The right to die for Jehovah

By Clare Murphy
Health reporter, BBC News

A young Jehovah's Witness has died just hours after giving birth to twins. She had signed a form refusing blood transfusions, and her family would not overrule her. Couldn't doctors have intervened?

No thanks: Jehovah's Witnesses have firm beliefs on blood

If they had, they may well have been charged with a criminal offence, and would not have had a legal leg to stand on in court.

The UK places great emphasis on respecting the religious convictions of patients - and increasingly the doctors who treat them too.

There is nothing medics can do when an adult refuses treatment on religious grounds, says Vivienne Nathanson, head of ethics at the British Medical Association.

"It's something we just have to live with - the alternative would be to change the law, change the human rights law," she says. "It's just too important that we all as individuals are able to make our own decisions."

Can't decide

There are exceptions.

Doctors treating children can obtain court orders to override the wishes of both child and parents, if they believe treatment to be in the best interests of their patient.

And any man from the house of Israel, or from the aliens who sojourn among them, who eats any blood, I will set My face against that person who eats blood, and will cut him off from among his people Leviticus 17:10 Mother dies after refusing blood

But in practice, this rarely happens, as most Jehovah's Witnesses accept their children are not old enough to make an informed decision about faith.

But there are also grey areas when it comes to adult consent.

In a landmark case from 1992, a court allowed a blood transfusion to be carried out on a 20-year-old lapsed Jehovah's Witness who declined treatment after a road accident.

A judge ruled she had been pressurised by her mother and that her ability to make a decision about the transfusion was impaired by the drugs with which she was being treated.

New guidelines being drawn up by the General Medical Council are likely to stress that when a patient is judged to lack the capacity to make a decision, doctors should act in what they believe is the patient's best interests.

But it will also restate that a "competent" patient's decision to refuse treatment is their right, and there is nothing to suggest that Emma Gough, the mother of the twins, was not in a sound state of mind when she signed that form.

Mother v baby

There is no other religion currently practised in the UK which takes such a hardline on one particular treatment, a belief based on the Witnesses interpretation of Bible verses that forbid Christians from ingesting blood.

We are ever more favourably received - doctors are increasingly sympathetic to needs of the community David Jones Jehovah's Witness liaison committee

Their views can spark immense upset, blamed for unnecessary deaths, as can their demands for special bloodless treatment, which can be both costly and ineffective.

But Jehovah's Witness liaison committees, who advise both doctors and patients on alternative treatments, are now firmly established in many UK hospitals.

"We are ever more favourably received - doctors are increasingly sympathetic to needs of the community," says David Jones, a member of the committee for North Bristol NHS Trust.

"We have drawn up detailed care plans for everything from heart surgery to giving birth, including ways to stem postpartum haemorrhage. All hospitals should have access to these."

Figures for the numbers of Jehovah's Witnesses who die as a result of their beliefs are not readily available, but childbirth and the risk of haemorrhage or blood loss after a Caesarean does seem to be a risky area.

And other countries are not quite as tolerant of mothers' religious convictions.

Like Emma Gough, a young woman in Dublin lost a lot of blood after giving birth to a healthy baby a year ago. A Jehovah's Witness, she too refused a transfusion.

But an emergency ruling permitted the hospital to carry out the procedure, arguing that the right of the newborn baby to have a family life overruled the mother's right to refuse treatment.