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Resumo Este estudo tem como finalidade refletir sobre os aspectos bioéticos e jurídicos implicados na relação médico-paciente testemunha de Jeová. Para isso, o trabalho abordará, inicialmente, a relação médico-paciente diante dos impasses terapêuticos desse grupo de pacientes, estudando essa relação do ponto de vista histórico e elucidando os pontos acerca dos pacientes adeptos à religião. Em seguida, abordar-se-ão os princípios bioéticos envolvidos no cuidado do paciente testemunha de Jeová, discutindo cada princípio e sua incorporação ao atendimento desse grupo. Por fim, será discutida a abordagem jurídica à luz dos direitos fundamentais do paciente, caracterizando as normas constitucionais e penais que se aplicam ao cuidado dos profissionais de saúde a pacientes adeptos a essa religião.

Abstract This study aims to reflect on the bioethical and juridical aspects tied to the doctor-Jehovah's Witness patient relationship. To that end, the work will focus, initially, on the doctor-patient relationship faced with the therapeutic obstacles of this group of patients, studying the relationship from the historical standpoint and elucidating the topics about the patients of this religion. Then, we will focus on the bioethical principles involved in the care for Jehovah's Witness patients, discussing each principle and its incorporation to the care for this group. Finally, we will focus on the juridical approach in the light of the patient's fundamental rights, characterizing the constitutional and criminal norms that apply to the care of health professionals to patients of this religion.

Resumen Este estudio tiene como objetivo reflexionar sobre los aspectos bioéticos y legales involucrados en la relación médico-paciente de los testigos de Jehová. Para ello, se abordará inicialmente la relación médico-paciente ante los impasses terapéuticos de este grupo de pacientes desde la perspectiva histórica teniendo en cuenta a los pacientes practicantes de esta religión. Luego, se plantearán los principios bioéticos involucrados en el cuidado del paciente testigo de Jehová, discutiendo cada principio y su incorporación en la asistencia a este grupo. Por último, se discutirá el enfoque jurídico a la luz de los derechos fundamentales del paciente, caracterizando las normas constitucionales y penales que se aplican a la asistencia de los profesionales de la salud a los pacientes practicantes de esta religión.

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BACKGROUND: Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself. CASE: We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per-operative care and restrictions being respected and attended. CONCLUSIONS: The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.

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Abstract Introduction: Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products. Objectives: This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT. Materials and methods: A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days post-transplantation. Results: Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course. Conclusion: It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes.

Resumen Introducción: El trasplante hepático ortotópico (THO) es un procedimiento caracterizado por índices significativos de sangrado y alta probabilidad de exposición a hemocomponentes. Objetivos: Esta serie de casos muestra la experiencia de un centro de referencia en la atención de testigos de Jehová (TJ) con enfermedad hepática terminal llevados a THO. Materiales y métodos: Se realizó una búsqueda en nuestra base de datos de TJ que hubiesen sido llevados a THO entre julio de 2007 y agosto de 2012. Se registraron datos correspondientes a su estado preoperatorio, manejo perioperatorio y evolución hasta los 30 días postrasplante. Resultados: Se encontraron cuatro sujetos (3M/1H) con una edad promedio de 42 años (rango de 22-55). Todos recibieron un manejo multidisciplinario que incluyó la optimización preoperatoria de su masa eritrocitaria, profilaxis antifibrinolítica y salvamento celular [volumen promedio de 344 ml (rango de 113-520)]. El volumen promedio de sangrado intraoperatorio fue de 625 ml (rango de 300-1000). Uno de los pacientes presentó disfunción primaria del injerto y muerte, mientras que los demás tuvieron un curso posoperatorio convencional. Conclusiones: Es posible ofrecer la posibilidad de THO para sujetos que se niegan a recibir transfusiones alogénicas, por medio de un abordaje integral que incluya la optimización hematológica perioperatoria y la utilización de medidas de conservación sanguínea, sin que esto afecte significativamente los resultados.

