ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1687101
A medico-legal approach to developing a structured decision-making process for patients refusing blood transfusions
Provisionally accepted
Lucia Tattoli1*
Davide Santovito2- 1Section of Legal Medicine - University of Turin, Turin, Italy
- 2Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
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Introduction: The healthcare providers should respect patients’ autonomy in making treatment decisions, which affect their health and well-being. Refusing life-saving treatments like blood transfusions raises ethical and legal concerns that should be discussed in informed consent. The dilemma is between respecting patient’s autonomy and beneficence principle, the physician’s duty of care. This article explores the communication and information process to provide to adult patients who refuse blood transfusions or related blood products, focusing on legal frameworks, clinical practices, and medico-legal risk management. Methods: The authors conducted a retrospective analysis of medico-legal consultations on patients ‘refusal of blood and blood components transfusions in the Hospital “Città della Salute e della Scienza” of Turin (Italy) from 2017 to 2021. The Authors divided the consultation process into 7 phases and 27 sub-phases which were analyzed through the PROSA risk assessment software. The strengths, weaknesses, opportunities, and threats (SWOT) analysis was used to evaluate the efficacy and potential of this structured protocol of consultation in clinical applications. Results: Based on 16 medico-legal consultations, high-risk sub-phases include medical record analysis, care pathway selection shared by the equipe; alternative therapy identification; communication regarding the transfusion and the Patient Blood Management process; communication regarding the not feasibility without transfusion. SWOT analysis showed that the informed consent process indicated advantages in 74% of aspects versus disadvantages in 26%. Discussion: Healthcare professionals should follow predictable, effective, efficient, transparent, and traceable guidelines when dealing with patients who refuse blood transfusions. A structured communication process, as a part of the informed consent, offers a replicable framework that can be adapted to other clinical contexts where high-stakes decision-making intersects with patient rights, supporting a culture of safety, transparency, and continuous improvement in healthcare delivery, while also helping to mitigate medico-legal risk and potential legal action.
Keywords: Informed Consent, blood transfusion refusal, autonomy, patient blood management, Risk Management, Medico-legal expert
Received: 16 Aug 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Tattoli and Santovito. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lucia Tattoli, lucia.tattoli@unito.it
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.