[Refusal of blood because of being Jehovah's witnesses or for fear of AIDS. Deontologic and legal aspects].

Difficult new medical and professional ethical problems have arisen by an increase in the number of patients refusing blood transfusion or the use of blood derivatives because of religious convictions. In particular Jehovah's Witnesses and patients frightened of catching AIDS and other diseases transmitted by blood are involved. Because of this it is necessary to consider how to prevent legal actions which may be brought under the heading of "death by negligence or by failing to give correct treatment for a patient in danger", particularly when the case is of death that could be connected with failure to resuscitate a patient where the basic treatment would be giving blood. The authors have analysed article by article of the Code of Medical Deontology of 1975 and have found ambiguities, not to say apparent contradictions, in the recommendations given to doctors who find themselves confronted by patients who have refused in this way needed treatment for haemorrhagic shock, as can occur particularly in obstetrics and gynaecology. The law is extremely weak in this matter because the Appeal Court has never taken a clear position in regard to the responsibility the doctor has when he finds himself with a patient who has refused the correct treatment. The authors have been driven to research through a large bibliography of medico-legal works to find out what doctors should do when they are confronted by patients who refuse the correct treatment by they adults or infants or mentally incapacitated. The practical advice that ends this analysis should make it possible for the readers to adopt a compromise way of dealing with these situations that at the same time accords with the normal medical contract between patients and doctor and the dignity that should be afforded to the patient but also the safety of the patient. This is done by avoiding on the one hand total rejection of the legitimate personal convictions of the patient but also on the other hand not accepting too readily these convictions, which could lead to being held responsible for failure to carry out one's obligations to patients or to just leaving the patient to her circle, stepping aside from caring for her.(ABSTRACT TRUNCATED AT 400 WORDS)