A coroner's reports into the deaths of two women following childbirth states everyone involved acted correctly, because people have the right to refuse treatment even if it proves lethal.
Luc Malouin wrote that in his reports into the deaths of Mirlande Cadet and Eloise Dupuis, two women who died following a refusal to accept blood transfusions. The refusals were based on their religious values, as both were Jehovah's Witnesses.
"Every person in Quebec has this freedom of choice," coroner Luc Malouin said in his report. "This freedom has been exercised here in accordance with the rules of law. It is up to everyone to make their choices and to fully assume the consequences."
Dupuis, 26, indicated as she went into labour in Levis that she did not want a blood transfusion under any circumstances, exercising her constitutional right to freedom of religion.
The delivery required a C-section, but further complications required her to undergo a hysterectomy. She also developed anemia and other life-threatening problems.
The coroner said that Dupuis and her family were informed that a blood transfusion would almost certainly save her life and that refusing one meant she would likely die however Dupuis told doctors, her husband, and a midwife that she would rather die than accept a transfusion.
Following a week of medical treatment Dupuis died of multiple organ failure caused by blood loss in October 2016.
There was some controversy surrounding Dupuis's death because some friends and cousins were not allowed to visit her on the day she died.
The coroner noted that Dupuis's final moments were spent with her parents and her husband, and that the people who arrived at the hospital minutes before her death were refused access.
Malouin said he saw nothing wrong with that decision, especially because Dupuis's death was inevitable.
“Any adult in Canada is entitled to decide refuse any treatment for any reason, religious or other,” said patients’ rights advocate Paul Brunet.
Hospitals admit it is not easy to do, but must be respected.
“To watch someone die like that would be very, very difficult but at the same time we're living in a society that says we respect your religious beliefs and we have to work in that context, as long as they seem free,” said Eugene Bereza of the MUHC Centre for Applied Ethics.
Similar situation in Montreal
Mirlande Cadet, 46, died on October 3, 2016 two days after being admitted to St. Mary's Hospital in Montreal to give birth via a C-section.
Cadet had complications during the delivery and was given a transfusion seven hours following her initial surgery, followed by a second operation to ensure she was not bleeding internally.
However Cadet continued to have difficulty breathing, and developed a kidney infection. She died early the next morning of lung failure.
The coroner wrote that Cadet had refused a transfusion when she was initially admitted to hospital, and that her husband, who had medical power of attorney, abided by her wishes. It was only after Cadet's parents convinced their son-in-law that a transfusion was performed.
The coroner said it was not possible to know if the seven-hour delay between the C-section and the transfusion affected Cadet's health.
Following these deaths, Malouin said hospitals should come up with action plans for patients who refuse blood transfusions.
“All that must be discussed before it happens,” he said.
- With files from CTV's Caroline van Vlaardingen and The Canadian Press