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Do Jehovah's Witnesses really mean it when they refuse a blood transfusion?

Quebec's coroner is investigating the death of a Jehovah's Witness who died after refusing a blood transfusion. The law says you can refuse blood if the standards of free and informed consent are met, but physician and ethicist Ian Mitchell says religious doctrine can make true consent impossible.
Canadian law allows patients to refuse blood transfusions, even if the refusal may result in death.

Quebec's coroner has opened investigations into the deaths of two Jehovah's Witness women. 

Both Eloise Dupuis and Mirlande Cadet gave birth to healthy children, but died from complications following delivery. At issue, in both cases, is the ability of a Jehovah's Witness to refuse a blood transfusion. While the circumstances are unclear in the Cadet case, in Dupuis's case her aunt alleges she was pressured into refusing a blood transfusion.  

Éloïse Dupuis, 26, died from complications related to blood loss six days after giving birth to her first child by C-section. (Manon Boyer)

The current law upholds the right of a Jehovah's Witness to refuse a blood transfusion, even if it results in death.

But not everyone believes that those who refuse blood on religious grounds, do so independently.

According to Dr. Ian Mitchell, when the 1990 decision was made, it appeared to the Court that a well-informed and freely held religious belief was in need of defending.

Mirlande Cadet's brother says he doesn't believe his big sister would have refused a blood transfusion. (Isaac Cadet)

"But that was then, and this is now," says Mitchell in an interview with The 180's Jim Brown. 

Mitchell says since the ruling decades ago, accounts of coercion and misinformation about blood transfusions by Jehovah's Witness elders have surfaced, and that makes true and informed consent impossible. 

While he acknowledges that Jehovah's Witnesses carry a card saying "no blood transfusion," Mitchell isn't convinced it qualifies as an advanced directive. 

"These cards are signed in the presence of the [Jehovah's Witness] elders who witness them. And if they don't sign them, the people will ultimately be disfellowshipped, and disfellowship is no small thing. You lose all your family, all your friends, all your neighbours. They won't speak to you, so it's coercive."

And Mitchell adds that people are also lied to about the health consequences of a blood transfusion.

Dr. Ian Mitchell is a pediatrician and medical ethicist in Calgary. (Provided)

Given the misinformation and the accounts of coercion, Mitchell says he's dubious a judge today would make the same decision. 

And he acknowledges that the result of that decades old ruling is far from ideal.

On one hand, there are doctors who swear to do no harm. 

On the other hand, a legal ruling that if they disregard, would not only mean they are breaking the law, but could also result in years of litigation.

Ideally, Mitchell would like to see hospital administrators take action to prevent patients from being seen by the Jehovah's Witness Hospital Liaison Committees — groups of trusted and respected elders who are dispatched to a hospital when a member is facing a blood transfusion decision. 

Lawrence Hughes, a former Jehovah's Witness whose 16-year-old daughter refused a blood transfusion, says years of 'intense indoctrination' and 'undue influence' rob a Jehovah's Witness of free choice. (Lawrence Hughes)

Having had direct experience with them, Mitchell says their presence is unusual and uncomfortable. 

"They come in, they're well-dressed, there a number of them. They are persistent. They want to be part of every conversation a physician has with the family, which is very unusual. They have very specific medical suggestions to make, which is very unusual for people accompanying families  — not that we expect families to necessarily agree with us and not do their own looking — but it is unusual for family friends to come in and be so persistent and so specific on medical suggestions on treatment."

Mitchell says it's time hospitals did something to make sure patients are given the space, and information, to decide on their own whether to accept or refuse blood transfusions.


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