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American Journal of   
Society and Law ( AJSL)

Normative Conflict between Human Rights: Blood Transfusions in Jehovah’s 
Witness Patients in Spain
Dia A Abu Fannas Abdel Jawad1*

Volume 4 Issue 2, Year 2025
ISSN: 2835-3277 (Online)

DOI: https://doi.org/10.54536/ajsl.v4i2.3580
https://journals.e-palli.com/home/index.php/ajsl

Article Information ABSTRACT

Received: July 20, 2024

Accepted: August 24, 2024

Published: August 05, 2025

The refusal of  Jehovah’s Witnesses patients to receive blood transfusions poses a normative 
conflict between several human rights. On one hand, there is the “Right to Religious 
Freedom”, which allows these patients to rely on their religious convictions to refuse such 
medical procedures. On the other hand, there are the “Right to Life” and the “Right to 
Health”, which obligate healthcare professionals to perform all necessary actions to preserve 
patients’ lives and improve their health. Additionally, healthcare professionals are bound by 
the commitments and guidelines of  their profession in performing their duties. Within this 
context, the current study conducts a qualitative analysis of  articles, legal instruments, and 
ethical frameworks. The study employs a legal analysis to explore the normative conflict 
surrounding blood transfusions for Jehovah’s Witness patients in Spain. It focuses on the 
interplay between the Right to Religious Freedom, Right to Life, and Right to Health using 
a qualitative approach. The analysis considers relevant legal instruments, ethical frameworks, 
and case law to identify critical factors influencing decision-making in medical practice, 
particularly the patient’s state of  consciousness and the urgency of  their condition. It 
concludes that the patient’s state of  consciousness and the severity of  their condition are 
the decisive factors. If  the patient is conscious and not in a critical condition, their decision 
to refuse the treatment should take preeminence. Conversely, in cases where a blood 
transfusion is necessary but not urgent, the matter should be brought before the competent 
judicial bodies for a decision. However, in situations where the transfusion is both necessary 
and urgent to save the patient’s life, the decision will be made by the healthcare professionals 
involved, who must then assume the consequences of  their actions. 

Keywords
Hemotransfusions, Human 
Rights, Jehovah’s Witnesses, 
Normative Conflict, Right to 
Health, Right to Life, Right to 
Religious Freedom 

1 Casa Di Consiglio FZE LLC, UAE 
* Corresponding author’s e-mail: AbuFannasAbdel@outlook.com

INTRODUCTION
In a diverse society, individuals navigate a complex 
framework of  rules and principles intended to balance 
personal freedoms with communal harmony (Mayer, 
2018). This framework includes both the rights and 
obligations that individuals must adhere to. These rights 
encompass all the prerogatives granted to individuals, 
typically established within the legal system of  a country, 
most notably in its supreme legal document (Loveland, 
2018). This document is often referred to as the 
“Constitution”. The Constitution, as the highest legal 
authority, encompasses a comprehensive set of  rights 
granted to individuals (Chemerinsky, 2023). This implies 
that the state is committed to creating and enforcing 
measures to ensure these rights are exercised and 
protected. The constitution also aims to restore victims’ 
legal status and provide compensation when needed. 
(Ashworth, 2019).
Moreover, the legal framework described above 
includes a set of  rights deemed particularly important 
for individuals, which is reflected in the willingness of  
states to sometimes limit their national sovereignty to 
align with international guidelines (Daly, 2020). As a 
result, these rights are often given constitutional or even 
supra-constitutional status, depending on the normative 
framework of  each country (Pejchal Grünwald, 2022). 
These rights are known as “Human Rights” and are 
rooted in the dignity of  the human being, with the 

primary goal of  protecting individuals and promoting 
their full development (Gilabert, 2019). Hence, the state 
is both a promoter and guarantor of  these rights.
It is also significant to understand the meaning of  the 
concept of  ‘Human Rights’. The concept of  “Human 
Rights” originated in ancient times with strong religious 
ties, but in modern times, it has evolved to focus on 
people while separating from any religious connections 
(Makrides, 2020). This new notion recognizes the 
equality of  all humans and the consequent need for 
respectful interaction among them, which leads to the 
future coordination of  legal resources to ensure equality 
in the legal and political landscapes, despite the multiple 
differences between the people (Łuków, 2018). With 
the emergence of  the theoretical foundation of  human 
privileges, human dignity broadened its scope in two 
ways, vertically, since human beings are superior to other 
species of  the animal kingdom, and horizontally, by 
establishing equal treatment among them regardless of  
their rank in society (Giustina, 2021).
Moreover, understanding the following terms is also 
crucial to capture the key concepts and clarify the complex 
interplay of  rights involved. The term “Right to Religious 
Freedom” can be defined as the liberty of  individuals to 
engage in their religious activities, which is an essential 
doctrine of  Jehovah’s Witnesses (Gunner, 2023; Martínez-
Torrón, 2006). At the same time, the “Right to Life” also 
highlights the responsibility for the safeguarding of  life, 



