In signing the form you are agreeing only to treatment you are willing to accept and which you have discussed with your doctor. Although the results of the 2005 audit were not strictly comparable with the 2003 audit, practice does appear to have improved in broad terms, it concludes: fewer patients were found without a wristband (6% compared with 10% in 2003); and fewer were unobserved during the first 30 minutes of transfusion (34% compared with 47% in 2003).

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This case illustrates how the law can interface with patient safety efforts, and highlights the need to pay close attention to patients' wishes, regardless of the potential clinical outcome.

Red blood cells carry oxygen around the body and their number is measured by testing your haemoglobin. Hence, in this case, providers should not have transfused the patient on both ethical and legal grounds. Emergency physicians should look for evidence of an informed refusal when evaluating these documents. Clear policies and procedures along with communication regarding protocol requirements in these situations should be extant and part of continuous safety training. The ‘Advance Decision to Refuse Specified Medical Treatment’ or any similar form should be seen and acknowledged by the doctor treating you.The possibility that in an emergency the dangers of blood may be relatively small, as compared with the likelihood of death due to exsanguination without blood, is not noted on the card. The minister, on the other hand, stated that the woman converted to this religion with the full knowledge of its tenets and was well aware of the consequences of her decision.