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Las cirugías de cabeza y cuello presentan un alto riesgo de sangrado que puede significar el uso de transfusiones sanguíneas. Existen casos en las que éstas son rechazadas, como sucede con los Testigos de Jehová. Se expone el caso de una paciente Testigo de Jehová con un tumor rinosinusal con alto riesgo de sangrado que consultó por epistaxis recurrente. Se evidencia un tumor ocluyendo la fosa nasal derecha de aspecto vascular a la rinoscopía y la tomografía computarizada. Múltiples aferencias de la arteria esfenopalatina y etmoidales se observaron en una angiografía cerebral. Previo a la resección, se embolizó la arteria maxilar. Durante la cirugía, se contó con un sistema de recuperación de sangre autóloga, hemodilución e infusión de ácido tranexámico. Se ligó la arteria etmoidal anterior derecha vía externa con apoyo endoscópico y luego se resecó el tumor vía endoscópica. La biopsia reveló un carcinoma sinonasal escamoso. Existen alternativas terapéuticas en pacientes que rechacen el uso de hemoderivados. Destacan medidas preoperatorias como la embolización endovascular, intraoperatorias como el uso de agentes hemostáticos, técnicas quirúrgicas y anestésicas. Es importante analizar todas las opciones disponibles de forma multidisciplinara y junto con el paciente, para determinar la conducta más adecuada a seguir.

Head and neck surgeries have a high risk of bleeding, and therefore could require the use of blood transfusions. There are cases for which blood transfusions are not an acceptable option, as is the case for Jehovah's Witnesses. We present the case of a Jehovah's Witness with a sinonasal tumor with a high risk of bleeding, who presented with recurrent epistaxis. Rhinoscopy and computed tomography revealed a vascular-like tumor occluding the right nasal cavity. Cerebral angiography showed afferents of the sphenopalatine and ethmoidal arteries leading to the tumor. Prior to the resection, the maxillary artery was embolized. During surgery, we relied on an autologous blood recovery system, hemodilution and tranexamic acid. Right anterior ethmoidal artery ligation was performed by an endoscopic assisted external approach. The tumor was resected endoscopically The biopsy revealed a squamous sinonasal carcinoma. There are therapeutic alternatives for patients who cannot receive blood products. There are preoperative measures such as endovascular embolization, intraoperative measures such as the use of hemostatic agents and specific surgical or anesthetic techniques. It's important to analyze all of the available options in a multidisciplinary team approach, and to take into consideration the patient's preferences, in order to determine the best surgical conduct.

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BACKGROUND: Cardiac hemangiomas are rare cardiac neoplasia usually diagnosed in autopsies, from being asymptomatic to debuting with sudden death. The largest hemangioma published in the literature is of 130 mm size, we present the following case of a successful cardiac hemangioma excision of 280 × 35 mm in size, diagnosed due to recurrent cardiac symptoms. CASE PRESENTATION: A 48-year-old female patient, Jehovah's Witness, with no previous diagnoses, is admitted due to recurrent syncopal episodes in the previous months. A transthoracic echocardiogram diagnosed a tumor in the right atrium and inferior vena cava producing a diastolic right ventricular, with preservation of the left ventricular ejection fraction at 55%. Given the high mortality risk, a surgical intervention was performed immediately. Successful excision was completed confirming a 280 × 35 mm mass without any complications, consistent with hemangioma on histopathology. Postoperative recovery showed no recurrence or complications. CONCLUSIONS: Cardiac hemangiomas are rare and its clinical course can be varied from patient to patient. We present excision of a large cardiac mass with a high mortality risk due to its size and the patient's spiritual beliefs.

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The management of patients, such as Jehovah's Witnesses, who refuse to receive blood transfusions, is often a medical challenge, not only because of the ethical dilemma, but also because it creates a major obstacle to rapid hemorrhage control in a setting of trauma. This article explores the reasons for this conflict between the physician's duty of care and the respect for the patient's autonomy, and draws a panorama of the main understandings of the Judiciary on the subject. Finally, it is concluded that the manifestation of the patient's will, although free, is not enough to release the doctor from his (her) duty of care. In case of danger to life, the doctor must carry out a blood transfusion, regardless of the patient's consent or the permission of those responsible for the patient.

