Mother’s death raises eth­i­cal de­bate

Choice to re­ject trans­fu­sion was hers, re­port says

Vancouver Sun - - NP - GRAEME HAMIL­TON

• The day be­fore she went into labour with her first child, an ex­cited Éloïse Dupuis had spo­ken to her aunt. “She said, ‘Do you re­al­ize, Aun­tie, that in a few days I will be hold­ing my life’s dream in my arms?’ ” Manon Boyer re­counted Tues­day.

Af­ter hem­or­rhag­ing fol­low­ing a cae­sar­ian birth, Dupuis, 27, a Je­ho­vah’s Wit­ness, re­peat­edly re­fused the blood trans­fu­sions that could have saved her life. Her baby was healthy, but Dupuis’ vi­tal or­gans failed, and she was dead within a week.

News of her Oct. 12, 2016, death sparked de­bate in a prov­ince grap­pling with lim­its on re­li­gious free­dom. Crit­ics said her life had been sac­ri­ficed for twisted re­li­gious be­liefs, and there were sug­ges­tions she had been pres­sured to forego treat­ment. But in a re­port made pub­lic Tues­day, Que­bec coroner Luc Malouin con­cluded that Dupuis chose freely to refuse trans­fu­sions with full un­der­stand­ing of the con­se­quences.

“I have no doubt that the med­i­cal staff tried ev­ery­thing to get Ms. Dupuis and her fam­ily to change their minds about the need to use blood prod­ucts to save her life,” the coroner wrote. He noted the fam­ily mem­bers were all Je­ho­vah’s Wit­nesses. “In ac­cor­dance with their re­li­gious prin­ci­ples, they re­fused the only med­i­cal treat­ment avail­able to pre­vent death.”

Malouin wrote that early in her preg­nancy, Dupuis ad­vised staff at the birthing cen­tre in Lévis, Que., that she would not ac­cept trans­fused blood, which Je­ho­vah’s Wit­nesses be­lieve is for­bid­den by the Bi­ble.

Af­ter com­pli­ca­tions dur­ing her labour, Dupuis was trans­ferred on Oct. 6 from the birthing cen­tre to Hô­tel-Dieu Hos­pi­tal in Lévis, where a C-sec­tion was per­formed and her baby was de­liv­ered in good health.

But soon af­ter she be­gan hem­or­rhag­ing and was trans­ferred to in­ten­sive care. She was di­ag­nosed with ane­mia — a short­age of red blood cells — and doc­tors per­formed a hys­terec­tomy.

In study­ing her med­i­cal records, Malouin found five oc­ca­sions when Dupuis told doc­tors she did not want a trans­fu­sion, even as her con­di­tion de­te­ri­o­rated. “Re­fusal of trans­fu­sion even if death is the re­sult,” one note said the even­ing af­ter she gave birth.

Af­ter she was se­dated, her hus­band and par­ents main­tained the re­fusal to pro­vide Dupuis with blood. She died Oct. 12 of mul­ti­ple or­gan fail­ure caused by loss of blood.

The coroner noted her death struck a chord in Que­bec, where the prac­tice of Catholi­cism has been largely aban­doned and strongly held re­li­gious be­liefs are of­ten viewed with sus­pi­cion.

“At a time when a ma­jor­ity of Que­be­cers do not ac­tively prac­tise any re­li­gion, this no­tion of re­spect­ing re­li­gious rules seems to come from a dif­fer­ent era,” Malouin wrote. “There was a time in Que­bec when such rules were very present and gov­erned the lives of all. It is no longer the sit­u­a­tion to­day, but the choice to ad­here or not to re­li­gious rules must be re­spected.”

In a sec­ond case from last year stud­ied by Malouin, doc­tors in a Mon­treal hos­pi­tal had to wait six hours be­fore pro­vid­ing trans­fu­sions to Mir­lande Cadet, also a Je­ho­vah’s Wit­ness.

She had in­di­cated at ad­mis­sion that she did not want trans­fu­sions, and when her con­di­tion de­te­ri­o­rated af­ter a cae­sar­ian birth, her hus­band main­tained the re­fusal. He re­lented af­ter the woman’s par­ents in­ter­vened, but Cadet died on Oct. 3.

Malouin said it was im­pos­si­ble for him to de­ter­mine whether the de­lay in trans­fus­ing played an im­por­tant role in her death from a pul­monary in­fec­tion.

In his re­port on Dupuis’ death, Malouin said the law is clear that adults of sound mind are free to refuse med­i­cal treat­ment. The same is not true of mi­nors. Last Septem­ber, the Que­bec Su­pe­rior Court au­tho­rized the McGill Univer­sity Health Cen­tre to give blood trans­fu­sions to a 14-year-old can­cer pa­tient, who had re­fused the treat­ment be­cause of her be­liefs as a Je­ho­vah’s Wit­ness.

Dupuis’ hus­band, Paul-André Roy, sent a mes­sage to me­dia Tues­day say­ing his wife’s re­fusal of trans­fu­sion “was out of re­spect for her con­vic­tions, to which she at­tached a great price.”

But Boyer be­lieves the price was too high.

“I agree with free­dom of re­li­gion, but not at any cost,” she said. “Her son Liam had the right to have a mother. He had the right to feel secure. He had the right to be breast­fed. He got noth­ing.”



Éloïse Dupuis, 27, a Je­ho­vah’s Wit­ness, would not con­sent to blood trans­fu­sions af­ter a cae­sar­ian birth in 2016. Her baby sur­vived, but she died. Que­bec coroner Luc Malouin con­cluded that Dupuis chose freely to refuse trans­fu­sions with full un­der­stand­ing of the con­se­quences.


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