Actually in this circumstance, legal requirements were apparently not followed. The children were seized without the hearing required by law. In that hearing the parents could have had expert medical representation either in person or via teleconference to present the alternatives. It could have been discussed and the judge issue an informed decision, having heard both sides. Unfortunately the process was evidently bypassed.

That is correct, the law generally requires this, even in a bloodless program. However in those programs the expertise and recurrent proficiency with blood conservation tools and techniques make such situations very uncommon.

Also the "trigger" criteria for state intervention is NOT necessarily when blood products provide the best or most familiar standard of care. The exact laws vary between nations and provinces. However Dr. Nicolas Jabbour describes the criteria as "when there are NO nonblood alternative treatments available" (emphasis mine, Transfusion-Free Medicine and Surgery, p. 14).

This is obviously not a black-and-white area. Treatments vary in efficacy, as does the expertise level, tools/techniques and proficiency at different medical centers.

E.g, Nicolas Jabbour at USC has done many bloodless live donor liver transplants. That doesn't mean such expertise is available everywhere. Duke University Medical Center is expert at hyperbaric medicine, and uses it in their bloodless program. Such expertise isn't available everywhere. Just because we read of such successes doesn't mean that's the general standard of care available everywhere. But -- it is available.

Thus we see a complication: what if expert (albeit non-mainstream) alternative treatment is available at a different location, and the doctors have successfully treated similar cases and are willing to take the patient? Suddenly it's not so black and white. Rather than state intervention to avoid certain death, the state is intervening based on the lack of expertise in the current facility or unwillingness to transfer the patient.

I have no idea if that happened with the Canadian sextuplets, but the fact is most situations can be successfully treated -- somewhere -- without blood, given sufficient tools and expertise.

That raises the issue of patient transport and related complications and decision factors. It's not always advisable to transfer the patient, although it's often possible. There are many variables -- distance, time, surface vs aerial transport, patient condition, etc.

The confusion in these cases often stems from a black-and-white view of what is a grey area, sometimes exacerbated by premature overly aggressive legal action. It's one thing if a minor child comes in the ER from a car wreck, bleeding profusely with a hemoglobin of 2 g/dl. It's another thing if the patient has a hemoglobin of 8-9 g/dl which is gradually declining.

While the law generally requires rendering lifesaving treatment to minor children regardless of the parent's wishes, the exact definition of what constitutes "lifesaving" treatment and threshold for legal intervention is fuzzy. In a slowly deteriorating, non-time-critical situation, transferring the patient to an expert specialized facility may avoid legal problems. Identifying and acting on these cases early avoids the patient degrading to a condition where transport is more risky.

Potential patients and parents should also understand there's a difference between a cooperative doctor vs a structured, formal bloodless program. In an elective situation best results are often obtained at a facility with a formal bloodless program. Even in some trauma situations the option may exist early on to transfer to such a facility. Once the situation medically deteriorates, transport is more difficult, although not necessarily impossible. In his book "No Man's Blood", Dr. Ron Lapin related an example of aerial transport and successful operation on a female adult patient with a hemoglobin level of 2.0 g/dl.

Where transport is impossible, expert medical consultation about nonblood treatment options can be made available via teleconference or video conference.