O manejo de pacientes que se recusam a receber transfusões de sangue e de seus produtos, como as Testemunhas de Jeová, apresenta-se frequentemente como desafio médico, não só pelo dilema ético, mas porque cria um importante obstáculo ao rápido controle de hemorragias num cenário de trauma. Este artigo explora as razões deste conflito entre o dever de cuidado do médico e o respeito à autonomia do paciente, e desenha um panorama dos entendimentos majoritários do Judiciário sobre o tema. Por fim, conclui-se que a manifestação de vontade do paciente, embora livre, não é suficiente para afastar o médico do seu dever de cuidado. Constatando perigo à vida, o médico deverá proceder a transfusão de sangue, independentemente de consentimento do paciente ou de seus responsáveis.

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The law N° 20.584 established the informed consent. This could suggest that patients have a right to refuse a blood transfusion. However, the dominant jurisprudence in protection claims filed against Jehovah Witnesses who rejected a blood transfusion, reveals that they do not have such a right. There were two exceptions in 2008, where courts acknowledged the patient's autonomy and denied the petition to authorize a blood transfusion. Most cases precede law N° 20.584. However, those cases which were upheld by the courts after the promulgation of the law, although few, follow exactly the same doctrine as before the appearance of this act.

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The law N° 20.584 established the informed consent. This could suggest that patients have a right to refuse a blood transfusion. However, the dominant jurisprudence in protection claims filed against Jehovah Witnesses who rejected a blood transfusion, reveals that they do not have such a right. There were two exceptions in 2008, where courts acknowledged the patient's autonomy and denied the petition to authorize a blood transfusion. Most cases precede law N° 20.584. However, those cases which were upheld by the courts after the promulgation of the law, although few, follow exactly the same doctrine as before the appearance of this act.

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Certain interventions in the neonatal intensive care unit are considered ethically obligatory, and should be provided over parental objections. After reviewing a case, comparative outcome data, and relevant ethical principles, we propose that extracorporeal membrane oxygenation for meconium aspiration syndrome may, in some cases, be an ethically obligatory treatment.

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RESUMO O manejo de pacientes que se recusam a receber transfusões de sangue e de seus produtos, como as Testemunhas de Jeová, apresenta-se frequentemente como desafio médico, não só pelo dilema ético, mas porque cria um importante obstáculo ao rápido controle de hemorragias num cenário de trauma. Este artigo explora as razões deste conflito entre o dever de cuidado do médico e o respeito à autonomia do paciente, e desenha um panorama dos entendimentos majoritários do Judiciário sobre o tema. Por fim, conclui-se que a manifestação de vontade do paciente, embora livre, não é suficiente para afastar o médico do seu dever de cuidado. Constatando perigo à vida, o médico deverá proceder a transfusão de sangue, independentemente de consentimento do paciente ou de seus responsáveis.

ABSTRACT The management of patients, such as Jehovah's Witnesses, who refuse to receive blood transfusions, is often a medical challenge, not only because of the ethical dilemma, but also because it creates a major obstacle to rapid hemorrhage control in a setting of trauma. This article explores the reasons for this conflict between the physician's duty of care and the respect for the patient's autonomy, and draws a panorama of the main understandings of the Judiciary on the subject. Finally, it is concluded that the manifestation of the patient's will, although free, is not enough to release the doctor from his (her) duty of care. In case of danger to life, the doctor must carry out a blood transfusion, regardless of the patient's consent or the permission of those responsible for the patient.

