title: When a patient refuses life-saving care: issues raised when treating a Jehovah's Witness.
abstract: Patients who are Jehovah's Witnesses frequently cross the path of nephrologists when they are acutely ill in the intensive care unit and stable in the long-term setting. It is important that we as a group have a rudimentary understanding of their philosophy about blood transfusion so that we can be proactive in their management. We use a case as a launching point to discuss the origins of the faith and the decision to refuse blood, as well as potential therapeutic strategies that can be used to improve the care of these patients. Improvement in our understanding as physicians will facilitate a more productive conversation with our patients about a complex and emotional issue.
authors.affiliation: Yale Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Panico
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Jenq
authors.forename: Ursula C
authors.initials: UC
authors.lastname: Brewster
mesh_terms: D000740:Anemia / Q000209:etiology / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D000925:Anticoagulants / Q000009:adverse effects; D001291:Attitude of Health Personnel; D001803:Blood Transfusion / Q000941:ethics / Q000523:psychology; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000209:etiology; D015658:HIV Infections / Q000150:complications; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D033221:Jehovah's Witnesses / Q000523:psychology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation / Q000941:ethics / Q000523:psychology; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010949:Plasma; D017713:Platelet Transfusion / Q000941:ethics / Q000523:psychology; D011369:Professional-Patient Relations / Q000941:ethics; D040841:Resource Allocation / Q000941:ethics; D012944:Social Support; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D016312:Treatment Refusal / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology
chemical_list: D000925:Anticoagulants; D006397:Hematinics