Argentinian man's relatives battle over transfusion

CNN/June 8, 2012

Relatives of a 38-year-old Argentinian man are fighting a legal battle over whether his religious beliefs should be allowed to trump doctors' recommendations that he be given a blood transfusion.

The life of Pablo Albarracini may hang in the balance.

Since early May, when he was shot six times during a robbery in which he was the victim, Albarracini has been hospitalized in critical condition in Buenos Aires. Though he was in a coma initially, that is no longer the case.

"He's not at risk of dying, but he could be at any moment in the event of some complication," said Jorge Albarracini about his son.

"Thank God that hasn't happened yet. But he needs to undergo several surgeries that will need blood. So I'm worried about the future. In three months or more, when they want to take the bullets out of his head and hip, which they have to do, they're going to think twice."

The father said he is seeking to have a court void a will signed four years ago by his son that said he would not want any blood transfusions.

The patient's wife, Romina Carnevale, is also a Jehovah's Witness.

She has said she wants her husband's desires to be followed, regardless of the possible consequences.

Argentina's Supreme Court has ruled in her favor.

"A judicial ruling allowing an adult to be subjected to a medical treatment against his will would not be constitutionally justifiable,"the high court said. "Especially if the patient's will has been signed with his full knowledge and understanding and it doesn't affect others."

Some ethicists would argue that saving the patient's life should be paramount; international declarations of human rights have concluded the same, said Roberto Cambarieri of the Favaloro Foundation on Bioethics in Buenos Aires. "In this case, the Supreme Court has chosen to give priority to the principle of free will," he said.

The conflict has heated in Argentina, especially after the death last month of another Jehovah's Witness who refused a blood transfusion.

The 35-year-old woman had pneumonia and died after 15 days in a hospital in northern Argentina.

In Britain in 2010, a 15-year-old who was hit by a car died after he did not receive a transfusion. The hospital said it had no right to override the minor's parental issues.

Last week in Australia, a court ordered a 4-year-old girl with leukemia to get a blood transfusion, despite opposition from the child's parents.

The church cites Acts 15:28-29 in the Bible, which says, "For the Holy Spirit and we ourselves have favored adding no further burden to you, except these necessary things, to keep abstaining from things sacrificed to idols and from blood and from things strangled and from fornication. If you carefully keep yourselves from these things, you will prosper."

The order that the Argentinian man's wishes be followed did not surprise Robert Veatch, a professor of medical ethics at the Kennedy Institute of Ethics at Georgetown University in Washington.

"We recognize the high value that we place on the rights of competent adults to be self-determining," he said. "As long as he didn't have children whose interests were seriously jeopardized, we would routinely, in Western medical ethics, make the same decision that the Argentine court made, which is to honor the patient's right of refusal."

But the court's reasoning may change in cases where children are involved, he said. "The logic is that, when you take on the duty of being a parent, you have certain responsibilities," Veatch said.

"You have to feed the child, you have to provide decent housing to the child, and if refusal of a medical treatment would lead to death, that - at least in some cases - has led the courts to say your duty to take care of your child overrides your right to refuse treatment."

And patients' desires may be disregarded in cases where they are considered incompetent.

"If a patient were mentally deranged while refusing treatment, then the patient would not be competent and wouldn't have the right to make decisions either for or against treatment," he said.

Though Albarracini has left explicit instructions, a patient's wishes are often absent. In such cases, the decision is typically left to the next of kin. In Albarracini's case, that would be his wife, Veatch said. It would be up to the court to determine whether the next of kin is acting maliciously or unreasonably, he said.

Though the matter is under Argentinian law, "it would come out the same way in the United States," said George Annas, professor of health law, bioethics and human rights at Boston University.

"The next of kin, which is his spouse, is the person to make the decisions," he said. "Her job would be to try to make the same decision he would make if he could talk for himself. That would be the way the case should come out. Since he's not a child any more, his father really doesn't have any decision-making authority at all over him."

CNN's Tom Watkins contributed to this report.

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