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while the “Right to Health” includes the possibility of  
receiving proper health care and treatment (Nampewo et 
al., 2022; Wicks, 2022). These definitions set the context 
of  the study, which is to discern the role of  the above-
mentioned rights in decision-making in the medical 
context. Analyzing these priorities, the current study 
aims to propose solutions for resolving the conflicts that 
arise when religious beliefs challenge standard medical 
practices (Mattei, 2023; Petrini, 2014).
The current study evaluates the normative clash of  
human rights referring to Jehovah’s Witnesses in Spain, 
with an emphasis on their religious beliefs towards blood 
transfusions (Ramírez-Salazar et al., 2003). Jehovah’s 
Witnesses are an independent group of  Christianity who 
hold different beliefs and practices, especially regarding 
the rejection of  blood products (Spencer, 2002). This is 
due to what they consider forbidden by the scriptures, 
including the consumption of  blood, which in their view 
includes transfusion (Murphy, 2023). They were founded 
in the late 1800s and focus on the individual’s life as 
explained in the Bible and stress holiness as opposed to 
physical existence (Peyton, 2020). Due to their beliefs 
regarding the intake of  blood transfusions, they pose 
ethical and legal dilemmas in healthcare facilities especially 
when the treatment options offered to them are against 
their faith (Loix et al., 2020). 
Evaluating this issue is significant, and is reflected in the 
novelty of  the current study since it focuses on the conflict 
of  interest between the liberty of  faith and the right to life 
and health (Harris et al., 2023). These rights define other 
basic human values and freedoms but they can clash in 
certain situations, such as when a patient’s freedom of  
religion clashes with the doctors’ and nurses’ code of  
ethics (Chemerinsky, 2023). Therefore, the objective of  
the article is to present a brief  analysis of  this conflict 
by presenting legal, ethical, and medical aspects (Petrini, 
2014). The research question guiding this study is: How 
the healthcare practitioners uphold the right to freedom 
of  religion with the rights to life and health of  individuals 
who are Jehovah’s Witnesses and decline to take blood 
transfusion? In answering this question, the article aims 
to advance the knowledge of  human rights and medical 
ethics practices for policy and practice purposes in similar 
cases (Mattei, 2023).

LITERATURE REVIEW
The issue of  blood transfusion refusal by Jehovah’s 
Witnesses has been a significant topic of  discussion 
within the fields of  medical ethics, law, and healthcare 
management. A paper published by Radovanović et al. 
(2019) explains that the best approach to minimize the 
use of  homologous blood components in massively 
bleeding Jehovah’s Witness patients is the transfusion of  
intraoperative blood and autotransfusion (Radovanović et 
al., 2021). However, as useful as these alternatives are, the 
literature reveals that they come with their drawbacks. 
Firstly, these methods are often applicable in very few 
centres, which means that they are impossible to access 

