Free The Children Act by Ian McEwan

and therecipient receiving their transfusion and there is potential for error at each stage of the process.’ ”
    “Our staff are highly trained. They take great care. I don’t recall a single hemolytic reaction in years.”
    “If we added all these dangers up, wouldn’t you say there was enough to give a rational person pause, Mr. Carter, without that person being a member of what you call a cult?”
    “These days, blood products are tested to the highest standards.”
    “Nevertheless, it would not be wholly irrational to hesitate before accepting to be transfused.”
    Carter thought for a moment. “Hesitate, perhaps, at a stretch. But to refuse in a case like Adam’s would be irrational.”
    “You accept that hesitation is in order. So it wouldn’t be unreasonable, surely, given all the possibilities of infection and error, for the patient to insist that his consent be sought.”
    The consultant made a show of self-control. “You’re playing with words. If I’m not permitted to transfuse this patient, he may not recover. At the very least he could lose his sight.”
    Grieve said, “Isn’t there something like an ill-considered fashion in your profession for transfusion, given the risks? It’s not evidence-based, is it, Mr. Carter? It’s rather like bloodletting in the old days, except, of course, in reverse. Patients who lose a third of a pint of blood during surgery are routinely transfused, no? And yet a donor gives up a whole pint and goes straight back to work afterward, and no harm done.”
    “I can’t comment on the clinical judgment of others. Thegeneral view, I suppose, is that a patient weakened by surgery should have all the blood that God allotted.”
    “Isn’t it the case that Jehovah’s Witness patients are regularly treated now by what’s called bloodless surgery? No transfusions are necessary. Allow me to quote to you from the
American Journal of Otolaryngology
: ‘Bloodless surgery has come to represent good practice, and in the future it may well be the accepted standard of care.’ ”
    The consultant was dismissive. “We’re not talking of surgery here. This patient needs blood because his treatment prevents him from making his own. It’s as simple as that.”
    “Thank you, Mr. Carter.”
    Grieve sat down and John Tovey, who appeared to depend on a cane with a silver head and who was counsel for Adam Henry, breathily got to his feet to cross-examine the consultant.
    “You’ve clearly spent time alone in conversation with Adam.”
    “I have.”
    “Have you formed an impression as to his intelligence?”
    “Extremely intelligent.”
    “Is he articulate?”
    “Yes.”
    “Is his judgment, his cognition, clouded by his medical condition?”
    “Not as yet.”
    “Have you suggested to him that he needs a transfusion?”
    “I have.”
    “And what has been his response?”
    “He firmly refuses it on the grounds of his religion.”
    “Are you aware of his exact age in years and months?”
    “He’s seventeen years and nine months.”
    “Thank you, Mr. Carter.”
    Berner rose to reexamine.
    “Mr. Carter, will you remind me again how long you’ve specialized in hematology?”
    “Twenty-seven years.”
    “What are the risks of an adverse reaction to a blood transfusion?”
    “Very low. Nothing compared to the certain damage that will be done in this case by failing to transfuse.”
    Berner indicated that he had nothing more to ask.
    Fiona said, “In your opinion, Mr. Carter, how much time do we have to resolve this matter?”
    “If I can’t give blood to this boy by tomorrow morning we’ll be in very dangerous territory.”
    Berner sat. Fiona thanked the doctor, who left with a curt, possibly resentful nod toward the bench. Grieve got to his feet and said he would call the father straightaway. When Mr. Henry came to the stand, he asked if he might swear on the New World Translation. The clerk told him there was only the King James. Mr. Henry nodded and swore on