A Quebec coroner has found that the refusal of blood transfusions played a key role in the deaths of two Jehovah's Witnesses who died of childbirth complications last year.
Dr. Luc Malouin looked into the deaths of Mirlande Cadet, 46, and Éloïse Dupuis, 26, after they died in separate incidents at hospitals in Montreal and Quebec City.
Blood transfusions are forbidden under Jehovah's Witness doctrine, which holds that the Old and New Testaments command them to abstain from blood. Quebec law upholds the right of adult Jehovah's Witnesses to refuse blood as long as their decision is considered "free" and "informed."
In his report about Dupuis's case, Malouin pointed out that sometimes, doctors and medical staff find themselves in "untenable" situations.
"On the one hand, they have taken the oath to protect and save human life and, on the other hand, they have an obligation to respect their patient's freedom of choice, even if they know that ultimately that choice will kill them when a simple medical treatment could prevent that death."
Would rather die than receive blood
Dupuis died of multiple organ failure following major blood loss at Hôtel-Dieu de Lévis Hospital near Quebec City on Oct. 12, six days after giving birth. Her child, a son, survived.
Malouin said he consulted her medical files, and saw that from the beginning of her pregnancy, numerous conversations were had between her and the staff at a birthing centre in Saint-Romauld, a Quebec City suburb, about blood transfusions. Every time, she reiterated her refusal to receive one.
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The report outlines at least 10 times where Dupuis, her parents or her partner, acting on her wishes, refused blood transfusions, including once when she told doctors at Hôtel-Dieu she would rather die than receive a blood transfusion.
Malouin determined the only thing that could have saved her life was receiving a blood transfusion.
Dupuis went into labour Oct. 5 and made her way to the birthing centre. Upon her arrival, she once again stated that she did not want to receive any blood transfusions or blood products on account of her faith.
Complications with the baby's health led to her being transferred to Hôtel-Dieu where she eventually gave birth. But in the hours that followed, complications arose including major bleeding that doctors could not stop. She was transferred to the intensive care unit.
Over the following hours and days, Dupuis developed severe anemia, coagulation problems, a rapid heart rate (tachycardia), lactic acidosis and had a hysterectomy.
Freedom to choose
Her partner, Paul-André Roy, released a statement early Tuesday saying Dupuis was an "intelligent woman with deep personal beliefs."
He said she revisited her decision throughout her pregnancy and during the childbirth process and chose to keep refusing transfusions.
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Her aunt Manon Boyer alleged that Dupuis was pressured into refusing treatment by Jehovah's Witness elders, but Roy refuted that notion, saying they provided her with information but never tried to influence her decision.
The coroner came to the same conclusion, saying he did not believe Dupuis was forced into making her choice.
Boyer said she is still convinced her niece was pressured into refusing treatment, pointing out that for her whole life, she was discouraged from receiving blood transfusions.
"I agree with freedom of religion but not at any price. Not at the price of a life," she said.
She also questioned the idea that Dupuis gave free and informed consent due to of the amount of pain and stress she experienced in the last week of her life.
Was transfusion too late?
Cadet, the second woman, died Oct. 3, 2016, from complications after giving birth to a healthy baby boy by caesarian section at St. Mary's Hospital.
According to the report, she clearly stated when she was admitted that she refused to receive any blood transfusions.
After the operation, her vital signs and hemoglobin count began to drop. Her husband reiterated Cadet's wishes not to receive blood to the medical team.
Cadet's parents eventually convinced her husband to allow the blood transfusion to go ahead, which it did, six hours after her vitals began to drop.
"It is impossible for me to determine specifically whether the time required to provide blood products had a significant impact on the [death]," Malouin said.
Cadet's condition continued to worsen until she died from respiratory failure at the McGill University Hospital Centre.
Her brother, Isaac Cadet, told CBC News not long after she died that he doubted his sister would have signed a document refusing a blood transfusion.
The Quebec Civil Code stipulates that an adult who is of sound mind and well informed has the right to accept or refuse medical treatment.
Health Minister Gaétan Barrette said the coroner's reports show health officials did all they could to help the two people. However, they could not overstep the patients' rights.
"We live in a society of freedoms and religious rights," Barrette said.