevant that neither she nor the surgeon had considered the issue of blood transfusions. The only
question that will be before the Court is whether the right to be informed can be waived. If it can, the
patient does not have a case against the surgeon.

Geoffrey Klempner