The Constitutional Court ruled that hospitals cannot force transfusions refused for religious reasons, even in cases of “extreme urgency”.
by Massimo Introvigne
On April 7, 2021, with a decision whose grounds have been recently published, Colombia’s Constitutional Court ruled in a landmark blood transfusion case involving an adolescent Jehovah’s Witness.
The 16-year-old D.S.C.L. entered on May 24, 2020, the Hospital of La Esperanza, and was diagnosed with acute lymphoid leukemia. She was informed by her doctors that their routine practice is to use blood transfusions as part of therapy for her illness. D.S.C.L. informed the hospital staff, that, as one of the Jehovah’s Witnesses, she would not accept blood transfusions and that she had her parents’ support.
Solicited by the hospital, an administrative authority, the Defensor of the Family of the area Centro Zonal Mártires (Bogotá) of the ICBF (Colombian Institute of Familial Wellbeing) issued on June 24, 2020, an order that all treatments deemed by doctors as needed to preserve the life and physical integrity of D.S.C.L. should be administered to her, if deemed necessary, against her will.
D.S.C.L. appealed the order before the Administrative Court of Bogotá through a Constitutional process, which ruled on August 4, 2020, that doctors should apply all needed remedies with the exclusion, however, of transfusions of whole blood or its four main components, which Jehovah’s Witnesses refuse for religious reasons.
However, on September 15, 2020, the order was modified on appeal by the Administrative Court of the Cundinamarca Region, which ruled that in cases of “extreme urgency” transfusions of blood or its four main components might be forced on D.S.C.L.
D.S.C.L. appealed to the Constitutional Court, which on January 26, 2021, suspended the effectiveness of the decision forcing blood transfusion on her. On March 16, 2021, the Constitutional Court in an interim decision refused the hospital’s request to revise the order of January 26 or interpret it to the effect that “extreme urgency” and an immediate threat to life would justify forcing blood transfusions on D.S.C.L.
On April 7, 2021, the Constitutional Court ruled that D.S.C.L. is entitled to refuse blood transfusions and receive treatment using transfusion-alternative strategies.
This is based on the principle that an “adult minor” such as a 17-year-old is entitled to make decisions affecting her life and health (besides, D.S.C.L.’s parents supported her).
It is also based on freedom of religion and the right to live with dignity as absolute rights, which include the right to refuse medical treatment contrary to one’s religious beliefs.
The court distinguishes between freedom of religion and freedom of worship. While freedom of worship is the right to participate in the religious activities of a church or organization, freedom of religion is the “right to live in accordance with the precepts” of one’s faith. For the believer, such precepts “were established by God.”
It is clear, the court says, that refusing blood transfusions for a Jehovah’s Witnesses is part of such sacred precepts. D.S.C.L. said she would resist blood transfusions “with all [her] strength […], as if it were a sexual violation.” She could only be transfused by “acting against her will,” i.e., “the health personnel could only transfuse blood ‘violently or by sedating [her] or narcotizing [her] so that [she] would not notice.’” For the young woman, the court notes, “to receive a transfusion of blood, or of its four main components, implies sacrificing her beliefs and moral values, with serious emotional, spiritual, and moral consequences, since she would have to live with the burden that implies, for her, having disobeyed God’s commands. That is to say, forcing the plaintiff to receive such transfusions would imply subjecting her to live in conditions that she considers unworthy in light of the faith she professes.”
In this case, according to the Constitutional Court, “the decision of the plaintiff [D.S.C.L.] is a clear exercise of her religious freedom. Indeed, the decision not to receive transfusions of blood or its four main components is neither capricious nor unfounded. On the contrary, this decision is based on her religious beliefs as a Jehovah’s Witness.”
The court goes on to say that “the decision to become a Jehovah’s Witness, according to the plaintiff, is the result of her personal study of the Bible, which also led her to the conviction that she ‘must abstain from blood.’” “In a free and informed manner, [she] decided to reject a specific medical procedure that she considers to be contrary to her religious beliefs and stated that, if she were to undergo it, she would be transgressing the moral precepts imparted by God, according to the religion she professes. In this sense, the plaintiff stated that she will only be able to ‘truly enjoy a dignified life’ if she is allowed to live according to ‘[her] moral and spiritual values based on the Bible.’ She further stated that ‘it is these very convictions that [are] helping [her] to cope with this painful illness and, more importantly than ever, [to] maintain [her] spiritual peace.’”
Forcing a blood transfusion on the young woman would “effectively threaten the fundamental rights to religious freedom and to life with dignity of the plaintiff. The former, because it would make it impossible for the plaintiff to fulfill her aspiration to live in a manner consistent with the faith she professes and, in turn, affect her personal relationship with God. In other words, if she were to receive transfusions or its four components, D.S.C.L. would not be able to be at peace with God.” The latter, because receiving blood transfusions “implies sacrificing her beliefs and moral values, with serious emotional, spiritual and emotional consequences, since she would have to live with the burden that implies, for her, having disobeyed God’s commands. That is to say, forcing the plaintiff to receive such transfusions would imply subjecting her to live in conditions that she considers unworthy in light of the faith she professes.”
Jehovah’s Witnesses seek the best available medical care. However, they believe that donor blood transfusions are against Biblical commands to abstain from blood (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29). Refusing blood transfusion and choosing therapeutic strategies that avoid transfusion are seen as an act of respect for God as the giver of life (quoting Leviticus 17:14).
The D.S.C.L. decision confirms a Colombian Constitutional Court precedent of 2016, when a Jehovah’s Witness called Héctor Manuel León won a case against the health authorities and the right to have an aortic valve replaced without blood transfusion.
However, the D.S.C.L. case is different, as it involves an “adult minor,” and a situation where some doctors claimed there was an absolute need for blood transfusions. As such, it is a precedent of international relevance in the ongoing efforts of the Jehovah’s Witnesses to affirm their right to refuse blood transfusions for religious reasons and to choose effective therapeutic alternatives.