when controlling is needed during an emergency when 
there is no time and available resources. Moreover, even 
though there are stimulators of  erythropoiesis such as 
recombinant erythropoietin (rEPO), they are relatively 
costly as compared to allogeneic blood transfusion. There 
is also a question about patient consent as Jehovah’s 
Witnesses may not be aware of  the current spectrum of  
blood-related components and techniques, which makes 
acceptance of  these alternatives an individual matter of  
faith. Such a circumstance can raise ethical issues for 
healthcare personnel who struggle between keeping alive 
and the principle of  the patient’s self-determination. 
Legal approaches to refusal for blood transfusion have 
also been extensively studied, chiefly in the context of  
Europe. In Europe, it has also been noted that patient 
self-determination has become more emphasized in the 
years after the mid-1990s. In their paper, Loix et al. (2019) 
describe the legal aspects of  transfusion refusal among 
Jehovah’s Witnesses in various European countries. The 
study contrasts and compares the legal conditions in 
different countries, citing some aspects of  paternalism 
and others that assert the patient’s sovereignty even 
if  it contradicts the doctor’s advice (Loix et al., 2020). 
However, the literature lacks a unified legal viewpoint, 
with unpredictable court rulings contributing to 
uncertainty in both medical practice and patient care. 
The scoping review by Peyton (2020) highlights a dilemma 
between a patient’s right to self-determination and the 
principle of  beneficence, a paramount consideration, 
especially if  the patient’s life is at risk due to refusal of  
treatment. The author emphasizes the emotional and 
moral costs that healthcare providers experience when the 
provider wants to save the patient’s life but also respects 
the patient’s decision to refuse blood transfusion. Despite 
the depth of  discussion on this topic, the literature reveals 
a gap in understanding how these ethical challenges are 
managed in real-time clinical settings (Peyton, 2020). 
The COVID-19 pandemic has significantly impacted 
various professional sectors, including legal professionals 
in Bangladesh, highlighting socio-economic and 
psychological challenges faced during the crisis (Rashid, 
2024). Similarly, issues of  human security and conflict, 
such as rustling in Nigeria, further complicate the legal 
landscape and necessitate a robust response from regional 
organizations like ECOWAS (Akah et al., 2023). These 
contemporary challenges underscore the importance of  
examining how legal and ethical frameworks adapt to 
crises that affect patient rights and healthcare practices.
There are several gaps in the existing literature, firstly, 
although the usefulness of  non-transfusion management 
approaches is established, there is a shortage of  studies 
on their long-term efficacy and patient outcomes, 
especially in non-specialized settings. Secondly, the legal 
interventions in cases of  transfusion refusal vary across 
jurisdictions, and more studies are necessary to establish 
the outcome of  such variability on both the clients and the 
practitioners. Last but not least, the bioethical discourse 
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conundrums rather than on actual experimental problem-
solving scenarios that clinicians have to deal with when 
handling such cases. The current study intends to bridge 
this gap by providing an empirical analysis of  the practical 
implementation of  alternative transfusion strategies, 
examining legal precedents and their impact on medical 
practice. It further aims to highlight the regional and 
global ethical issues faced in actual clinical practice.
 
MATERIALS AND METHODS
The methodology employed in this study involves a 
legal analysis of  the normative conflict encapsulating 
blood transfusions for Jehovah’s Witness patients in 
Spain. This study focuses on the correlation of  the 
Right to Religious Freedom, the Right to Life, and 
the Right to Health through an integrative, qualitative 
approach that analyses articles, legal instruments, and 
ethical frameworks (Vandemeulebroucke et al., 2022). 
The review section of  the study includes a total of  ten 
articles that were considered in the analysis. The selection 
procedure involved identifying relevant literature that 
addresses the intersection of  the Right to Religious 
Freedom, the Right to Life, and the Right to Health, 
particularly in the context of  Jehovah’s Witnesses’ refusal 
of  blood transfusions. This process aimed to ensure a 
comprehensive understanding of  the ethical, legal, and 
medical implications surrounding the issue, drawing from 
diverse perspectives to inform the qualitative analysis 
conducted in the study. Therefore, studying case law and 
statutory provisions, the study identifies critical factors 
influencing the decision-making process in medical 
practice (Anderson et al., 2012). Moreover, the current 
study particularly the patient’s state of  consciousness 
and the urgency of  their medical condition. This creates 
a discussion because the patient’s autonomy the roles 
of  the healthcare professionals, and the potential legal 
repercussions of  their decisions are explored.

RESULTS AND DISCUSSION
Human Rights
“Human rights” are a set of  privileges inherent to every 
person and have seen a progressive rise in international 
law both from normative and organizational perspectives 
(Martínez-Torrón, 2006). Incidentally, Article 1 of  the 
“Universal Declaration of  Human Rights” stipulates that 
everyone is born independent and equal in dignity and 
rights (Juaristi, 2023). Consequently, under Article 2, all the 
rights contained therein must be recognized, respected, 
and guaranteed by the States within their respective 
jurisdictions to all individuals without any distinction 
(Ramcharan, 2021). This normative position is echoed 
in Article 2.1 of  the “International Covenant on Civil 
and Political Rights”, Article 2.2 of  the “International 
Covenant on Economic, Social, and Cultural Rights”, 
and Article 1 of  the “Convention for the Protection of  
Human Rights and Fundamental Freedoms” (Dziurda 
et al., 2021; Ikawa, 2020; Stanislovas, 2019). These 
international documents also frame the obligation for 

