From:
Beninu Andersen
Denmark
I am not aware of how many of you are familiar with the Danish case of a Jehovah's Witness who was hospitalized after a tragic accident where he fell several floors from a scaffolding where he was working.
The patient was admitted to the intensive care unit and was conscious (albeit somewhat confused) for the first three weeks. But suddenly the situation develops drastically, and the patient loses consciousness and at the same time an urgent need arises for a life-saving blood transfusion.
The patient certainly had an older advance directive in his medical record, and it also appeared from old medical records that the patient is a Jehovah's Witness and did not want to receive a blood transfusion.
The doctors hold an emergency conference and reach the conclusion that their oath as doctors is more important than an advance directive that may or may not be used as a basis for choosing treatment.
The man never regains consciousness and a week later he dies from the injuries he sustained in the work-related accident.
The estate of the deceased files a complaint against the hospital and the attending physician before the Danish Agency for Patient Complaints, but the agency acquits the doctor and the hospital. The widow then takes the agency itself to court, and here the widow is initially successful. However, the Agency for Patient Complaints appeals this decision to the Supreme Court, and the Supreme Court overturns the judgment from the High Court and acquits both the Agency, the doctor and the hospital because it was a special situation where doctors suddenly had to decide whether a patient still maintained his prohibition against the use of blood products in the treatment of his disorder, while the doctors could not get an unequivocal statement about this from the patient due to loss of consciousness.
The Supreme Court emphasized that an unequivocal statement about the prohibition of the use of blood prior to a scheduled operation must always be respected, but in borderline cases where doctors cannot get a clear answer from the patient confirming that they stand by their decision, the doctors have the right to draw a personal discretion and assess whether their oath as doctors carries more weight than an advance directive.
The estate of the deceased was not satisfied with the decision from the Supreme Court, and therefore appealed the decision to the European Court of Human Rights (ECHR). The ECHR has just upheld the national court's decision and supports Denmark's Supreme Court.
This must be considered a significant development in the attitude to whether there are situations where doctors can override an advance directive.
Beninu Andersen
Denmark