Your Medical Freedom—The Courts Speak!
THREE recent court cases may affect your life and medical care. Physicians, hospital personnel, judges, and Jehovah’s Witnesses have given the cases much attention. All who know the facts can be grateful for the bearing these cases have on human rights, legal protections, and respect for God’s laws.
The Randolph Case—Death After Transfusion
An accurate understanding of the first case might be hard for you to come by. Why? Because many newspapers and medical publications gave a distorted picture of it. In fact, this distortion evidently displeased Judge Bambrick, of the Supreme Court of the State of New York, who had presided over the case. He wrote a clarifying 53-page opinion.1
In it Judge Bambrick observed that “the fourth branch of government, the press,” had so misrepresented the case that he had “to set the record straight, and restate the law of the case as it was presented to the jury.” The press sadly has kept quiet about this valuable opinion that focused in on their failure. But we are happy to share with you vital information from what Judge Bambrick wrote. His accurate account can bear on your medical freedom, whether you are a doctor, a lawyer, or simply a citizen concerned about your own rights involving medical care.
Let us draw from the judge’s published opinion the basic facts, italicizing noteworthy points: In July 1975, Mrs. Bessie Randolph (age 45) was admitted to a New York City hospital to deliver her fourth child, by cesarean section. It was noted on hospital documents that, as one of Jehovah’s Witnesses, she would not take blood.* Her physician accepted her deep-seated religious convictions, for she had made her decision as a conscious, competent adult. After the successful delivery, a uterine condition led to a total hysterectomy. But Judge Bambrick states: “Due to both Mrs. Randolph’s condition and [the doctor’s] surgical technique, there was massive hemorrhaging.”
During the next hour or so she lost much blood. At 12:45 p.m. the doctor began to transfuse one unit of blood, and at 1:30 p.m. a second unit. However, Mrs. Randolph’s heart stopped, and she was pronounced dead at 2:00 p.m. Later, her husband (not one of Jehovah’s Witnesses) sued the physicians and the hospital. One doctor settled out of court. Then in February 1984 a jury returned a verdict in favor of Mr. Randolph. News reports of this were rather critical. One legal publication stated: “A jury awarded $1.25 million to the husband of a Jehovah Witness patient who died after refusing a blood transfusion.” Such reports left the impression that doctors had honored the choice of a Witness, yet they were still sued. As a result of the press distortion, other physicians have wondered whether they should cooperate with Jehovah’s Witnesses. A few hospitals have even established a policy of refusing to admit patients who will not agree to accept blood. Such policies are unwise legally and financially because federal law protects against discrimination based on race, religion, or color.
So it is understandable that Judge Bambrick would want “to set the record straight.” In his opinion he stressed that the suit was not because a death resulted from honoring a patient’s informed refusal. Rather, the suit was for malpractice. He explained:
“It is undisputed that Bessie Randolph was a competent adult who unequivocally indicated to the defendants that she refused any proposed blood transfusion treatment under any circumstances. The legal right to refuse treatment, it has been noted, is part of the common law right to self-determination or the right to bodily integrity. . . .
“It is to be remembered that this is not a ‘right to die’ case. On the contrary, Bessie Randolph wanted very much to live. But since her religious beliefs prohibited her from receiving lifesaving blood transfusions, Bessie Randolph’s spiritual ‘right to everlasting life’ was more important to her. . . . One might even argue that from the perspective of a Jehovah’s Witness, for the believer to accept a blood transfusion and thus forsake everlasting life is tantamount to ‘spiritual suicide’.”
You can appreciate that the doctors were in a difficult position when they saw that their patient might die. Yet Judge Bambrick said: “The current law identifies the patient’s right to determine the course of his own treatment based on informed consent as paramount to what might otherwise be the doctor’s obligation to provide needed medical care. . . . The ethical integrity of the medical profession is not tarnished when a competent adult rejects proposed treatment, even lifesaving treatment, and a physician honors the informed choice of his patient.”
What about the State’s interest that children in the family not be abandoned? Judge Bambrick noted that Mr. Randolph was a policeman and in a position to support and care for the children. So the judge wrote: “Under the circumstances, Mr. Randolph had the capability to support his children, and there was never any real question of abandonment.”
If you had been on the jury, you would have known these facts about Mrs. Randolph and the legal right to refuse a transfusion while relieving doctors of liability. The jury had been told: “A competent adult has a common law right to decline or accept medical treatment despite the fact that the treatment may be beneficial or even necessary to preserve a patient’s life. The patient’s right to determine the course of his or her own medical treatment is paramount to what otherwise might be the doctor’s obligation to provide needed medical care.
“Therefore, the defendants . . . cannot be held to have violated any legal or professional responsibilities when they honored the right of Bessie Randolph to decline medical treatment, specifically not to be transfused.”
Why, then, did the jury rule as it did in giving the award?