the States Parties to implement all legal, judicial, and 
administrative measures necessary to guarantee and 
protect the aforementioned rights.
Additionally, human rights are inherent and inalienable, 
meaning they cannot be traded or extinguished, although 
their exercise can be suspended or limited in extreme 
situations (Nowak, 2021). They are also non-transferable, 
as individuals cannot transfer or waive these rights. 
Moreover, humanitarian rights are also accumulative and 
irreversible as new rights can be gained over time or the 
scope of  existing rights expanded, making it impossible 
to reduce or reverse already recognized rights (Goodale, 
2022). They are inviolable, meaning no individual, legal 
entity, or governmental body is authorized to infringe, 
damage, or destroy them.
The transboundary nature of  human privileges allows 
the international community to intervene when aware of  
a State violating the human privileges of  its population, 
and the aggressor State cannot claim violation of  its 
national sovereignty in such cases. Lastly, they are also 
universal, meaning any person, regardless of  age, sex, 
physical, social, political, legal, economic, or cultural 
condition, has human rights (Provea, 2008). This 
characteristic implies that these rights are ascribed to all 
individuals notwithstanding of  any context, motivated by 
the fact that such adjudication is carried out regardless of  
any temporal, spatial, political, or cultural circumstance 
(Ferrajoli, 2008).
The legal doctrine has classified human rights into three 
generations. The first-generation rights include municipal 
and governmental privileges, such as the right to life, 
freedom of  transit, freedom of  expression, assembly, 
and religion, as well as political rights like suffrage, 
participation, and political association (Viola, 2015). The 
second-generation rights cover monetary, social, and 
ethnic rights, including the right to work, a decent salary, 
health, social security, education, and a decent standard of  
living. Lastly, third-generation rights, known as peoples’ 
rights, encompass diffuse rights such as the right to a 
healthy environment, peace, sustainable development, 
and the self-determination of  peoples (Viola, 2015). 
According to this classification, first-generation rights 
have a negative character, therefore such rights only 
require the State not to participate negatively in their 
realization, being of  direct application and judicially 
enforceable; while second-generation rights have a 
positive character, as they require positive action by the 
State to achieve their exercise (Bidart Campos, 1998). 
In this regard, the State, as the main guarantor of  human 
rights, has three primary duties: the duty to respect, 
the duty to protect, and the duty to fulfil. The duty to 
respect means the State must refrain from any actions 
that interfere with the full realization of  rights. On the 
other hand, the duty to protect involves safeguarding 
these rights from actions by third parties that might 
negatively affect them. The duty to fulfil requires the 
State to take concrete measures to ensure these rights are 
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Facilitating involves promoting rights and acting 
preventively to favour their realization and avoid their 
violation. Providing, on the other hand, is necessary in 
cases of  need or emergency, such as disability or natural 
or social catastrophes, where individuals cannot realize 
their rights on their own. In these exceptional cases, the 
State must provide the necessary means for individuals to 
enjoy their rights (Viola, 2015). 

Right to Religious Freedom
The right to religious freedom, along with freedom 
of  thought and ideology, is one of  the fundamental 
freedoms and falls within the category of  first-generation 
rights (Giles, 2020). Its international legal foundation is 
drawn from Article 18 of  the “Universal Declaration 
of  Human Rights” and the “International Covenant 
on Civil and Political Rights,” along with Article 5 of  
the European Convention on Human Rights (Dziurda 
et al., 2021; Weissbrodt, 2021). These provisions assert 
that every person has the right to liberty of  thought, 
morality, and religion, including the autonomy to change 
faith or principles, and to manifest them individually or 
collectively (Gunner, 2023). The only limitations to this 
right are those necessary for security, public order, health, 
morals, or the fundamental rights and freedoms of  others.
The doctrine of  religious freedom defines it as the freedom 
to make moral decisions based on one’s moral code, which 
stems from their system of  thought or religious beliefs 
(Ramírez-Salazar et al., 2003). Additionally, it is important 
to distinguish religious freedom from other related terms: 
“ideological freedom” refers to the ability to express and 
defend one’s ideas; “freedom of  conscience” means acting 
without interference from authorities; while “religious 
freedom” pertains to the right to live according to one’s 
religious convictions (Hernández, 2020). Furthermore, 
religious freedom includes the right to conscientious 
objection, which is the right to act according to one’s 
convictions and beliefs.
It should also be noted that the “Right to Religious 
Freedom” is based on a broad international religious 
reality, which includes traditional religions, analogous 
institutional practices, and new religious movements, 
as long as they are not sects that threaten the dignity 
and integrity of  the human being. Religious belief  is 
recognized as a cultural and historical reality, which shapes 
the right and freedom of  individuals to experience their 
existence as an essential part of  their dignity (Abdulla, 
2018). To better conceptualize religion, doctrine identifies 
three categories: belief  (including non-belief), identity 
(including beliefs, cults, traditions, and rites), and way 
of  life (religious activities and practices) (Whitehead & 
Chryssides, 2022).
Religious freedom is further understood to have four 
dimensions:
The first dimension is that of  intellectual and spiritual 
search, in which individuals have the freedom to use 
reason in exploring and understanding the order of  
reality, seeking deeper insights into existence. The second 

