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Patient’s Right To Refuse Blood Upheld, Though Posthumously

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Maria Isabel Duran was a devout Jehovah’s Witness. The 34-year-old New York woman believed, along with most members of her faith, that the Bible prohibits transfusions of blood or blood products, even when life is threatened.

Ms. Duran also needed a liver transplant operation. Her faith does not teach that organ transplants are prohibited, and so Ms. Duran searched for a medical facility that would recognize her medical and spiritual needs. She learned that the University of Pittsburgh Medical Center had performed transplants on Jehovah’s Witnesses without transfusions.

Knowing that her husband did not share her religious convictions, Ms. Duran took precautions to ensure that she would not receive blood transfusions. She named a friend as her agent for health care decisions, and her health care power of attorney included strong language making her refusal clear. “I absolutely, unequivocally and resolutely refuse homologous blood (another person’s blood) and stored autologous blood (my own stored blood) under any and all circumstances, no matter what my medical condition,” wrote Ms. Duran (the provisions in bold print here were in bold in her original power of attorney).

Immediately after the 1999 transplant Ms. Duran’s body began to reject her new liver, and her condition declined precipitously. She lapsed into a coma, and her health care agent was called upon to consent to a second transplant operation. Before that operation Ms. Duran’s physicians decided that she needed an immediate transfusion.

Presumably realizing that Ms. Duran’s health care agent would refuse permission for a blood transfusion, her husband instead filed an emergency guardianship proceeding with the Pennsylvania courts. An attorney was appointed to represent Ms. Duran, and her physician, husband and sister all testified to the need for a blood transfusion. Her health care agent was not notified about the legal proceeding. After a brief hearing the judge approved transfusions. Ms. Duran’s health care agent objected, but transfusions continued during the ensuing legal maneuvers. Ms. Duran died three weeks later.

Despite the death of Ms. Duran her health care agent pursued an appeal of the order permitting transfusions. Recognizing that the situation could arise again, and that it was important to have some legal resolution of the dispute, the Pennsylvania Superior Court accepted jurisdiction of the case.

That court ruled that the crystal-clear language of Ms. Duran’s health care power of attorney should have been enforced. Furthermore, Ms. Duran’s health care agent was entitled to be notified of the proceedings and defend her wishes in court. Although Ms. Duran did not survive the operation or the legal proceedings, her case reinforces the right of patients to control their own treatment. In Re Duran, February 21, 2001.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

Famous people's wills

Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.