More often than not, the behavioural patterns of humans are guided by beliefs. These beliefs are products of our existence and involvements in societies we find ourselves. They can be religious, societal, political etc.
This analysis is based on Jehovah Witnesses’ religious stance on blood transfusion. It is worthy to note that the analysis will be restricted to the legal implications of this belief leaving out the biblical exegesis.
Blood transfusion is the lifesaving procedure of transferring blood or blood components from one person (the donor) into the bloodstream of another person (the recipient). Jehovah Witnesses believe that the Bible prohibits Christians from accepting blood transfusions. Several biblical references that supported this belief are Leviticus 17:11, Leviticus 3:17, Acts21:25, etc.
This article sets to answer these questions: can an adult Jehovah Witness reject blood transfusion even in a life-threatening situation? Who bears the liability if such a refusal leads to death – the doctor or the patient? What happens in a case where this life-threatening situation involves a child who cannot make a decision? Who makes the decision? The parents or the Courts?
In answering the questions, attention will first be paid to the case of Medical And Dental Practitioners Disciplinary Tribunal v. Dr Okonkwo.
FACTS OF THE CASE
Mrs. Okorie and her husband are Jehovah Witnesses. She was a patient of the respondent. While at the respondent’s hospital, she refused the transfusion of blood or any bloody material to her body, and she signed an undertaken that no matter what happens, that blood should not be transfused to her. Her undertaken read that: “I Martha K. Okorie, direct that no blood transfusions be given me, even though physicians deem such vital to my health or my life. I accept non-blood expanders, such as Dextran, saline or Ringer’s solution, hetastarch, I am 29 years old and execute this document of my own initiative. It accords with my rights as a patient and my beliefs as one of Jehovah’s witnesses. The Bible commands: keep abstaining from blood”. (Acts 15:28,29). This is and has been, my religious stand for 6 years. I direct that I be given no blood transfusions. I accept any added risk this may bring. I release doctors, anesthesiologists, hospitals, and their personnel from responsibility for any untoward results caused by my refusal, despite their competent care. In the event that I lose consciousness, I authorize either witness below to see that my decision is held. The respondent accepted her undertaken and proceeded to treat her without transfusing blood.
However, the patient died on 22nd August, 1991. The mother and uncle of the deceased then charged the respondent before the Medical and Dental Practitioners Disciplinary Tribunal. Due to procedural defects by the Tribunal, the respondent was held guilty. His appealed to the Court of Appeal was successful and the tribunal now brought the case before the Supreme Court.
THE JUDGMENT
The principle of law held was that a competent adult has the constitutional right to choose whatever medical treatment he or she wants without interference by the medical practitioners. As held by Ayoola JSC, ‘the patient’s constitutional right to object to medical treatment or, particularly, as in this case, to blood transfusion on religious grounds is founded on fundamental rights protected by the 1999 Constitution as follows: (i) right to privacy: section 37; (ii) right to freedom of thought, conscience and religion: section 38…. the sum total of the rights of privacy and of freedom of thought, conscience, or religion which an individual has, put in a nutshell, is that an individual should be left alone to choose a course for his life unless a clear and compelling overriding state interest justifies the contrary.’
The Court further stated that when faced with this dilemma, a doctor has a duty to inform the patient or relatives of the potential risk of non-refusal of blood transfusion without any imposition of the doctor’s preferred mode of treatment.
By contrast, in a Canadian case of Malette v. Shulman 47 DLR (4th Edition) 18, Malette was injured in a car accident and was unconscious. Dr Shulman administered blood transfusions to save her life, despite being aware of Malette’s religious objections to blood transfusions as a Jehovah Witness. The defendant was found liable for battery and held to pay the plaintiff 20000$ in damages. Under the doctrine of informed consent, a doctor cannot perform a medical operation unless he has the consent of the patient.
Furthermore, there is also the exception of a life threatening situation, where the person has a religious belief, but such a person is unconscious or mentally incapable of consenting to the treatment as well as the absence of a surrogate decision maker, the doctor may proceed to save his life because it is in his best interest. This is known as the Best Interest exception. It applies in medical emergency situations. At that point, as long as he can’t consent or no one is there to consent on his behalf, then whether or not he is a Jehovah Witness, the doctor will not be liable because the treatment was is in his best interest.
WHEN IT INVOLVES A CHILD
Unlike the aforementioned cases that involved competent adults and doctors, when the question involves a child, the principle will change because the Courts always step in. In a 2019 case of Tega Esabunor & Anor & v. Dr Tunde Faweya (2019) LPELR-SC.97/2009, a child who belonged to Jehovah Witnesses fell ill after a month of his birth. His parents made it abundantly clear that on no account should their child (the 1st appellant) be given blood transfusion. Unyielding, the respondent (Dr Faweya) saved his life through a blood transfusion after gotten a Court order enabling him to do so. He was then sued by the appellant for the trespass of transfusion on the body of the 1st appellant without consent.
The court held that: ‘when a competent parent or one in loco parentis refuses blood transfusion or medical treatment for her child on religious grounds, the Court should step in, consider the baby’s welfare, i.e. saving the life and the best interest of the child, before a decision is taken. These considerations outweigh religious beliefs of the Jehovah Witness Sect.
The rationale for this is that the survival and total well-being of a child in the Nigerian society is not within the purview of the parents alone. See S.13 and 59 of the Child’s Right Act 2003.
In addition, the Court held the view that ‘it could have amounted to a great injustice to the child if the Court had stood by and watched the child being denied basic treatment to save his life on the basis of the religious conviction of his parent. He probably would not be alive today’.
In conclusion, though the parties in these cases are Jehovah Witnesses, the principles held in those cases are of universal application to everyone in Nigeria. A competent adult, exercising his rights under S.37 & 38 of the Constitution, has the right to choose his/her medical treatment which a medical practitioner is bound to follow. However, when it involves a child, the safety of such a child overrides any religious convictions.
Thank you for reading. See you next Year and Merry Christmas in advance❤.
THELEGALSTANDPOINT 