Dilemmes éthiques et juridiques dans le refus de transfusion sanguine : analyse de l'affaire Andrea d'un point de vue casuistique

Abstract

Refusal of blood transfusions for religious reasons raises ethical and legal dilemmas in cases where patients are critically ill and unable to express their wishes. This study aimed to analyze medical decision-making in these contexts using a decision tree, allowing for the assessment of the appropriateness of beneficence-based interventions when the refusal is not clearly documented. A qualitative design with a case-by-case approach was used, analyzing cases documented in the bioethics and medical literature under selection criteria that included critically ill patients without a valid advance directive or clear legal representation. The instrument's construction considered key variables such as autonomy, beneficence, medical urgency, and therapeutic alternatives. The results indicated that, in the absence of an explicit and verifiable refusal, the most medically ethical decision is to proceed with the transfusion, consistent with previous studies that prioritize the preservation of life. Among its scope, this study structured a replicable methodology in different clinical contexts, although its limitations include the lack of direct clinical data and legal variability across countries. As a contribution to the area of ​​study, the implementation of formalized advance directives and future empirical research on medical decision-making in emergency situations are recommended.