BLOODLESS SURGERY AND MEDICINE FOR JEHOVAH'S WITNESS-ROLE OF INFORMED CONSENT AND MEDICAL COOPERATION-

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  • エホバの証人への無輸血治療―インフォームドコンセントと院内医療連携の重要性―

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Abstract

[Background] The issue of medical beneficence for patients of the Jehovah's Witness faith has been under consideration.<br> [Objective] The role of informed consent (IC) and medical cooperation between respective medical units was reviewed in order to improve bloodless surgery and medicine for patients of the Jehovah's Witness faith, on the basis of a common understanding of the patient's right to bodily self-determination.<br> [Materials & Methods] During the decade, 113 patients and 128 cases were subjected to IC as well as ongoing medical cooperation. Discussion focused on confirmation of the refusal of blood transfusion, the extent of acceptable alternatives and due caution or recognition of possible life-sustaining treatment. Medical community involvement included surgeons, anesthetists, radiologists, gastroenterologists, emergency physicians and other specific medical co-workers.<br> [Results] No case failed to meet at least one indications for treatment. Bloodless surgery was performed in 107 cases, interventional radiological procedures in 10, endoscopic treatment in 4 and irradiation-chemotherapy in 17. Emergency cases numbered 15. Decision-making for treatment was established after the repetition of IC and medical assessment between all parties concerned. All patients refused allogenic blood and storaged autologous blood transfusion. Acceptable alternatives included intraoperative autotransfusion consisting of hemodilutional and/or salvaged blood in continuity with circulation, which was adopted in 29 cases (23% of all). Bloodless management did not disturb the curability per se of after treatment and there were no associated fatal complications or death. <br> [Conclusion] Bloodless surgery and medicine were promoted by IC achieved in an open, concrete and comprehensive form, as well as with advanced care by medical communities in individual hospital.<br>

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