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INTRODUCTION: The outcomes of Jehovah's Witness (JW) patients submitted to open heart surgery may vary across countries and communities. The aim of this study was to describe the morbidity and mortality of JW patients undergoing cardiac surgery in a tertiary hospital center in Southern Brazil. METHODS: A case-control study was conducted including all JW patients submitted to cardiac surgery from 2008 to 2016. Three consecutive surgical non-JW controls were matched to each selected JW patient. The preoperative risk of death was estimated through the mean EuroSCORE II. RESULTS: We studied 16 JW patients with a mean age of 60.6±12.1 years. The non-JW group included 48 patients with a mean age of 63.3±11.1 years (P=0.416). Isolated coronary artery bypass graft surgery was the most frequent surgery performed in both groups. Median EuroSCORE II was 1.29 (IQR: 0.66-3.08) and 1.43 (IQR: 0.72-2.63), respectively (P=0.988). The mortality tended to be higher in JW patients (18.8% vs. 4.2%, P=0.095), and there was a higher difference between the predicted and observed mortality in JW patients compared with controls (4.1 and 18.8% vs. 2.1 and 4.2%). More JW patients needed hemodialysis in the postoperative period (20.0 vs. 2.1%, P=0.039). CONCLUSION: We showed a high rate of in-hospital mortality in JW patients submitted to cardiac surgery. The EuroSCORE II may underestimate the surgical risk in these patients.

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Abstract Introduction: The outcomes of Jehovah's Witness (JW) patients submitted to open heart surgery may vary across countries and communities. The aim of this study was to describe the morbidity and mortality of JW patients undergoing cardiac surgery in a tertiary hospital center in Southern Brazil. Methods: A case-control study was conducted including all JW patients submitted to cardiac surgery from 2008 to 2016. Three consecutive surgical non-JW controls were matched to each selected JW patient. The preoperative risk of death was estimated through the mean EuroSCORE II. Results: We studied 16 JW patients with a mean age of 60.6±12.1 years. The non-JW group included 48 patients with a mean age of 63.3±11.1 years (P=0.416). Isolated coronary artery bypass graft surgery was the most frequent surgery performed in both groups. Median EuroSCORE II was 1.29 (IQR: 0.66-3.08) and 1.43 (IQR: 0.72-2.63), respectively (P=0.988). The mortality tended to be higher in JW patients (18.8% vs. 4.2%, P=0.095), and there was a higher difference between the predicted and observed mortality in JW patients compared with controls (4.1 and 18.8% vs. 2.1 and 4.2%). More JW patients needed hemodialysis in the postoperative period (20.0 vs. 2.1%, P=0.039). Conclusion: We showed a high rate of in-hospital mortality in JW patients submitted to cardiac surgery. The EuroSCORE II may underestimate the surgical risk in these patients.

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Objetivo - O presente trabalho visa estudar o conflito de princípios fundamentais na base de bioética e no ordenamento jurídico brasileiro. Metodologia - Foi feita uma revisão narrativa de literatura. Resultados - Pacientes que são vinculados / adeptos da religião "Testemunhas de Jeová" recusam tratamento de transfusão de sangue por motivo de suas crenças religiosas, contudo, é necessário respeitar o princípio da dignidade humana. O tratamento com sangue para os adeptos da Testemunhas de Jeová é uma problemática complexa que envolve diferentes paradigmas e uma colisão de preceitos fundamentais, como a liberdade de crença e o direito à vida. Há um conflito entre a autonomia do paciente e o dever e responsabilidade civil do profissional de saúde. Para o tratamento alternativo, alguns métodos são oferecidos para mas o sangue não tem um substituto eficaz, sendo muitas vezes o único meio para se manter uma vida. Conclusão - Há escassa literatura para o tema da transfusão de sangue em adeptos da Testemunhas de Jeová e as posições são antagônicas.

