Dilemma for Doctors

HOSPITALS and doctors in Illinois were stunned by a high-court ruling handed down late in 1970. Their dismay was echoed by members of the medical profession throughout the United States.

What was the decision that provided such a jolt? The Supreme Court of Illinois ruled that hospitals may be liable for damages when a patient contracts hepatitis from a blood transfusion.

The ruling came as a shock to many doctors. But really, it should not have been so unexpected. Why not? Because for years a mountain of evidence has accumulated showing that blood transfusions can injure and even kill.

Doctors who have kept up with the latest developments in the field of medicine know this to be true. As Winfield Miller, associate editor of Medical Economics, said: “No biologic product has a greater potential for fatal mistakes in medical practice than blood. More than one doctor has learned to his sorrow that every bottle of blood in the blood banks is a potential bottle of nitroglycerin.”

Medical authorities admit that each year in the United States alone about 3,000 deaths occur from hepatitis contracted from blood transfusions. Also, an estimated 30,000 serious cases of hepatitis result, and several times that number not as serious. Additional deaths and illnesses result from other complications of blood transfusions.

Because of such deaths and illnesses, many lawsuits have been directed against doctors and hospitals in recent years. Dr. Lester Unger, a nationally known hematologist, said: “Lawsuits arising from blood transfusions are more prevalent now than any other time in my recollection.”

A most significant lawsuit was the one brought before the Supreme Court of Illinois. The case had to do with a Mrs. Frances Cunningham. She had entered MacNeal Memorial Hospital in Berwyn, Illinois, for treatment of anemia back in 1960. As part of her treatment she was given several pints of blood. But the blood was infected, and she came down with a severe case of serum hepatitis. She sued the hospital for $50,000 in damages.

A lower court threw out her suit. But Mrs. Cunningham appealed to a higher court. Her lawyers cited decisions in other cases where sellers were held responsible for the safety of their products. They argued that blood is a product and that hospitals should be held responsible when it is defective.

The Illinois Supreme Court agreed. It ruled that the seller of a product “should legally bear the consequences of injury caused thereby, rather than allowing such loss to fall upon the individual consumer who is entirely without fault.” The American Trial Lawyers Association also agreed with the court. They noted that churches, schools, Y.M.C.A.’s and orphanages are not given immunity, so hospitals should not be either.

Justice John Culbertson of the court turned down defense contentions that blood was a ‘service’ and not a ‘product’ and that hospitals should be immune from prosecution. He ruled that blood is a product like other articles “unchanged from their natural state, which are distributed for human consumption.” He noted that Illinois law holds the distributor of poisonous mushrooms liable for damages, although the mushrooms are “neither cooked, canned, packaged, nor otherwise treated.”

As a result of this decision, doctors feel that a flood of lawsuits may be coming their way. But they have no one but themselves to blame, For years they have been pushing blood transfusions, insisting that they are absolutely necessary, when the evidence has shown that they are not. Many substances other than blood have served very well.

The team of heart specialists from the Texas Heart Institute in Houston, which includes Dr. Denton Cooley, wrote in the Journal of the American Medical Association of August 10, 1970: “It is our policy to avoid the use of blood transfusion whenever possible in all operations . . . We have found that blood transfusion is not a necessary accompaniment to vascular surgery, but indeed has certain disadvantages such as the risk of hepatitis. . . . patients who refuse to accept blood can usually undergo major operations without prohibitive risk and enjoy favorable postoperative results.”

In view of such findings, doctors should remember that, while they may recommend the use of blood, the patient’s right to refuse it should be respected. And generally, the courts in the United States have agreed, ruling that a patient has the right to refuse any treatment he does not want.

Doctors indeed perform a very valuable service. Their hard work and help for sick persons are commendable. But when a doctor ignores his patient’s wishes, then he is no longer helping. Such a doctor would do well to ask himself what he is really concerned about​—his patient, or his business and reputation?

A few doctors have even refused to give any treatment at all to patients who for conscientious reasons rejected potentially dangerous blood transfusions. Offered no help whatsoever, the patients in some cases had to waste precious time transferring to another hospital where doctors would treat them according to their wishes. Also, other doctors have tried to get, or have gotten, court orders forcing adults and babies to have blood transfusions to ‘save life.’ But then these same doctors have turned around and performed, or approved, abortions that kill life. Such actions are inconsistent, to say the least.

What is the trouble with that kind of doctor? Dr. Ervin Nichols of Palo Alto admitted: “It seems to me that some of our reaction has to do with our own egos in that . . . the patient does not respond to our bidding.” And Dr. John Morton of Los Angeles agreed: “Perhaps too often our egos make us think that if our recommendations are not acceptable that the patient should go elsewhere.”

But now, doctors who do not face up to the dangers of blood transfusion place themselves in a serious dilemma. They may be faced with an expensive lawsuit.

Honest doctors who really have their patients’ welfare at heart realize that they are not the patients’ masters, but are in fact employees. They understand that they are free to make recommendations, but that the patient is also free to accept or reject them. And when a recommendation is rejected, these doctors offer the best alternatives they know. They help the patient to the best of their ability. For the service of such considerate men, ailing persons can be grateful.