dimension is Practical reason which underscores that 
people possess the ability to align their lives with an 
invisible order and commit to any truths they discover, 
integrating these beliefs into daily life. Thirdly, according 
to the dimension of  human sociability, there is freedom 
to engage with others, sharing and expressing one’s 
understanding of  a transcendent order through social 
interactions. Finally, juridical and political expressions are 
the dimension where People have the right to manifest 
religious beliefs in civil society and political life, including 
owning property, directing educational and cultural 
centres, forming associations, and participating in politics 
(Shah et al., 2012).
Jehovah’s Witnesses often invoke their right to religious 
freedom to refuse blood transfusions, based on 
conscientious objection (Mattei, 2023). This right allows 
patients to refuse treatment proposed by doctors due 
to religious or moral beliefs, thereby obligating doctors 
to respect their decision if  viable alternative treatments 
exist. This refusal is also supported by the Principle of  
Autonomy, which states that no medical treatment can be 
administered without the patient’s prior consent, except 
in cases where their life or other fundamental rights are at 
risk (Ramírez-Salazar et al., 2003).
Finally, the rejection of  blood transfusions by this 
religious group is supported by their religious convictions. 
These convictions are based on various biblical passages 
that expressly prohibit ingesting blood (Rongved, 2024). 
Additionally, they believe that failing to comply with divine 
commands means losing the hope of  the ‘Resurrection’ 
and the ‘Promised Paradise’ (Murphy, 2023). 

Biblical Passages that Prohibit Ingesting Blood
It has been exposed by the authors that Jehovah’s Witnesses 
accept the vast majority of  medical treatments (“Those 
who are well do not need physicians, but those who are 
sick...” Luke 5:31). But in the case of  blood transfusion, 
the situation is different. Based on various passages in 
the Bible, such as “You shall only abstain from eating 
flesh with its soul, that is, its blood” (Genesis 5:4), “No 
one from among you... shall eat blood” (Leviticus 17:12), 
“.... for the life of  all flesh is blood; whosoever eateth 
(eats) it shall be destroyed” (Leviticus 17:14). Therefore, 
the Witnesses firmly do not accept the transfusion 
of  primary blood components. The primary blood 
components include red blood cells, white blood cells, 
platelets and plasma (Spencer, 2002). Plasma derivatives 
like albumin, clotting factors and immunoglobulins are 
usually taken by Jehovah’s Witnesses because they are 
biological components that cross the placental barrier 
during pregnancy and as such are not considered primary 
components. In addition, the entities that would have 
been classified as blood in the list of  simpler components 
would not be so classified any longer (Petrini, 2014). 

Right to Life and Right to Health
The Right to Life is a first-generation right of  great 
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Declaration of  Human Rights”, which states it is inherent 
to every person. This principle is echoed in Article 6 of  
the “International Covenant on Civil and Political Rights”, 
which mandates that this right be safeguarded by law and 
prohibits arbitrary deprivation of  life (Ramcharan, 2021). 
The death penalty is permissible only for the most serious 
crimes, following legal procedures, with the possibility of  
commutation. In Europe, Article 12 of  the “Convention 
for the Protection of  Human Rights and Fundamental 
Freedoms” protects this right. It allows exceptions only 
for lawful executions, self-preservation, lawful arrests, 
and prevention of  riots or insurrections (Harris et al., 
2023). Similarly, Article 2 of  the “Charter of  Fundamental 
Rights of  the European Union” asserts everyone’s right 
to life and prohibits the death penalty (Wicks, 2022).
Doctrinally, the “Right to Life” has different meanings; 
as the privilege to exist, to live a decent life, to be 
provided with food and shelter and not to be killed by 
another person or at the behest of  another  (Figueroa 
García-Huidobro, 2008). The ECHR has underlined 
that the State should not only avoid unlawful intentional 
and unintentional killings but also prevent deaths within 
its jurisdiction. This entails enacting criminal laws to 
discourage such crimes and putting measures in place to 
guard vulnerable persons (ECHR, 1998). Also, the State 
has the responsibility to investigate thoroughly cases 
of  violation of  the Right to Life, to bring to book the 
offenders and to compensate the victims whenever the 
“Right to Life” has been disrupted (“Judgement of  the 
Court 28 March “, 2000 ). Another right that is closely 
linked to the content of  this research is the ‘‘Right to 
Health,’ which the World Health Organization describes 
as the absence of  disease and infirmity (Organization, 
2019). This encompasses the choices over one’s own 
life and physical integrity, including the liberty to make 
decisions regarding sexual and reproductive matters, and 
the right not to be subjected to torture or degradation.
The legal regulation of  this right is found in Article 25 of  
the Universal Declaration of  Human Rights (Eide, 1992). 
Article 5 contains the items that shall constitute the right to 
a decent minimum, which consists of  receiving necessary 
medical treatment, social assistance, and insurance in case 
of  sickness, disability, widow, old age or for other reasons 
in cases of  loss of  the means of  livelihood, special 
protection of  motherhood and childhood. This right is 
anchored on Article 12 of  the International Covenant on 
Economic, Social and Cultural Rights (Olumese, 2021). 
According to this article, individuals are free to attain the 
highest level of  health possible (Eide, 1992). 
Moreover, the right to health encompasses a set of  
essential and interrelated features such as, public states 
are obliged to provide adequacy of  health services, 
programmes, products, and facilities such as safe water, 
hygiene facilities, quality human health resources, and 
relevant health commodities (UN. Committee on 
Economic, 2000). There must be no restrictions when 
it comes to making these health resources available 
to society that is, there should not be any prejudices 