Judge Bambrick wrote: “Had [the doctor] followed Mrs. Randolph’s instructions completely, by not administering any blood transfusions whatsoever, he would not have been held liable for omitting to transfuse her, even if such an omission was held to be a proximate cause of her death. . . . The facts in this case, however, were that at 12:45 P.M. on July 17, 1975 [he] did administer a blood transfusion to Bessie Randolph and the consequences of this intervention became a jury question.”
During the trial, the jury heard expert testimony as to the nature and quality of the treatment given, once the doctor began a transfusion against the patient’s wishes. So what was involved was the question of malpractice. The judge relates: “The jury unanimously found the defendants . . . to be . . . negligent in their treatment of Bessie Randolph; and that such negligence was a proximate cause of her death. . . . Accordingly, the Court concludes that the unanimous jury verdict in favor of the plaintiff [Mr. Randolph] on the question of liability was not against the weight of the evidence and was correct in law.”
The defendants have appealed that finding. We can await the appellate court’s decision. Yet, whatever the outcome of the appeal, Judge Bambrick’s opinion merits our attention. It clarifies what happened, and it shows that press distortion has unjustly affected medical opinion, thus interfering with the rights of innocent patients.
The Doreen Shorter Case—Lacerated, Perforated Uterus
Across the continent, another case was decided by the Washington State Supreme Court on January 11, 1985.2 It, too, involved malpractice. But this time news reports were accurate and positive. They focused on a helpful step that Jehovah’s Witnesses take to relieve medical personnel of concern about possible liability. Witnesses sign legal documents stating that they will not hold others liable for damages that seem to result from their not accepting blood. Even if you are not a Witness, the case of Doreen Shorter relates to your medical rights.
Doreen and Elmer Shorter signed such a release of liability when she was admitted to a hospital. This Christian couple had learned that the fetus in Doreen’s womb had died but had failed to be discharged. The State Supreme Court opinion reports that her physician, Dr. Drury, recommended cleansing the uterus by a “dilation and curettage” (D & C), which involves carefully scraping the uterine walls.
The Court explained: “The operation did not go smoothly. Approximately 1 hour after surgery, Mrs. Shorter began to bleed internally and go into shock. Emergency exploratory surgery conducted by other surgeons revealed Dr. Drury had severely lacerated Mrs. Shorter’s uterus.” She bled to death.
“Mr. Shorter thereafter brought this wrongful death action alleging Dr. Drury’s negligence proximately caused Mrs. Shorter’s death . . . The jury found Dr. Drury negligent and that his negligence was ‘a proximate cause of the death of Doreen Shorter’. Damages were found to be $412,000.” However, the jury held that the Shorters’ stand had contributed to the outcome, so the award was changed to $103,000.
One important issue was the validity of a document for release of liability for nonuse of blood, such as the Shorters had signed. Is it appropriate for Jehovah’s Witnesses to sign such documents?* Do these protect doctors and hospitals involved? Also, do such documents release medical personnel from all liability, including negligence (malpractice) during surgery?
The State Supreme Court said: “Given the particular problems faced when a patient on religious grounds refuses to permit necessary or advisable blood transfusions, we believe the use of a release such as signed here is appropriate. . . . The alternative of physicians or hospitals refusing to care for Jehovah’s Witnesses is repugnant in a society which attempts to make medical care available to all its members.
“We believe the procedure used here, the voluntary execution of a document protecting the physician and hospital and the patient is an appropriate alternative and not contrary to the public interest.”
You may well wonder, though, ‘What if a surgeon is guilty of negligence during surgery? Is he still responsible for that malpractice?’
Notice what the Court stated: “While Mrs. Shorter accepted the consequences resulting from a refusal to receive a blood transfusion, she did not accept the consequences of Dr. Drury’s negligence which was, as the jury found, a proximate cause of Mrs. Shorter’s death.”
You deserve to know that four of the nine members of the State Supreme Court believed that the award should not have been reduced under a reasoning of “shared risk.” They wrote: “The refusal form signed by the Shorters represents their assent to relieve Dr. Drury of his duty to administer blood if required by the non-negligent performance of the procedure. . . . If Dr. Drury had performed the operation without negligence, but Mrs. Shorter had bled to death anyway, the doctor could not be held liable in this case.” However . . .
“The dangers of performing the D and C were never fully explained to the Shorters; they were not informed that three methods of accomplishing the procedure were available, nor were they told that the method Dr. Drury planned to use was the method most likely to result in uterine perforation and excessive bleeding.” Hence these judges held: “Dr. Drury’s negligence greatly increased Mrs. Shorter’s chances of bleeding to death; thus, the ‘magnitude’ of the risk was increased.” These judges felt that the full $412,000 should be restored.
