Management of Patients Who Refuse Blood Transfusions for Religious Reasons

NTT Medical Center Tokyo Guidelines

The NTT Medical Center Tokyo Ethical Review Board indicated hospital policies regarding this matter on September 5, 1990 and July 27, 1999. Thereafter, a joint committee of five related academic and professional associations in Japan (The Japan Society of Transfusion Medicine and Cell Therapy, Japan Surgical Society, Japan Pediatric Society, Japanese Society of Anesthesiologists, and Japan Society of Obstetrics and Gynecology) published the “Guidelines Regarding the Refusal of Blood Transfusions for Religious Reasons” considering patients’ rights and informed consent on February 28, 2008Based on these Guidelines, the hospital has newly formulated its “Management of Patients Who Refuse Blood Transfusions for Religious Reasons”.

Ⅰ.Basic Hospital Guidelines Regarding the Refusal of Blood Transfusions for Religious Reasons

1. If a patient indicates their intent to refuse blood transfusions for religious reasons, the hospital will comply with their wishes with regards to general treatment and procedures from the perspective of respect for personal rights, however, in emergency situations where transfusion is determined to be essential as a life-saving measure, transfusion will be performed (relative non-transfusion).
2. If a patient seeks medical care in which transfusions will not be performed under any circumstances (absolute non-transfusion), no agreement consenting to bloodless procedures or treatment should be signed. Even if the patient or the patient’s family requests to submit a waiver based on the premise of absolute non-transfusion, the hospital should not accept this waiver.

Ⅱ.Treatment Policy for Patients who Refuse Blood Transfusions for Religious Reasons

1. Physicians who are assigned a patient who refuses blood transfusions for religious reasons should immediately report to and consult with the hospital director or head of their clinical department.
2. The physician shall indicate these Guidelines to the patient in question and explain the hospital’s treatment policy for patients who refuse blood transfusions for religious reasons.
3. The contents of the explanation to the patient and their family and the status of treatment should be indicated in the medical records without delay.

Patients Aged 18 and Over

Explain the hospital’s basic policy of relative non-transfusion to the patient, explaining that it applies to normal clinical practice such as general procedures and surgeries where there is sufficient time, and give the patient an opportunity to make a decision. If the patient agrees to relative non-transfusion, obtain a transfusion consent form. However, if the patient seeks absolute non-transfusion where transfusions will not be performed under any circumstances, explain that the hospital is unable to accept them as a patient for ethical reasons.
In cases where a patient requiring emergency transfusion comes to the hospital or a patient requires emergency transfusion during hospitalization due to a sudden change in their condition and there is no time for the patient to make a decision or transfer to a different hospital, the hospital will make the utmost effort to explain the need for transfusion to the patient and their family as time permits and obtain their consent; however, if consent cannot be obtained, the hospital will prioritize life-saving measures and apply its policy of relative non-transfusion to perform a transfusion.

Patients Aged 15 and Over to Under 18

If both the patient and their parent or guardian refuse transfusion, the policy for patients aged 18 and over shall apply.
If the patient seeks transfusion but their parent or guardian refuses, that patient shall submit the transfusion consent form.
If the patient refuses transfusion but their parent or guardian seeks it, the patient’s wishes will be respected; however, if their situation is such that there are no other life-saving measures available, their parent or guardian shall submit the transfusion consent form.

Patients Under Age 15

If both parents or guardians (father and mother) refuse transfusion, the policy for patients age 18 and over shall apply. If a situation should arise where medical care would be obstructed, the hospital shall notify the child welfare center, and the child welfare center shall notify the family court of the loss of parental authority, and the representative with parental authority determined by the provisional disposition shall give the consent to perform the transfusion. If there is no time to go through this process, the hospital shall prioritize life-saving measures based on the premise that “refusing transfusions for a patient under age 15 whose ability to make autonomous decisions is not fully developed is an abuse of parental authority” and apply its policy of relative non-transfusion to perform a transfusion.
If one parent or guardian consents while the other refuses, the hospital will make an effort to obtain the consent of both parties; however, if an emergency arises where there are no other life-saving measures, the parent or guardian consenting to transfusions shall submit the transfusion consent form.

Ⅲ.Other

The hospital will provide information on its treatment policy for patients who refuse transfusions for religious reasons on its website.

Version 1 prepared on July 27, 1999
Title of individual responsible for preparing and storing this document: Chairperson of the NTT Medical Center Tokyo Ethical Review Board
Date of last revision: July 14, 2015
Title of individual responsible for disseminating revisions: Director of the Quality Improvement Department
Date of last confirmation: July 14, 2015
Title of individual responsible for confirmation: Chairperson of the NTT Medical Center Tokyo Ethical Review Board