Objective - This study aims to study the conflict of fundamental principles based on bioethics and the Brazilian legal system. Methodology - A narrative review of the literature was done. Results: Patients who are "Jehovah's Witnesses" adherents refuse blood transfusion treatment for reasons related to their religious beliefs. This, in turn, underlies the life and principles that these people will follow, however, it is necessary to respect the principle of human dignity. Therefore, allogeneic blood treatment in Jehovah's Witnesses is a complex problem involving different paradigms and a collision of fundamental precepts such as freedom of belief and the right to life. The autonomy of the patient and the duty and responsibility of the health professional to save lives also come into conflict. For the alternative treatment some methods have been created with the intention of minimizing this problem, however, despite the numerous techniques to avoid transfusion, blood does not have an obsolete and effective substitute, it is often the only way to maintain life of the patient. Conclusion - There is little literature on the topic of blood transfusion among Jehovah's Witnesses

Objetivo - El presente trabajo pretende estudiar el conflicto de principios fundamentales en la base de bioética y en el ordenamiento jurídico brasileño. Metodología - Se realizó una revisión narrativa de la literatura. Resultados - Pacientes que son vinculados / adeptos de la religión "Testigos de Jehová" rechazan tratamiento de transfusión de sangre por motivo de sus creencias religiosas, sin embargo, es necesario respetar el principio de la dignidad humana. El tratamiento con la sangre para los adeptos de los Testigos de Jehová es una problemática compleja que involucra distintos paradigmas y una colisión de preceptos fundamentales, como la libertad de creencia y el derecho a la vida. Hay un conflicto entre la autonomía del paciente y el deber y responsabilidad civil del profesional de la salud. Para el tratamiento alternativo, algunos métodos se ofrecen pero la sangre no tiene un sustituto eficaz, siendo a menudo el único medio para mantenerse una vida. Conclusión - Hay escasa literatura para el tema de la transfusión de la sangre en adeptos de los Testigos de Jehová y las posiciones son antagónicas

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Examina-se, neste estudo, decisão da Sexta Turma do Superior Tribunal de Justiça no Habeas Corpus n. 268.459/SP, proferida em 02 de setembro de 2014, que discutiu a responsabilidade penal dos pais por recusa de transfusão sanguínea em paciente menor de idade. A metodologia utilizada foi do tipo documental-bibliográfico, com pesquisa pura de abordagem qualitativa, descritiva e exploratória. O referido habeas corpus aborda o caso de uma adolescente de 13 anos, que deu entrada no hospital em virtude de grave estado de saúde provocado por anemia falciforme. O quadro clínico da paciente exigia, com urgência, transfusão de sangue para salvaguardar sua vida. Todavia, seus pais, por razão de convicção religiosa da seita Testemunhas de Jeová, assinaram declaração recusando o referido tratamento, dando, assim, ensejo ao óbito da menor impúbere. O fato gerou precedente judicial no STJ, permitindo ao médico fazer a transfusão de sangue sempre que o paciente menor de idade estiver em iminente perigo de morte, independentemente da escolha religiosa de seus representantes legais. Conclui-se que o caso no Habeas Corpus n. 268.459/SP é marcado por uma colisão entre o direito à vida da criança e do adolescente e o direito à liberdade de consciência e de crença dos pais, que foi ponderada pela Sexta Turma do STJ.(AU)

This study examines the decision of the Sixth Chamber on Brazil's Superior Court of Justice (SCJ) in Habeas Corpus 268.459/SP, issued on September 2, 2014, which discussed the criminal responsibility of parents for refusing a blood transfusion to a minor patient. The methodology used was of the documentary-bibliographic type, with pure research of qualitative, descriptive and exploratory approach. The aforementioned habeas corpus addresses the case of a thirteen- year-old girl who was admitted to the hospital due to a serious health condition caused by sickle cell anemia. The patient's clinical condition urgently required blood transfusion to safeguard her life. However, her parents, due to their belief in Jehovah's Witness cult, signed a declaration that refused such treatment, thus leading to the girl's death. This fact gave rise to a judicial precedent in the SCJ, allowing doctors to conduct blood transfusions whenever minor patients are in imminent danger of death, regardless of the religious choice of their legal representatives. It is concluded that the Habeas Corpus case is marked by a collision between the right to life of the child and the adolescent and the right to freedom of conscience and belief of the parents, which was considered by the Sixth Chamber of the SCJ.(AU)

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Abstract Background and objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. Conclusions: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.

