The High Court has upheld the right of a Dublin hospital to seek a court order allowing it to give a blood transfusion to a woman who refused to have it on religious grounds.
The landmark case arose out of the case of Ms K, a 23-year-old woman from the Democratic Republic of Congo (DRC), who was given the transfusion in September 2006 when she suffered a massive post partum haemorrhage after giving birth.
When the woman refused to have the proceedure, the Master of the hospital went to the High Court which granted the hospital an order allowing the transfusion to go ahead. The hospital subsequently took an action to vindicate its right to seek the court order. The case began last October before Ms Justice Mary Laffoy and ran for 37 days before concluding in January with judgment reserved.
The case involved the first time an Irish court was asked to decide in what circumstances a court may make an order authorising medical treatment for a competent adult who has refused such treatment.
The hospital claimed the State had a constitutional duty to protect and safeguard the woman's right to life and her personal rights generally as well as to protect the family life of the woman and the right of her child to be nurtured and reared by his mother.
Ms K, a member of the Jehovah's Witnesses faith, argued in a counterclaim that the transfusion was a breach of her rights under the European convention for the protection of human rights and she had a right to refuse the transfusion. She also claims that the hospital committed assault and trespass on her person.
Ms Justice Laffoy today upheld the right of the hospital to seek the court order which she said was lawful, despite the fact that certain aspects of the process were "flawed".
She said the “appropriate medical treatment” for Ms K was a blood transfusion and the that the hospital “did not exceed the authority thereby conferred”.
She said it was “regrettable” the intervention of the court probably could have been avoided if Ms K “had not misrepresented the facts as to her religion when booking into the Hospital and had not perpetuated the misrepresentation and compounded it by misrepresenting the position in relation to her family throughout her dealings with the Hospital.”
Ms K admitted she had falsely stated to the Coombe that she was a Roman Catholic and had done so previously during a visit to another hospital in the country.
Ms Justice Laffoy said she was satisfied the Coombe was a hospital “in which the wishes of patients of the Jehovah's Witness faith who do not wish to be transfused are respected.
“The situation in which Ms. K was transfused against her wishes unfortunately was of her own making,” the judge concluded.
At the end of the judgment Ms Justice Laffoy said it would be “helpful” if guidance and assistance was put in place for hospitals. She set out a list of five recommendations:
1. If every maternity hospital had documented guidelines for the management of obstetric haemorrhage in women who refuse blood transfusion. I note that there is a template in existence in the Guidelines of the Rotunda Hospital dated 11th May, 2006, which were put in evidence, but I express no view on their adequacy in relation to legal issues.
2. If the information sought when a woman is booking into a maternity hospital specifically addressed whether the patient would accept a blood transfusion in the case of emergency.
3. If the Medical Council Guidelines specifically addressed how capacity to give a valid refusal to medical treatment is to be assessed and, given the inevitability that it will arise in the future, the issues which may arise relating to the giving effect to advance directives to refuse medical treatment.
4. If, pending the implementation of the recommendations of the Law Reform Commission in legislative form, the State were to designate a legal officer to perform functions of the type performed by the Official Solicitor in England and Wales in relation to patients who refuse medical treatment where an issue as to capacity arises.
5. If a practice direction were put in place in the High Court setting out the procedure to be followed in relation to urgent applications in case of medical emergencies for authority to administer blood transfusions and other medical procedures, distinguishing the three situations which may arise:
(a) where an adult patient is incompetent;
(b) where the patient is a minor and the parents are refusing consent, and
(c) where the patient is an adult and competent but a doubt arises as to his or her capacity to refuse treatment.
