Jehovah’s Witness and a Potentially Bloody Operation

A 54-yr-old (American Society of Anesthesiologists physical status 1), 79 kg, 5′11″ man is scheduled for a prostatectomy. While in the operating room (OR), you hear from the circulating nurse that the patient is a Jehovah’s Witness. The scrub nurse mentions that she has had a patient like this die under a similar operation. In the hope that he may take albumin, you get two bottles of 4% albumin from the pharmacy and place it on your anesthetic table behind the anesthesia machine. You meet him for the first time in the preoperative holding area. He is surrounded by 15 of his family and friends. They inform you of the patient’s unbending refusal to accept blood transfusions and all related blood products. You inform the patient that you will abide by his wishes, but tell him, in no uncertain terms that he may die from hypovolemia. His response is to say he’d rather die then get blood products. You write down that you have explained the serious consequences of his refusal and get him to sign that he does not want any blood products and that he is prepared to die. You get this witnessed by as many of his family and friends that want to sign. You make a copy of this statement for your own record and place the original in the patient’s chart?