In the management of an unconscious adult (e.g. ruptured ectopic pregnancy) the status may be unknown. Most practicing Jehovah’s Witnesses will carry a clear Advance Directive/Release card with them at all times. This is a legal document and, if in clear and unambiguous terms, should be respected. Contact could also be made with the patient’s GP who may hold a copy of such an Advance Directive.
Every effort should be made to avoid the use of blood and blood products in the perioperative period under these circumstances, however if a patient is unable to give an opinion, and no applicable advance directive exists, then the clinical judgement of the doctor should take precedence over the opinion of relatives or associates and this may include the administration of blood products. GMC guidance on patients who refuse treatment affirms this stating that: ‘In an emergency, you can provide treatment that is immediately necessary to save life or prevent deterioration in health without consent’ (Personal Beliefs and Medical Practice, paragraph 27 [GMC, 2013]).
Any blood or blood products administered without prior patient consent should be clearly documented in the casenotes and it is the clinician’s duty to inform the patient about its use and the reasoning for this as soon as possible.