Resumo Justificativa e objetivos: Os pacientes testemunhas de Jeová recusam transfusão sanguínea por motivos religiosos. O anestesiologista deve dominar conhecimentos jurídicos específicos para atender esses pacientes. Entender como o direito e o Conselho Federal de Medicina tratam essa questão é fundamental para saber agir dentro desse contexto. O objetivo deste artigo foi estabelecer um protocolo de atendimento do paciente testemunha de Jeová com ênfase no dever ético e legal do anestesiologista. Conteúdo: O artigo analisa a Constituição, o Código Penal, resoluções do Conselho Federal de Medicina (CFM), pareceres e jurisprudência para entender os limites do conflito entre a autonomia de vontade da testemunha de Jeová em recusar transfusão e a obrigação do médico em transfundir. Baseado nessas evidências um protocolo de atendimento é sugerido. Conclusões: A resolução do CFM 1021/1980, o Código Penal no artigo 135, que classifica como crime a omissão de socorro, e a decisão do Supremo Tribunal de Justiça sobre o processo HC 268.459/SP impõem ao médico a obrigação de transfusão quando houver risco de vida. Não é necessário concordância do paciente ou de seu responsável, pois não é proibida a manifestação de vontade do paciente testemunha de Jeová ao recusar transfusão sanguínea para si e seus dependentes, mesmo em emergências.

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BACKGROUND AND OBJECTIVES: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. CONTENT: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. CONCLUSIONS: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.

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O objetivo do estudo foi descrever a abordagem do enfermeiro frente à recusa de hemotransfusão por parte do paciente Testemunha de Jeová, contemplando os aspectos assistenciais, éticos e religiosos. Trata-se de uma revisão integrativa, retrospectiva, exploratória, utilizando as bases de dados SCIELO, BDENF e LlLACS, o corte epistemológico foi de 2010 a 2015, a amostra final constituiu-se de 17 artigos. Os dados analisados foram divididos em 4 categorias: Religião (82,35%), Métodos Alternativos (58,82%), Equipe médica (52,63%) e Enfermagem/Parecer Técnico (11,76%). Conclui-se que a assistência deve advir da ponderação de cada hipótese, ao enfermeiro cabe atuar pautando nos princípios bioéticos, visando a melhor solução para ambas as partes.

The main objective of this study was to describe the approach nurse in the refusal of blood transfusion by the patient Witness, considering the welfare, ethical and religious. This is an integrative review, using the data bases SCIELO, BDENF and LlLACS, the epistemological break was 2010 to 2015, the final sample consisted of 17 articles. The paper were divided into 4 categories: Religion (82.35%), Alternative Methods (58.82%), medical staff (52.63%) and Nursing /Technical Opinion (1176%). We conclude that the assistance should come from the weight of each case, it is up to the nurse to act basing on bioethical principies to the best solution for both the parties. (AU)

El objetivo dei estudio consistió en describir el abordaje dei enfermero frente ai rechazo de la transfusión de sangre por parte dei paciente Testigo de Jehová, contemplando los aspectos asistenciales, éticos y religiosos. Se trata de una revisión integradora, utilizando las bases de datos SCIELO, BDENF Y LlLACS, el corte epistemológico fue dei 2010 ai 2015, Ia muestra final está compuesta por 17 artículos. Los datos analizados se dividieron en 4 categorías: Religión (82,35%), Métodos Alternativos (58,82%), Equipo Médico (52,63%) y Enfermería/Parecer Técnico (11,76%). Se llegó a la conclusión de que la asistencia debe provenir de la ponderación de cada hipótesis, ai enfermero le cabe actuar tomando como referencia las pautas de los principios bioéticos, con el objetivo de encontrar la mejor solución para ambas partes.

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This article, the byproduct of a larger research project, presents a case study of a Jehovah's Witness with hypertension and cardiac problems. Semi-structured interviews were used to reconstruct the individual's illness experience: diagnosis, treatments, and cure, focusing on pervasive religious social representations, lending meaning to his own life and to the physical and moral suffering and disturbances involved in this process.

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