Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of Patient Blood Management

This article provides an ethical and medico-legal analysis of ruling no. 465 of 30May 2018 issued by the Court of Termini Imerese (Palermo) and confirmed on appealon 11 November 2020, which, in the absence of similar historical precedents in Eur ope, convicted a medical doctor of a crime of violent assault for having ordered theadministration of a blood transfusion to a patient specifically declining blood trans fusion on religious grounds. We analyse the Court’s decision regarding the identifi cation of assault in performing the blood transfusion and its decision not to acceptexculpatory urgent ‘necessity’ as a defence. In addition, we present an updated revi sion of the current standard of care in transfusion medicine as well as the ethicalprinciples governing the patient’s declining of transfusion. In doing so, we highlightthat respect for the patient’s self-determination in declining transfusions and respectfor the professional autonomy of the doctor protecting the safety and life of thepatient could be equally satisfied by applying the current peer-reviewed evidence