Abstract
The disagreements between patients and their physicians on the proper choice of therapy remain a challenge in the practice of modern medicine. Although it has been clearly recognized that competent adults have the final say in what procedures may or may not be performed on their bodies,1 these conflicts can still strain the critical doctor-patient relationship.2 Few disagreements over therapy have drawn as much attention in the medical, legal, and public spheres as the refusal of blood transfusion.3 Although much has been written about specific pharmacologic and surgical techniques for use in patients who refuse blood, less has been written on the approach to the patient. Describing the approach to the patient may prove beneficial to health-care practitioners and physicians in training, as well as to the patient. The following nine points offer a practical approach to caring for patients who refuse blood transfusion (see Table 1).