in terms of  the geography of  the society or economic 
status or capacity of  the society by among other things 
ensuring health information. Acceptability states that the 
health services delivered to the clients should be ethical, 
culturally appropriate, confidential, and oriented towards 
the client’s health enhancement. Requirement of  quality 
holds that these services should conform to scientific 
and medical requirements of  qualified medical personnel, 
efficient medicine, relevant equipment and clean water 
(UN. Committee on Economic, 2000).

Right to Health in the European Context
In the European context, the privilege to health is 
enshrined in Article 35 of  the “Charter of  Fundamental 
Rights of  the European Union” (Şaramet, 2020). This 
article states that everyone has the right to preventive and 
health care, under the legal and practical conditions of  each 
country. Furthermore, the design and implementation 
of  all policies and actions of  the European Union must 
prioritize a high level of  protection for human health.
The Convention for the Protection of  Human Rights and 
Fundamental Freedoms addresses this issue, albeit in a 
limited manner (De Schutter, 2018). Article 8.2 correlates 
the right to health with the “Right to Respect for Private 
and Family Life” (Lagoutte, 2003). It establishes health 
protection as an exception that legitimizes interference by 
public authorities in an individual’s private and family life.
However, this initial legal approach was refined by the 
European Social Charter. Article 11 of  the Charter 
enshrines the commitment of  states to adopt appropriate 
measures to eliminate the causes of  poor health (Dalli, 
2020). It emphasizes the establishment of  training and 
consultation services to improve health and promotes a 
sense of  individual responsibility for such improvements. 
Additionally, it addresses the prevention of  accidents, as 
well as endemic and epidemic diseases.

Jurisprudential Perspectives
At the jurisprudential level, the European Court 
of  Human Rights has examined the right to health 
concerning the right to life (Yaroshenko et al., 2021). The 
court has analyzed cases of  medical negligence, where the 
actions of  healthcare providers not only violate the right 
to health by failing to provide adequate services but can 
also result in the death of  patients.
For example, in the case of  Asiye Genç v. Turkey, the 
court addressed the death of  a newborn due to a lack 
of  coordination and insufficient medical resources 
(KwiatKowsKi, 2022). This case illustrates how 
inadequate medical services can violate the right to health 
and, consequently, the right to life. It underscores the 
imperative need to ensure suitable emergency services 
for individuals. Similar principles were applied in the 
“Center of  Legal Resources on Behalf  of  Valentin 
Câmpeanu v. Romania” (Domaradzka, 2023). In this case, 
the court found violations of  Articles 2, 13, and 4G of  
the European Convention due to the death of  a disabled 
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treatment.
Additionally, in Šilih v. Slovenia, the court ruled on a case 
involving a patient’s death caused by administering drugs 
to which the patient was allergic (Simović & Simović, 
2021; Türmen). This case further demonstrates how 
medical negligence, which constitutes a clear abuse of  
the right to health in terms of  the quality and suitability 
of  medical services, can ultimately lead to a desecration 
of  the “right to life” (Kapelańska-Pręgowska, 2019). In 
summary, the evolving legal framework and jurisprudential 
interpretations highlight the critical interconnection 
between the right to health and the right to life within the 
European context.

