PHYSICIANS’ INSTITUTIONAL AND LEGAL KNOWLEDGE ON JEHOVAH´S WITNESS PATIENTS’ AUTONOMY

full name / name of organization: 
Chehaibar and Grinberg / Heart Institute (InCor) of HCFMUSP
contact email: 
graziela@usp.br / max.grinberg@incor.usp.br

Bioethics was developed in the 1970’s as a structured response to the atrocities committed against human beings during the Second World War and to the human rights movement that followed (Durand, 2003) . Bioethics Committees have since been created in hospitals worldwide, aiming to discuss complex issues. They focus on human dignity and improvement in the rapport between patients and health professionals, preserving both sides’ autonomy (Gohel et al., 2005) .

Among the bioethical questions is the conflict between the patient’s or family’s will and that of the health team. This conflict is related to the autonomy principle that generally translates into respect for choices of treatments (Walker,2010) . One of such conflicts involves Jehovah’s Witness (JW) patients because their right to refuse the medical procedure of blood transfusion might go against the medical duty to use all available resources to preserve life (Rogers & Crookston 2006; Ferrer et al., 2006) .

There are over 7 million Jehovah’s Witnesses worldwide and almost 700,000 in Brazil, representing about 0.36% of the Brazilian population (Watch Tower, 2009). This population accesses the health system, public or private, and requires special care. It also requires the full awareness on the part of their physicians regarding the limitations imposed by their religious beliefs on procedures such as blood transfusion. In Brazil, these patients are immersed in a normative background including the Brazilian Code of Medical Ethics as well as the country´s Constitution and its penal code. The first states the patient’s right to decide on diagnostic and therapeutic techniques as well as to complete information about these matters and the goals of the treatments suggested (São Paulo, 1999) . The Constitution states the patient’s right to refuse a specific treatment as well the freedom of creed as provided by the Brazilian Constitution of 1998 (Brasil, 1998) .
This study was set at the Hospital das Clínicas of the University of São Paulo (HCFMUSP), a major public hospital in the most populated Latin American capital (São Paulo). Its Bioethics Committee (CoBi) developed in 2004 a clear set of suggestions in the form of Recommendation 007/2004, entitled Guidelines on Blood Transfusion for Jehovah’s Witnesses , which describes internal policies and strategies on how to deal with JW patients.
Nevertheless, it is not clear whether the doctors of this major public hospital are aware of the aforementioned Brazilian legal framework, the existence of the hospital’s CoBi and its Recommendation 007/2004, and of other professional and constitutional normative frameworks concerning the care of JW patients. Herein we aimed to evaluate health team knowledge about these matters by performing semi-structured interviews with physicians who cared for JW patients presenting a potential need for blood transfusion. We also correlated these findings with information obtained from the patients’ medical records reporting the clinical procedures that were actually employed.

cfp categories: 
religion