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 ingesting blood goes against their beliefs and that 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.
A Canadian Jehovah's Witnesses spokesman said the community was deeply saddened by the two deaths.
"We express our sincere condolences to their families and friends," Matthieu Rozon said in a statement Tuesday.
"In his report, Mr. Malouin confirmed that Eloise made her own medical decisions, without undue influence.
"Jehovah's Witnesses love life and seek the best medical care available. Every year, Jehovah's Witnesses successfully give birth, undergo chemotherapy, have major surgeries, and are managed in trauma and critical care settings all without the use of donor blood."
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Sidhartha Banerjee, The Canadian Press