VANCOUVER — She went to New York to get away from doctors who insisted on giving her a blood transfusion without her consent.
But the 14-year-old Jehovah’s Witness with bone cancer may still end up receiving blood.
The doctors in New York say they will try harder than Canadian doctors to avoid a transfusion.
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“Blood transfusions continue to be too widely used,” Michael LaCorte, director of the blood avoidance program at Schneider Children’s Hospital, stated in an affidavit submitted to British Columbia Supreme Court last week.
However, hospital staff also assured the court that if all else fails, the doctors would not let her die because she did not receive blood.
“I have explained [to the child] I cannot give her an absolute guarantee there will not be unexpected exigencies that might result in the use of blood products in her treatment,” Jeffrey Lipton, who heads the medical team in charge of the girl’s care, told the court.
“I believe it is difficult for a physician to give a 100-per-cent guarantee that any medical procedure will be entirely successful.”
The girl’s struggle to assert her right to take control of her medical care and refuse a blood transfusion has captured the attention of the country, raising questions about whether a minor is mature enough to make such life-and-death decisions. B.C. requires a person to be 18 years old.
The medical care provided at the New York hospital has also opened debate on whether Canadian doctors are too quick to provide blood transfusions.
The Anemia Institute for Research and Education made a public appeal this month for the B.C. government to finance alternatives to transfusion as the standard of care for cancer patients undergoing chemotherapy.
Last week, the girl went to Schneider Children’s Hospital in New York after an agreement was reached with B.C.’s director of child protection. The family and government officials refused to comment or release details of the agreement. Court orders in B.C. and Ontario prohibit the news media from identifying the girl.
She was diagnosed in December with bone cancer, called osteogenic sarcoma, in her right calf. Her treatment was to include six courses of chemotherapy, each lasting 35 days. Chemotherapy affects the body’s ability to replace blood cells, and transfusions are often required.
Her doctor in B.C. advised the girl and her parents that he had never provided chemotherapy treatment without blood transfusions, court documents state.
The doctor said that if a blood transfusion were warranted, he would perform one against the girl’s wishes.
The girl consented to the chemotherapy treatment, surgical removal of her tumour and, if necessary, amputation of her leg. But, as a Jehovah’s Witness, she would not consent to blood transfusions.
Her refusal is based “on God’s word,” she said in an interview this month with The Globe and Mail. “[God] told us to abstain from blood and we need to obey his commandments.”
In a written statement to court in April, she said a blood transfusion was “no different than somebody getting sexually assaulted or raped or robbed or something.”
Although a psychiatrist decided the girl is mature enough to make an independent decision about her medical treatment, the B.C. Supreme Court granted an order requested by the province’s director of child protection to authorize blood transfusions if necessary.
The girl sought a second opinion last month from doctors at Toronto’s Hospital for Sick Children. She was told her treatment in Toronto would be exactly the same as in B.C., documents submitted to court show.
“The chemotherapy required to complete her treatment protocol will put her at risk for requiring blood-product support, and therefore I would be uncomfortable to administer further chemotherapy without the possibility of supporting her with blood products,” Michael Capra, a physician in the hospital’s oncology clinic, stated in a medical report submitted to court.
The possibility of requiring blood products will increase as treatment progresses, he stated. “I agreed there is a chance no blood products would be necessary, but I definitely could not guarantee this.”
Dr. Capra advised the girl to return to B.C., re-establish contact with her doctor and continue her treatment within the established medical plan. “I wished [her] strength in making a decision. . . . I explained to her that I was only able to offer emergency care to her while she remains in the Toronto area,” Dr. Capra said.
While in Toronto, the girl’s family contacted the New York hospital, the girl’s mother stated in an affidavit to the court.
Dr. Lipton of Schneider Children’s Hospital indicated that, in his opinion, the girl could receive the remainder of her treatment “with a reasonable probability” that she would not require a blood transfusion, documents submitted to court show. Dr. Lipton is the hospital’s chief of hematology-oncology and stem cell transplantation.
He told the court that physicians have avoided blood transfusions in cases similar to the girl’s by using micro-sampling techniques to reduce blood drawn for testing and by giving appropriate dosing of the hormone erythropoietin, iron supplements and other drugs to stimulate blood production.
Schneider’s Dr. LaCorte said a body of scientific evidence shows that avoiding or minimizing use of blood products is good medicine.
“It is the experience of Schneider Children’s Hospital that use of blood products in the clinical setting can be reduced or avoided by careful monitoring of the patient, withdrawing limited amounts of blood for testing, allowing hemoglobin and platelet levels to drop below traditional levels and administering drugs . . . to stimulate bone marrow’s production of blood,” he said.
The hospital’s successful experience in treating patients who were Jehovah’s Witness “assisted the medical community to conclude that some previous views about blood levels at which transfusions were traditionally administered had no scientific validity,” Dr. LaCorte said.