Children of Jehovah’s witnesses: a review of judicial responses to the refusal of blood transfusion

We present 19 judgments of English courts; all that we could find relating to the refusal of blood transfusion by or on behalf of children of Jehovah's Witness families.This provides detailed context to clinicians faced with this dilemma.Our review identifies demographic patterns of applications to the court: the broad separation into infants and capable teenagers; their underlying diagnosis; proximity to majority; prognosis; their independent capability to refuse life-saving treatment. The positions taken by the applicant trusts, the parents, the children themselves and the clinicians seeking permission compulsorily to transfuse also form patterns, together with the judicial response and the demonstrable evolution of judicial thinking.Without these thematic patterns, it would not be possible to provide generic guidance for patients, their families, clinicians or trust managers, as to what factors should be considered when facing the situation where a child or her family is refusing treatment that may save life or prevent irremediable harm.Our conclusions, based on the emerging patterns, including the benefits of centralising clinical judgement relating to compulsory transfusion in paediatric haematology/oncology centres; the suggestion of specific research (including to determine how the judges in these cases reached a conclusion on the individual teenager's capacity to make the choices that they advanced to the court) and avoiding the temptation to seek a rolling or enduring authority to compel transfusion.These and other patterns and conclusions provide guidance as to what should be considered if contemplating an application for judgement in these circumstances.