Patients with significant medical problems who refuse some aspects of their medical care present medicolegal and management problems for their physicians. The selective refusal of transfusion of blood products by Jehovah's Witnesses typifies such situations. To explore physicians' reactions to these constraints, we sent a questionnaire to medical students, residents, and faculty wherein we asked them to respond to case simulations involving Jehovah's Witnesses and refusal of transfusion. Fifty percent of all respondents, including 84% of the faculty, reported experience in dealing with Jehovah's Witnesses. Overall, respondents were more likely to give transfusion to an infant or an incompetent adult than to competent adults. Only educational level made a significant difference in response: faculty members most frequently mentioned obtaining a court order when giving transfusion against a patient's will. Case law, upon which legal grounds such decisions stand, is often conflicting and is evolving toward allowing patients a freer hand in their choices of therapy. We sketch the history and present status of these precedents and offer a framework for dealing with patients' refusal of care.
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