A 78-year-old with metastatic cancer refuses a blood transfusion that you believe is life-saving. What do you do?

Question

Accepted Answer

I would treat this as an issue of consent and capacity under the Mental Capacity Act 2005. Capacity is presumed unless proven otherwise, is decision and time specific, and an unwise decision does not equate to lacking capacity. I would sit with the patient, ensure they have the relevant information about benefits, risks and alternatives, and assess their ability to understand, retain, weigh and communicate that information. If capacity is present I must respect their autonomous refusal, even if I disagree, and document the conversation carefully including their reasoning. I would explore what matters to them, offer non-blood alternatives such as IV iron or tranexamic acid, and check for an advance decision. With their consent I would involve family and the palliative care team, and ensure symptom control. If capacity were absent I would act in their best interests under section 4, consulting those close to them and any LPA. I would discuss with my consultant and consider a second opinion.

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