Physicians and hospital authorities can see from the Randolph and Shorter cases that the courts recognize that treating Jehovah’s Witnesses while using documents for release of liability is “appropriate.” Such documented refusal of blood by an adult can be honored even where minor children and non-Witness relatives are involved. But as the Shorter opinion stated: “Such a release does not, however, shield those released from liability for their own negligence in treating the patient.” That is fair both to doctor and to patient.
In the Randolph and Shorter cases, death followed claimed malpractice. Yet in a more recent case the outcome was far happier.
The Jackson Case—Mother and Daughter Are Fine
Ernestine Jackson was about 26 weeks pregnant when labor began in February 1984. The staff at Mercy Hospital in Baltimore, Maryland, found that because of previous surgery and the position of the fetus she risked a ruptured uterus. They urged a cesarean delivery. Mr. and Mrs. Jackson gave permission, but they asked that no blood be given. They accepted the Christian beliefs of Jehovah’s Witnesses, with whom they were studying the Bible.
The staff of the Catholic hospital advised that there was up to a 50-percent chance that Mrs. Jackson would need a blood transfusion. When she “steadfastly refused to compromise,” the hospital asked Circuit Court Judge Greenfeld to appoint a guardian authorized to permit a transfusion. After a bedside hearing, Judge Greenfeld denied the hospital’s request.
‘So what happened?’ you may wonder. Well, lacking permission to use blood, the doctors performed the cesarean. No blood was needed or used. Both mother and daughter survived and later went home. They are still well.
That might seem to end the matter. But it did not. The hospital appealed, based on the question: “Did the . . . (circuit) court err in holding that a competent, pregnant adult has a paramount right to refuse consent to a blood transfusion on the basis of her religious beliefs in the circumstances presented?”
The Court of Special Appeals of Maryland3 admitted that the issue was no longer pressing because Mrs. Jackson and her child survived the operation without the use of blood. But the Court decided to consider the appeal, since other such cases might arise.
The Court observed that Mercy Hospital argued that it was run by a Catholic order and was “dedicated to the preservation of life.” Yet the Court said that Mercy Hospital could “not properly complain that Mrs. Jackson’s religious beliefs were upheld to the detriment of the hospital’s . . . Freedom of religion means the right to pursue one’s religious beliefs without interference from any other religion, non-religion or the government.”
What about the State’s interest? “The State of Maryland . . . participated in this appeal by submitting a written brief as amicus curiae, and despite Mercy’s assertions to the contrary, pointed out that any State interest in the preservation of life is not necessarily absolute.” Further, the Court observed that Maryland statutory law “embodies an emphatic legislative mandate that the patient’s decision regarding the type of treatment the patient shall endure is paramount. The statute goes so far as to declare that, in the final analysis, it is the patient who determines whether there shall be any treatment at all.”
Note the Court’s conclusion: “In his denial of Mercy’s petition for a guardian for Mrs. Jackson, Judge Greenfeld said: ‘This Court is of the opinion that a competent, pregnant adult does have the paramount right to refuse a blood transfusion in accordance with her religious beliefs, where such decision is made knowingly and voluntarily and will not endanger the delivery, survival or support of the fetus. This conclusion is consistent with a patient’s right of informed consent to medical treatment . . . and the corollary right to refuse that medical treatment.’ We agree. JUDGMENT AFFIRMED.”—April 4, 1985.*
These cases are truly important. They underscore that each of us has the right to decide on medical treatment and that our decision can reflect our deepest religious or ethical convictions. Doctors and hospitals can further see that they can safely provide the nondiscriminatory medical care that they desire for all. As they do so, they will find that Jehovah’s Witnesses are cooperative, appreciative patients whose strong will to live adds a vital element to their recovery.
1. Randolph v. City of New York, N.Y.L.J., Oct. 12, 1984, at 6, col. 4 (N.Y. Sup. Ct. Oct. 1, 1984)
2. Shorter v. Drury, 103 Wash. 2d 645, 695 P.2d 116 (1985)
3. Mercy Hospital, Inc. v. Jackson, 62 Md. App. 409, 489 A.2d 1130 (Md. Ct. Spec. App. 1985)
4. St. Mary’s Hospital v. Ramsey, 465 So. 2d 666 (Fla. Dist. Ct. App. 1985)
For a discussion of the religious and ethical reasons, see Jehovah’s Witnesses and the Question of Blood, (1977), published by the Watchtower Bible and Tract Society of New York, Inc.
The American Medical Association provides a release of liability form in Medicolegal Forms With Legal Analysis (1976), page 85. Jehovah’s Witnesses have widely used the form.
On March 27, 1985, a similar decision was reached by the Fourth District Court of Appeal of Florida.4 It affirmed that even in a life-threatening situation a transfusion could be refused by a 27-year-old man even though he contributed to the support of a minor child. It added: “Moreover blood transfusions are not without risk and we take judicial notice of the adverse consequences, perhaps abhorrent to the donee, which can arise from a transfusion of impure blood.”