THE RIGHT OF JEHOVAH'S WITNESSES TO REFUSE AND TO ACCEPT BLOOD TRANSFUSION PRAVO JEHOVINIH SVEDOKA DA PRIHVATE ILI ODBIJU TRANSFUZIJU

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Contributions to Authorship
The aim of this paper is to answer the following questions: whether a patient who is a Jehovah's Witness has the right to accept or refuse transfusion; is it allowed to administer blood transfusion to  Jehovah's Witnesses also put a ban on organ transplant for a certain period of time. 10  the WTS corporation started to meticulously implement their doctrine on blood transfusion among their followers and they introduced the so-called -no-blood card‖, which is a specific form. being a proposed sanction, and denunciation, as a means through which the organization receives information on potential transfusion, add to the effectiveness of the imposed blood transfusion ban.
It is hard to believe that an individual, when threatened with such a grave and contingent punishment, has the actual freedom of choice. Free will, being an essential element of the choice on whether to accept or refuse the blood transfusion, is rarely present among Jehovah's Witnesses.

Jehovah's Witnesses right to refuse the blood transfusion
A medical procedure is not allowed without a patient's consent, as freedom of will and personal integrity are above reasons that exist due to medical nature. xxvii Every individual that is capable of giving consent in regard to accepting a medical intervention can also refuse it, no matter how dangerous or mindless that might seem. This principle lies on one's right to make their own decisions and choices. Unlike the paternalistic traditional medicine and its main principle that -saving a patient is the ultimate law‖, modern ethics and the concept of patients' rights along with the modern medicine insist that -patient's will is the ultimate law‖. xxviii The concept of informed consent was adopted in the Convention for the Protection of Human Rights and Dignity of the Medical procedure that is against patient's will can only be performed in exceptional cases which are explicitly prescribed by law and in accordance with medical ethics. xxxiv The right of a patient capable of rational thinking to refuse a medical treatment even exists in the case where the treatment would save or preserve one's life. xxxv Respecting patient's rights on consent is also a physician's ethical duty. xxxvi Accepting blood is a particularly sensitive medical topic. This is the reason why the law prescribes special rules for the form in which consent to accept blood is given, and of free will, who has been previously informed about considerable risks by a qualified physician, persistently refuses transfusion, then one should not receive it.

The right of Jehovah's Witnesses to accept blood transfusion
Absolute obedience regarding religious bans does not exist in cases of bans that are related to health. It is possible and permitted by the positive law that a follower accepts a medical procedure that is prohibited by religious norms. Certain research has documented that Jehovah's Witnesses could be willing to accept the transfusion. 18  individual, not as a -sect‖. Medical doctor must never consider an individual patient to be the same as religious group to which that patient belongs. Wrong actions might be undertaken should a patient be treated merely as a religious follower. A physician with such perception will not provide appropriate treatment to a patient, due to their unfavorable standing on a -religious sect‖. Reverse scenario might be that a physician who considers that a Jehovah's Witness patient is the same as their religious organization, might involve the WTS in the entire treatment and decision process, due to the appreciation towards the minority religion group and his personal dislike towards traditional church. In that case, a physician will consult the leaders of the Jehovah's Witnesses and their hospital liaison committee members, thus allowing them to make a decision on transfusion.

Patient in a state of unconsciousness
Unconscious patients cannot make a decision for themselves. Medically indicated intervention is in the patient's interest, therefore, it is considered that the patient would agree with the procedure. 43 The Convention on Human Rights and Biomedicine stipulates that a medical intervention may only be carried out on a person who does not have a capacity to consent, for his direct benefit. xliv According to the Convention, a risky medical intervention, such as giving someone else's blood to an unconscious patient, may be undertaken if there is no alternative of comparable effectiveness. Risks which are incurred in that situation should not disproportionate to the potential benefits of the transfusion. 45 Laws on patient's rights also stipulate that an urgent medical procedure can be performed on a patient in a state of unconsciousness without their consent. Such medical procedure is provided based on consiliummedicum. Immediate family members must be informed about the medical procedure performed without patient's consent, whenever possible. 46 Medical ethics states that a physician is to administer urgent medical procedure to a patient in a state of unconsciousness even without patient's consent. 47 Being given someone else's blood, in case there is no alternative equally efficient, is a medical intervention that can produce real and direct benefit for the recipient's health.Lex specialisregulating transfusion permits administering blood transfusion to a patient in a state of unconsciousness, or in other cases when patient is unable to provide consent. Under these circumstances physician who is administering immediate medical care is allowed to opt for the transfusion without patient's consent. 48 Transfusion is regulated by the law and in modern medicine it is accepted medical procedure that directly benefits a patient whose life is in jeopardy. It can be undoubtedly concluded that the transfusion is allowed even in case a patient is in a state of unconsciousness without one'sprior consent, if administering the blood is Due to this, physiciansmust not blindly obey the instructions stated in the form. No-blood card, imposed by the WTS should only be taken into account. Legally, the act of -taking into account‖ is fulfilled if physicians acknowledge the form, if they assess whether patient's condition has changed since the form was signed, if they potentially consult each other and make a propernotification in a medical record. After all these formalities, physicians should maintain their approach, as they would towards any patient in a state of unconsciousness.

