Patient autonomy and Patient Blood Management: lessons from the Pindo Mulla v. Spain Case

Abstract

The Pindo Mulla v. Spain judgment (European Court of Human Rights, 2024) demonstrates that violations of patient autonomy may arise not from individual clinical decisions, but from inadequate procedural and institutional preparedness. The case involved a competent Jehovah’s Witness who received a blood transfusion despite her explicit refusal. From a transfusion medicine perspective, the judgment makes clear that respect for informed refusal depends on system readiness rather than ad hoc decision-making. The Court’s finding of a violation of Article 8 exposes cumulative failures, including insufficient Patient Blood Management (PBM) optimization, omission of available bloodless alternatives, and the absence of meaningful patient participation before judicial intervention. These shortcomings transformed an ethically manageable situation into a procedural emergency. PBM should be understood as an organizational framework that operationalizes respect for autonomy while fulfilling the duty to protect life, reconciling Articles 2 and 8 through institutional design rather than emergency exception.