Women who died af­ter giv­ing birth had right to refuse trans­fu­sions: coroner

Times Colonist - - Life - SIDHARTHA BANERJEE

MON­TREAL — Any­one has the right to refuse a blood trans­fu­sion, even if it means cer­tain death, says a Que­bec coroner who stud­ied the cir­cum­stances sur­round­ing the deaths of two Je­ho­vah’s Wit­nesses who had re­cently given birth.

Je­ho­vah’s Wit­nesses be­lieve they should not ac­cept trans­fu­sions or do­nate their own blood.

“Ev­ery per­son in Que­bec has this free­dom of choice,” coroner Luc Malouin said in his re­port, which was made pub­lic Tues­day.

“This free­dom has been ex­er­cised here in ac­cor­dance with the rules of law. It is up to every­one to make their choices and to fully as­sume the con­se­quences.”

Eloise Dupuis, 27, of Ste-Mar­guerite died of mul­ti­ple or­gan fail­ure re­sult­ing from hem­or­rhagic shock on Oct. 12, 2016, just seven days af­ter giv­ing birth to her first child.

She had been trans­ferred to hos­pi­tal in Le­vis from a birthing cen­tre af­ter com­pli­ca­tions, but had said from the start she would refuse blood prod­ucts or trans­fu­sions.

A note in her med­i­cal file said she told med­i­cal staff she would pre­fer to die rather than re­ceive blood prod­ucts.

Malouin’s re­port noted nu­mer­ous oc­ca­sions over sev­eral days when doc­tors tried to get Dupuis or her fam­ily to sign off on a trans­fu­sion as her health de­te­ri­o­rated — and each at­tempt was re­buffed on the ba­sis of re­li­gious prin­ci­ples.

“The only med­i­cal so­lu­tion that ex­isted for Ms. Dupuis in order to re­cover her health was to re­ceive blood, but she al­ways re­fused to do so,” Malouin wrote.

Malouin said no med­i­ca­tion or ar­ti­fi­cial blood prod­uct ex­ists that is ap­proved by Cana­dian or Amer­i­can au­thor­i­ties and that can re­place nat­u­ral blood.

“Even in­ter­na­tion­ally, the re­search into this sub­ject is at an ex­per­i­men­tal stage,” Malouin wrote. “At this time, only a blood trans­fu­sion can com­pen­sate for se­vere blood loss.”

Her husband, Paul-An­dre Roy, re­leased a writ­ten state­ment Tues­day to say his wife’s death was a tragedy and that she is deeply missed.

Roy com­mended the care his wife re­ceived and re­it­er­ated her choices were “made in­de­pen­dently and not un­der duress.”

“She was an in­tel­li­gent woman with deep per­sonal con­vic­tions,” Roy said. “She re­fused the blood trans­fu­sions not be­cause she was forced to do so, but out of re­spect for her con­vic­tions to which she at­tached a great price.”

Roy said Dupuis un­der­stood the risks and ben­e­fits of blood trans­fu­sions and of other med­i­cal treat­ments avail­able and considered them long be­fore she gave birth.

But her aunt, Manon Boyer, who has long ques­tioned the cir­cum­stances un­der which her niece died, said she was dis­ap­pointed in the re­port.

“It talks about hav­ing a Plan B in sim­i­lar cases, but it’s also men­tioned there was no Plan B for Eloise,” Boyer said in an in­ter­view.

Malouin also found there was no re­li­gious in­flu­ence from Je­ho­vah of­fi­cials in Dupuis’ case as had been al­leged by some of her rel­a­tives.

But Boyer dis­putes her niece made that de­ci­sion freely and with­out ex­ter­nal pres­sure — given she be­longs to a re­li­gious com­mu­nity op­posed to blood trans­fu­sions.

She said she wants to see the laws change and al­low doc­tors to be able to treat peo­ple.

“Her baby boy [now one year old] also had rights, he had a right to have a mother to take care of him,” Boyer said. “I’m fine with free­dom of re­li­gion, but with cer­tain con­di­tions and not at the cost of some­one’s life.”

The coroner also looked at the case of Mir­lande Cadet, 46, of Re­pentigny, who died of res­pi­ra­tory fail­ure on Oct. 3, 2016, at St. Mary’s Hos­pi­tal in Mon­treal.

She did re­ceive a blood trans­fu­sion when her husband even­tu­ally con­sented sev­eral hours af­ter her health had be­gun to de­te­ri­o­rate fol­low­ing a cae­sarean sec­tion.

Cadet had noted upon her hos­pi­tal­iza­tion she would refuse blood trans­fu­sions and her husband ini­tially main­tained that po­si­tion un­til her par­ents con­vinced him she needed the trans­fu­sion.

She had un­der­ly­ing health is­sues and Malouin con­cluded it was un­clear if a de­lay in the trans­fu­sion pro­ce­dure led to her death just two days af­ter her ad­mis­sion.

In no case was med­i­cal staff to blame, Malouin said, adding they had no other choice but to re­spect a pa­tient’s wishes.

The Que­bec Civil Code stip­u­lates that an adult, who is of sound mind and well in­formed, can ac­cept or refuse med­i­cal treat­ment.

Malouin wrote that every­one has the right to free­dom of con­science and re­li­gion un­der the Char­ter of Hu­man Rights and Free­doms.

In an in­ter­view, he called the cases a rar­ity in Que­bec, but in­sisted that prepa­ra­tion is key in such cases.

The coroner rec­om­mended that hos­pi­tals and doc­tors draft a spe­cific treat­ment plan for pa­tients likely to refuse blood trans­fu­sions, adding that ev­ery minute counts.

“It’s ex­actly in this [type of] case that it’s very im­por­tant to save time and to have an idea be­fore — what will we do if we have to go to the hos­pi­tal, a surgery room,” Malouin said.

Malouin also rec­om­mended his re­port be dis­trib­uted to any Que­bec health cen­tre where ob­stet­rics is prac­tised.

Eloise Dupuis, 27, died af­ter re­fus­ing a blood trans­fu­sion seven days af­ter giv­ing birth to her first child.

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