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“I have no doubt that the medical staff tried everything to get Ms. Dupuis and her family to change their minds about the need to use blood products to save her life,” the coroner wrote. He noted the family members were all Jehovah’s Witnesses. “In accordance with their religious principles, they refused the only medical treatment available to prevent death.”

Malouin wrote that early in her pregnancy, Dupuis advised staff at the birthing centre in Lévis, Que., that she would not accept transfused blood, which Jehovah’s Witnesses believe is forbidden by the Bible.

After complications during her labour, Dupuis was transferred on Oct. 6 from the birthing centre to Hôtel-Dieu Hospital in Lévis, where a C-section was performed and her baby was delivered in good health.

But soon afterwards she began hemorrhaging and was transferred to intensive care. She was diagnosed with anemia — a shortage of red blood cells — and doctors performed a hysterectomy.

In studying her medical records, Malouin found five occasions when Dupuis told doctors she did not want a transfusion, even as her condition deteriorated. “Refusal of transfusion even if death is the result,” one note said the evening after she gave birth.

After she was sedated and no longer able to express her wishes, her husband and parents maintained the refusal to provide Dupuis with blood. She died Oct. 12 of multiple organ failure caused by severe loss of blood.