Are there any circumstances where hospital staff may force blood on a dissenting patient? What preparatory steps can be taken prior to entering the hospital for major surgery?

"Dissent" implies that the patient is an adult who is mentally competent to make their own decisions, has been given information that enables them to be informed about the consequences of their decision, and still refuses blood transfusion. If those criteria are met, then (to my understanding) giving blood transfusions implies "battery" by the medical staff as it is done against the person's will.

If the patient is not mentally competent, has no previously designated decision-maker (durable power of attorney for health care), is medically unstable and the physician determines the patient needs blood, the patient will probably be given blood as they are unable to consent or refuse.

If you are a person who does not wish to receive blood, it is important to identify that in your communications with your surgeon and surgical team and to make a plan to avoid blood. Talk with your surgeon about the amt of blood loss he/she anticipates and the frequency with which they give blood for this procedure. Seek out all available information about the procedure, use of surgical and equipment options. Seek out a facility for your surgery that supports blood conservation and has a "no blood" program. (Check this website for facilities in your area). Legally support your wishes by having an Advanced Health Care Directive filled out and available that spells out your specific wishes regarding care in a critical situation including the use of blood transfusions. Familiarize yourself with available minor blood fractions or if you are a Jehovah's Witness, work with your HLC member to become knowledgeable about products that fit in the "conscience" realm. Talk with your family members about your wishes and request their support so that the medical team isn't caught between your written wishes and your family's wishes if they are different from your own. Make sure that you are not anemic or seek treatment for it if you are so that you are in the best physical condition to undergo a surgical procedure.

I totally agree with the post by NW Sukosky RN, but would like to add that there are circumstances that can 'muddy the water', so to speak. I have had an elderly adult who refused to have a blood transfusion, completed a medical directive/release form on admission, presented a Power of Attorney for Health Care, and discussed the situation with her family, who did not support this decision. This patient underwent total hip replacement, became very anemic and confused after surgery, and was being pressured by her family to have a blood transfusion. I received a call from the attending physician concerned that the family would take court action to overturn their mothers decision, and was concerned that the one daughter stated she also had documentation that she was her mothers Power of Attorney for everything. As it turned out, over the course of a couple of days, her condition improved and we avoided a confrontation with this family, but it really showed that we need to make sure that everyone is clear about who is to speak for a patient if and when they become unable to speak for themselves, and if someone other than family is listed as the POA, make sure there are no conflicts with family members who believe they are the POA.

would like to know the outcome. HPOA have been set aside be a few courts in certain situations.

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Yvette Bunch