{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:00:37Z","timestamp":1785297637828,"version":"3.55.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Tokai University, Isehara Campus"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Monash Bioeth. Rev."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Refusal of blood transfusion is often framed as a conflict between competent patients\u2019 refusal and clinicians\u2019 responsibility to prevent death or serious harm. In Japan, many hospitals have adopted relative non-transfusion policies, which seek to avoid transfusion where possible while reserving emergency transfusion when necessary. Existing debates have asked whether such policies are ethically or legally justified. This study examines how they structure access and responsibility as hospital policies. We conducted a document analysis of publicly available transfusion refusal policies from all designated advanced treatment hospitals in Japan (n\u2009=\u200988), using qualitative content analysis and ethical interpretation. Publicly available institution-wide policies were identified in 50 hospitals (56.8%). Three approaches were identified: structured relative non-transfusion policies specifying thresholds, emergency transfusion provisions, and the clinical or institutional locus of decision-making (41\/50); transfer-first or standard-care prerequisite policies (5\/50); and low-specification or deferred policies (4\/50). Emergency transfusion override provisions appeared in 45\/50 policies, thresholds in 47\/50, decision-making locus in 46\/50, elective\u2013emergency distinctions in 25\/50, and transfer or referral recommendations in 33\/50. These findings suggest that relative non-transfusion policies do more than specify whether emergency transfusion may be undertaken despite refusal. They organize conditions under which patients access care, emergency transfusion may be reserved, referral or transfer may be recommended, and institutions retain, redirect, or leave under-specified responsibility. Ethical evaluation should consider meaningful access, transparent thresholds, feasible referral pathways, case-specific assessment, and institutional support for bedside judgment before emergencies arise.<\/jats:p>","DOI":"10.1007\/s40592-026-00306-0","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:10:36Z","timestamp":1785294636000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structuring access and responsibility in transfusion refusal: a document analysis of relative non-transfusion policies in Japan"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2119-4628","authenticated-orcid":false,"given":"Tomoari","family":"Mori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kana","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizuho","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Unzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Ohnuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Takeshita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"306_CR1","unstructured":"American College of Surgeons. 2018. Recommendations for surgeons caring for patients who are Jehovah\u2019s Witnesses. Retrieved 30 June 2026, https:\/\/www.facs.org\/about-acs\/statements\/recommendations-for-surgeons-caring-for-patients-who-are-jehovah-s-witnesses\/."},{"issue":"Suppl 1","key":"306_CR2","doi-asserted-by":"publisher","first-page":"S72","DOI":"10.1016\/S1344-6223(02)00092-5","volume":"5","author":"T Ariga","year":"2003","unstructured":"Ariga, T., and K. Hayasaki. 2003. Medical, legal and ethical considerations concerning the choice of bloodless medicine by Jehovah\u2019s Witnesses. Legal Medicine 5 (Suppl 1): S72\u2013S75.","journal-title":"Legal Medicine"},{"key":"306_CR3","volume-title":"Principles of biomedical ethics","author":"TL Beauchamp","year":"2019","unstructured":"Beauchamp, T. L., and J. F. Childress. 2019. Principles of biomedical ethics. 8th ed. 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Qualitative Research Journal 9 (2): 27\u201340. https:\/\/doi.org\/10.3316\/QRJ0902027.","journal-title":"Qualitative Research Journal"},{"issue":"5","key":"306_CR6","doi-asserted-by":"publisher","first-page":"658","DOI":"10.4103\/0019-5049.144680","volume":"58","author":"NK Chand","year":"2014","unstructured":"Chand, N. K., H. B. Subramanya, and G. V. Rao. 2014. Management of patients who refuse blood transfusion. Indian Journal of Anaesthesia 58 (5): 658\u2013664. https:\/\/doi.org\/10.4103\/0019-5049.144680.","journal-title":"Indian Journal of Anaesthesia"},{"key":"306_CR7","volume-title":"Setting limits fairly: Learning to share resources for health","author":"N Daniels","year":"2008","unstructured":"Daniels, N., and J. E. Sabin. 2008. Setting limits fairly: Learning to share resources for health. 2nd ed. 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The ethics of blood transfusion refusal in clinical practice among legal and medical professions in Japan. Nagoya Journal of Medical Science 82 (2): 193\u2013204. https:\/\/doi.org\/10.18999\/nagjms.82.2.193.","journal-title":"Nagoya Journal of Medical Science"},{"key":"306_CR11","unstructured":"Joint Committee on Religious Refusal of Blood Transfusion. 2008. Sh\u016bky\u014dteki yuketsu kyohi ni kansuru gaidorain (Guidelines on religious refusal of blood transfusion). Retrieved 30 June 2026, https:\/\/anesth.or.jp\/files\/pdf\/guideline.pdf."},{"key":"306_CR12","first-page":"93","volume":"7","author":"Y Kato","year":"2013","unstructured":"Kato, Y. 2013. Objections to blood transfusion by Jehovah\u2019s Witnesses in Japan and a reconsideration of self-determination in healthcare. Journal of Philosophy and Ethics in Health Care and Medicine 7:93\u2013113.","journal-title":"Journal of Philosophy and Ethics in Health Care and Medicine"},{"issue":"2","key":"306_CR13","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1513\/AnnalsATS.202310-925ST","volume":"21","author":"JM Kruser","year":"2024","unstructured":"Kruser, J. M., D. C. Ashana, K. R. Courtright, E. K. Kross, T. H. Neville, and E. Rubin et al. 2024. Defining the time-limited trial for patients with critical illness: An official American Thoracic Society Workshop Report. Annals of the American Thoracic Society 21 (2): 187\u2013199. https:\/\/doi.org\/10.1513\/AnnalsATS.202310-925ST.","journal-title":"Annals of the American Thoracic Society"},{"issue":"5","key":"306_CR14","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1001\/jama.2011.32","volume":"305","author":"J Lantos","year":"2011","unstructured":"Lantos, J., A. M. Matlock, and D. Wendler. 2011. 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