Tokyo psychiatrist, Dr. Douglas Berger, comments on “Blood, Truth—and the Decision to Transfuse” by Cynthia Geppert, MD, MA, MPH, MSB, DPS, June 03, 2016 issue of the Psychiatric Times.

I think Dr. Geppert made this case more complex than necessary.

  1. S can only act as surrogate if state law allows, and then the hospital legal dept needs to confirm S fulfills the criteria. The case is stated as emergent and so there is no time to investigate S’s status, so she has no confirmed legal connection to Mr. M for this current decision.
  2. Mr. M’s status as stated Jehovah’s Witness is not relevant. The only relevant issue is whether he has decision-making capacity or not to understand the proposed treatment and its risks and benefits. Any competent person can decide they want to refuse, or accept, a medical treatment based on whatever reason they say is their reason, whether they decided to be a certain religion on a sudden whim, or decided to exit a certain religion on a sudden whim is free-choice and not relevant for the right to choose medical care.

Mr. S either has decision-making capacity to refuse or he does not at the point he is being evaluated.

If he seems not to have the capacity, then he can be transfused or given other non-blood products as the team sees appropriate. His decision-making capacity may change over time and he can be reevaluated. The consulting psychiatrist already thinks he has a delirium…

If he has the decision-making capacity, then he can refuse any treatment. I would have him write himself, or dictate to the psychiatrist making the capacity decision along with a staff acting as witness that what he dictated was accurately transcribed, that he wishes to refuse the transfusion, why, and his knowledge of the risks and benefits. I would keep a copy and place a copy in his chart.

Doug Berger, M.D., Ph.D.
US Board Certified Psychiatrist
Tokyo, Japan

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