The Link Between Rights to Life and Health in 
Medical Practice
Having outlined the notions and international legal 
parameters regarding the Rights to Life and Health, 
it is essential to clarify their connection to the current 
issue (Hemberg & Hemberg, 2020). Safeguarding these 
rights represents the primary commitment of  medical 
and healthcare professionals (Nampewo et al., 2022). 
Their actions are deeply rooted in these principles, as 
they are responsible for providing care and treatment 
in a manner that optimally ensures the improvement 
or maintenance of  patients’ physical and mental well-
being. The performance of  these professionals can 
significantly impact whether individuals enjoy these rights 
or experience their violation (Nampewo et al., 2022).   
In this context, medical personnel dedicate their training 
and efforts to healing their patients as efficiently and 
effectively as possible (Shanafelt et al., 2019). They 
constantly assess the consequences and feasibility of  
applicable treatments, typically opting for those most 
likely to achieve a curative effect with the least harmful 
side effects. This commitment is further supported by the 
Ethical Principles of  Medicine (Nampewo et al., 2022). 
These include the Principle of  Beneficence which claims 
that physicians should act for the benefit of  patients and 
society (Avant & Swetz, 2020). Similarly, according to the 
Principle of  Equity physicians are obligated to provide 
medical care based on current health needs, without 
discrimination, preferences, or privileges(Blanchet 
Garneau et al., 2019). Similarly, the principle of  Autonomy 
implies that adult patients, in full use of  their faculties, 
have the right to decide on the type of  medical care 
they wish to receive (Lewis, 2020). Their willingness and 
acceptance are fundamental for the application of  the 
medical treatments to which they are entitled. Finally, 
according to the Principle of  Confidentiality, patients 
have the right to ensure that information shared during 
doctor-patient interactions remains confidential (Murtaza 
et al., 2021).
In summary, the intersection of  these rights and ethical 
principles underscores the critical role that healthcare 
professionals play in upholding the “Right to Life and 
Health” (Nampewo et al., 2022). Also belonging to this 
set of  principles, the Principle of  Dignity consists of  

the commitment of  physicians to provide care to their 
patients following their human condition, their organism, 
conscience, will and freedom (Camosy, 2021). On 
the other hand, according to the Principle of  Respect, 
the medical care given to patients should be based on 
consideration and courtesy to their condition as patients.
The Principle of  Solidarity indicates the obligation of  
physicians to share their goods and knowledge with 
people who need their services or support, as well as 
the promotion of  organ donation for transplants (Shaw, 
2019). Moreover, the Principle of  Honesty is based on 
the duty of  health professionals to express themselves 
and act in strict compliance with current regulations and 
religious ethical principles (Varkey, 2021). The Principle 
of  Loyalty implies the obligation of  the physician to 
correspond to the trust placed in them and the Principle 
of  Justice, is based on giving to each person what 
corresponds to them, according to law or reason (Huang 
et al., 2021; Kelsen, 2022).
Finally, it is important to specify that the described legal 
relationship has two scenarios. The first one is when 
the patient is conscious and in a state that does not 
represent a risk to his physical integrity. In this case, he 
will determine, according to the Principle of  Autonomy, 
whether or not to apply the required transfusions 
(Bolcato et al., 2021). The patient, knowing the details, 
situation, and consequences of  the application or non-
application of  the treatment proposed by the physician, 
indicates his approval or refusal of  the application of  the 
same (Utomo).
The second scenario is when the patient is not conscious, 
there is no legal representative who can give any approval, 
or the refusal to hemotransfusions was established in the 
informed consent, but the patient’s medical situation is 
so serious that it puts his life or the quality of  his life at 
significant risk. In this case, the medical professional has 
the responsibility to decide, based on the urgency of  the 
patient’s situation, how to safeguard the Rights to Life 
and Health, based on his professional ethical principles 
(Burkholder et al., 2019). This may lead to the application 
of  blood transfusion, an action that may imply the 
violation of  the Right to Religious Freedom of  the 
Jehovah’s Witness patient, an aspect that will be discussed 
further in the following section.

Spanish Context of  Blood Transfusions in Jehovah’s 
Witness Patients
The Spanish regulatory framework is governed by the 
Spanish Constitution, a legal instrument that establishes 
the macro guidelines for governmental action (da Silva 
RodriguesI et al.; Solanes Mullor & Torres Pérez, 2019). 
This framework naturally includes the obligations of  
individuals and their rights, which the State must guarantee 
and protect. The obligation extends to Human Rights, 
especially when the Government commits itself  by signing 
international conventions on the matter. These conventions 
become part of  the internal legal system after their official 
publication, as stated in Article 5 of  the Constitution. 



