Greewich, Conn. -- When Carol Ferenz stood by her religious principles, it may have cost her life. It certainly left authorities in a quandary about her son.
Ferenz, a Jehovah's Witness, turned down a blood transfusion after she was stabbed multiple times in her Greenwich home on New Year's Eve. The Westchester County Medical Examiner in New York said her death was a homicide caused by blood loss due to stab wounds.
Her 42-year-old son, Stephen Ferenz, who is mentally ill, is charged with two counts of first-degree assault. Authorities are weighing whether to charge him with homicide, evaluating whether the victim's decision to refuse a transfusion played a central role in her death.
"Certainly it had to play some role," said prosecutor Jim Bernardi. "At this point the degree to which it affected the outcome is still awaiting a review of the medical records."
The Jehovah's Witnesses shun the outside world in many respects. They cite verses in Leviticus and Acts that they say forbid blood transfusions. One often-cited Leviticus passage reads: "Whatsoever man ... eats any manner of blood, I will cut him off from among his people."
Ferenz, who was arraigned Jan. 2 and is being held on $1 million bond under a suicide watch, is due back in court Tuesday.
A similar case occurred in 1998 in California, when a Jehovah's Witness who was hit by a drunken driver refused a blood transfusion and died. The 32-year-old driver, Keith Cook, blamed Jadine Russell's death on her religious faith, but Cook was convicted of manslaughter and sentenced to 10 years in prison.
Most defenses in such cases fail, said Laurie Levenson, a criminal law professor at Loyola Law School.
"Overwhelmingly, the person who inflicted the harm is still responsible, notwithstanding the victim's decision to reject medical treatment," Levenson said. "The issue is who caused her death _ her son or her decision not to have the blood transfusion."
But Levenson said prosecutors are wise to proceed cautiously, noting that the reaction of jurors is unpredictable.
"It's out of the ordinary. They (prosecutors) tend to pause because they realize it's a more complicated case," Levenson said.
Ferenz, 63, was stabbed in the chest and arm with a household knife. She was taken to Greenwich Hospital and later to Westchester Medical Center in Valhalla, N.Y., where she died on New Year's Day.
"She looked the doctor in the eye and said, 'No transfusion, no blood,"' her husband, said Andrew Ferenz.
He said he was not sure whether the lack of a transfusion contributed to her death. He said at one point he asked a doctor if his wife could have a transfusion, but said his wife had already given her instructions.
Ferenz said his son has been on medication for 25 years.
"When he does go off of it, he can't control himself," Ferenz said. "This is the only time he got violent."
Ferenz said "no way" should his son be charged with homicide.
"He doesn't know what he's doing," Ferenz said. "He needs help."
Police said they had been called to the Ferenz's house many times. Stephen Ferenz suffers from bipolar disorder, Bernardi said.
Hospital officials declined comment, citing patient confidentiality. Ferenz's public defender also declined to comment.
Church officials said Carol Ferenz made the decision not to accept a transfusion.
"The family called us for comfort and encouragement," said Jonathan Saxon, a church spokesman. "She did not ask us for a blood transfusion."
Saxon said church members accept alternatives to transfusions.
"We all seek high quality medical treatment," Saxon said. "If we refuse one type of treatment, we have alternatives."
But Ferenz apparently lost too much blood, said Fred Kida, a longtime friend and fellow church member.
A decision to turn down a transfusion does not automatically mean it contributed to her death, said Suzanne Russell, coordinator of the Center for Bloodless Medicine and Surgery at Hartford Hospital. Russell noted that some trauma victims receive plenty of blood through transfusions and still die, while others with multiple stab wounds who turned down transfusions have survived.
The Hartford Hospital center uses a combination of alternatives to transfusions, including aggressive steps to stop bleeding, liquid solutions to replace blood loss and medications to speed up the buildup of blood, Russell said.
"I don't think we can say if this woman had accepted blood she would be alive today," Russell said. "The most important thing, even if it's a life-threatening situation, is to be obedient to God's law as they understand from the Bible."
Ferenz and her husband, a retired mail carrier, were close and enjoyed fishing together, Kida said.
"It's heartbreaking to see him," Kida said. "He misses her."
In addition to caring for her son, Carol Ferenz looked after for her elderly mother, visiting her daily, Kida said. He described her as remarkably upbeat.
"She never complained. She always had a smile on her face and had nice things to say," Kida said. "Everybody loved her."
The family lives in a neighborhood of modest homes in this mostly wealthy suburb of New York City. Ferenz was devout, opening her home to others for weekly Bible study discussions, Kida said.
"She loved her God Jehovah," Kida said. "She showed this by her speech, her actions, keeping her integrity to the very end."