An anaesthetist was unsure how to proceed after clashing with a colleague over patient consent to receive blood products.

The scene

An ST6 in anaesthetics called the MDU's medico-legal helpline for urgent advice. She was reviewing the records of the first patient on the orthopaedic theatre list and noted that the records stated 'Jehovah's Witness - no blood'. This had not been noticed by the person who had completed the pre-operative assessment.

The patient himself had early onset dementia and the member considered that he would not be able to give informed consent to the use of blood products. His preoperative Hb was low at 112g/dl.

The anaesthetist had alerted the theatre team as soon as she read the information. The consultant surgeon was keen to proceed with the surgery and any necessary blood products, saying, 'what he doesn't know won't hurt him,' but had reluctantly agreed to wait whilst the anaesthetist obtained further advice.

The anaesthetist was unsure what to do. She was worried that she was wasting theatre time, and felt a little intimidated by the surgeon.

MDU advice

The medico-legal adviser clarified that the procedure was an elective one and could be safely postponed whilst further information was obtained, so an appropriate decision could be made in accordance with the Mental Capacity Act 2005 and an alternative plan considered if necessary.

The anaesthetist had quite rightly started with an assumption that the patient had capacity (despite the diagnosis of dementia) but had established that the patient lacked capacity to accept or refuse the use of blood products. She had also confirmed that there was no known advance decision to refuse treatment, nor was there a relevant power of attorney. The patient's only relative, his granddaughter, was driving to the hospital and was expected to arrive within the next two hours.

The adviser suggested that the procedure was delayed until after the anaesthetist had spoken with the granddaughter, to confirm whether or not the patient was indeed a Jehovah's Witness and would have refused blood products. However, the granddaughter could not make the decision for the patient, and as there was no relevant advance decision or power of attorney, the clinical team were left in the position of having to reach a 'best interests' decision.

In order to do so they would need to try and establish what they could about the patient's previously expressed views on the matter and the views of also important of family members or carers. The adviser also explained that it would be important to make sure that the assessment of capacity and these discussions, as well as the views of the relevant members of the medical team, were documented.

The GMC's guidance on personal beliefs and medical practice makes clear that the doctor's words and actions must not imply judgement of the patient's beliefs and values.

Guidelines offered by the Joint UKBTS Joint Professional Advisory Committee (JPAC) state that many Jehovah's Witnesses will accept the transfusion of derivatives of primary blood components, and there is usually no objection to intraoperative cell salvage, or to recombinant products. The anaesthetist was happy to discuss with the surgeon whether any of these options could be used in this case.

The GMC's guidance on personal beliefs and medical practice makes clear that the doctor's words and actions must not imply judgement of the patient's beliefs and values.

Once they had further information from the patient's granddaughter, the adviser recommended that the member and the surgeon speak with the trust solicitor to make sure their decision of whether or not to proceed was supported by the trust.

The member was reassured that she had done the right thing in alerting the team to the issue and seeking further advice, particularly as there was a difference in opinion within the team.

This page was correct at publication on 06/06/2017. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.