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Right to Religious Freedom
Regarding the “Right to Religious Freedom”, its legal 
basis is implicit in Article 16 of  the Spanish Constitution, 
which guarantees the ideological, religious, and 
worship freedom of  individuals and their consequent 
manifestations (Martínez-Torrón, 2001). The only 
limiting factor is the maintenance of  public order, which 
includes a prohibition against forcing individuals to 
declare their beliefs, religion, or ideology. However, the 
limits to exercising this right have been extended legally. 
Article 3, paragraph one of  the Organic Law of  Religious 
Freedom stipulates that this right may be exercised except 
in cases where public liberties, fundamental rights, public 
safety, health, and morals may be affected (Martínez-
Torrón, 2001, 2006).
Additionally, the Organic Law of  Religious Freedom, 
according to Article 1, approves the State’s obligation 
to guarantee the enjoyment, exercise, and protection of  
religious freedom (Martínez-Torrón, 2001). It prohibits 
discrimination based on religious beliefs and establishes 
the secularity of  the State. The law also outlines the 
aspects of  this right, which include professing religious 
beliefs and manifesting them, changing or abandoning 
religious beliefs, practising acts and activities of  worship, 
receiving assistance related to their faith, providing and 
receiving religious teachings and information by any 
means, meeting or expressing themselves, publicly for 
religious purposes, and associating to develop religious 
activities as a community (Justicia, 2017).
These provisions are detailed in Article 2 of  the 
aforementioned law (Canamares, 2010). Given this 
context, Jehovah’s Witnesses, as patients exercising their 
religious freedom, have the right to express and assert their 
conscientious objection to receiving hemotransfusions. 
This objection is a manifestation of  their beliefs and 
convictions, and it must be duly communicated to the 
relevant medical personnel, who are obligated to respect 
the patient’s wishes, within the legal limits described 
above.

Implications
The legal analysis of  Jehovah’s Witness patients’ negative 
stance on blood transfusions leads to several important 
conclusions. Both in the international and Spanish 
spheres, the right to life is considered to have a developed 
hierarchy than the rest of  human rights, as without it the 
existence of  the others is not possible (Delmas-Marty, 
2021). There is a strong connection between the Right 
to Life and Health and the medical profession since 
the latter’s activities are a determining factor between 
the exercise or violation of  such rights. The negligent 
performance of  medical tasks may generate a desecration 
of  both the “Right to Health” and the “Right to Life” in 
the same patient (Akter & Tamanna, 2020).
In cases where the patient is conscious and his/her life is 
not in danger, his/her manifest will refuse to receive blood 
transfusions due to religious beliefs (Obidimma, 2019). It 
will be given preeminence, by the principle of  autonomy. 

When blood transfusion is necessary for the patient’s 
condition but not urgent and the patient has expressed 
his or her disapproval of  this medical procedure, the case 
must be brought before the competent judicial bodies 
for resolution. The judges, when evaluating the case, 
have the responsibility to take into account the imminent 
danger that the non-application of  hemotransfusions 
would represent for the patient’s life or the quality of  the 
transfusion.
In cases where blood transfusion is necessary and urgent 
given the seriousness of  the patient, the medical staff  
will make the respective decision, which should lean 
towards the application of  such transfusion given the 
preeminence of  the “Right to Life” and the “Right to 
Health” over the Privileges to Religious Independence in 
the Spanish legal system (Casey-Maslen & Heyns, 2021). 
Moreover, the non-application of  the blood transfusion 
to the Jehovah’s Witness patient when it was necessary 
and urgent to preserve his life or the quality of  his life, 
may result in administrative and/or criminal liabilities 
for health professionals, such as a criminal investigation 
for the crimes of  injury or culpable homicide, due to the 
condition of  guarantor of  the rights to life and health 
that these professionals have in the performance of  their 
duties (Ernest & Okpokam, 2019).

CONCLUSION
The evaluation of  the normative conflict regarding blood 
transfusions for Jehovah’s Witness patients highlights 
a clash between the privilege of  Religious Freedom 
and the “Right to Life and Health”. This conflict 
illustrates the necessity of  considering individual beliefs 
in medical practice while healthcare providers uphold 
their oath to save lives. Consequently, the patient’s 
state of  consciousness and critical health condition are 
paramount in determining the appropriate course of  
action. If  the patient is fully conscious, even in a severe 
condition, their religious belief  to refuse treatment 
should prevail. However, in situations where a blood 
transfusion is necessary and life-threatening, healthcare 
professionals must act in the best interest of  the patient, 
even if  it means potentially violating the patient’s 
religious rights. Ultimately, this analysis emphasizes the 
need for established legal and ethical standards that guide 
healthcare providers in managing such conflicts while 
respecting patient rights and beliefs.

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