Autologous transfusion
Autologous transfusion in which own blood is being accepted, i.e., in which donor and receiver are the same person,has a number of advantages over allogeneic transfusion, in which a receiver is given someone else's blood. Risk of transmitting contagious diseases is eliminated. Also, shortage of blood supply is one of the reasons for the autologous transfusion. Medical advantages of autologous transfusion are ratio legis, due to which this method has the legal priority over allogeneic transfusion. Acting physician has a legal obligation to inform a patient about the possibility of autologous transfusion.Error! Reference source not found. The WTS has a different standing on autologous transfusion in comparison to allogeneic transfusion. Accepting someone else's blood, as well as giving own blood for someone else is prohibited. However, transfusion in which the donor and receiver are the same individual may be acceptable for this religious group. 12 The Law does not differentiate between intraoperative blood salvaging and autologous preoperative blood giving that would be used in the perioperative period. The WTS differentiates between autologous transfusion in which the blood is taken (and put back in the body) during the procedure itself and autotransfusion of predeposited blood (blood that was taken beforeand saved for the operation). Intraoperative blood salvaging is acceptable as per the WTS, if the extracorporeal circulation, circulation of blood outside patient's body, is uninterrupted. 52 Therefore, this method can, in an optimal way, resolve the conflict between the patient's right to refuse a medical treatment that is not in accordance with their religious beliefs and the need for him/her to receive an adequate medical treatment.

The right of a physician to cancel surgical intervention
Patients are obliged to actively participate in the protection, preservation and improvement of their health, having received medical care. 53 The duty of a patient to cooperate with health professionals is in direct relation with one's own health. If patients do not cooperate with a physician, they may bear consequences that would affect their own health. 54 Refusal to accept someone else's blood, in case when it is not possible to perform required medical procedure legeartis without allogeneic transfusion, could be consideredas a patient's refusal to cooperate. The Law does not prescribe neither legal nor financial penalty for a patient who does not cooperate with health professionals in the process of their own medical treatment. However, a physician is not required to act in the same manner concerning a patient who actively cooperates with a view to his own healing, in contrast to a patient who refuses to cooperate. A physician is permittedby the law to cancel further treatment, should patientsfail to fulfill their obligations, including the obligation to cooperate. Cancelling the treatment is to be followed by certain formalities, such as initial warning of the patientby a physician and, afterwards, a written notice by the physician to thedirector of the medical institution. 55 Article 14 of the European Convention on Human Rights prohibits discrimination, while recognizing rights and freedoms prescribed by the Convention. Along with the European Convention, Protocol No. 12 provides for a general prohibition of discrimination. 56 A physician, upon deciding whether to perform a procedure or not, cannot be influenced by potential discriminatory motives. Difficultieswith which bloodless surgery faces should not be an excuse for religious discrimination.Depriving of the right to heal, due to patient's religious affiliation, is a type of discrimination. Denying or restricting the right to heal on the grounds of religion could be considered as violation of equality crime. 57 In particular situations physicians should exercise their discretion to cancel the treatment due to the fact that a patient refuses blood transfusion, not only without any discrimination, but also restrictively. Technical conditions and lack thereof, as well as insufficient expertise of medical staff, could be a fair reason due to which a on a Jehovah's Witness patientwho refuses transfusion would be recalled. Safe and successful performance of a surgical treatment without the application of allogeneic transfusion cannot be performed legeartis in every medical institution. A medical institution and its health professionals that manage to perform a complex surgical intervention without allogeneic transfusion deserve the highest praise.

Conclusion
Jehovah's Witnesses' teachings on refusing transfusion, based on a ban to eat blood, seems bizarre in a modern world. Still, patients have the right to make a choice based on their beliefs and values, regardless of whether that choice may seem irrational, unwise and ill-considered. Undoubtedly, a patient has the right to choose whether one will accept the transfusion or not. It is an innate patient's right, not the right of a religious organization to which the individual belongs. Jehovah's Witnesses organization, their hospital liaison committees, as well as their local elders, ought to be excluded from the decision making process regarding the treatment. Jehovah's Witnesses, as per the rules of their organization, have an obligation to carry a signed form on refusing the transfusion, which may cause dilemma if a patient is in a state of unconsciousness. Health professionals must not demonstrate full obedience towards instructions given in the document. It would be enough for physicians to take the wishes expressed in no-blood card into account, to consider the no-blood card, observe it and assess whether patient's health state changed from the moment of the document signing. All these activities should be noted in a patient's medical records. After these formalities, physicians should act as they would with any other unconscious patient. Intraoperative blood salvaging, as one of the methods of autologous transfusion, enable an adequate medical treatment to a Jehovah's Witness patient, still being in accordance with their religious beliefs. Refusal to accept someone else's blood, in case when it is impossible to perform necessary medical intervention legeartis without allogeneic transfusion can be qualified as patient's refusal to cooperate. In such cases, the law empowers physicians to cancel the treatment. This possibility should not be applied extensively. A surgeon's decision to recall a surgical procedure on a patient who is a Jehovah's Witness has to be, primarily, based on a justified reason. It should most certainly not be based on religious discrimination.