Medical ethics: blood transfusions
Medical ethics: blood transfusions
Jehovah's Witnesses refuse blood transfusions, including autologous transfusions in which a person has their own blood stored to be used later in a medical procedure, (though some Witnesses will accept autologous procedures such as dialysis or cell salvage in which their blood is not stored) and the use of packed RBCs (red blood cells), WBCs (white blood cells), plasma or platelets.
Witnesses believe that God has forbidden this in Bible passages such as:
Only flesh with its soul-its blood-you must not eatGenesis 9:3-4
Abstain from ... fornication and from what is strangled and from bloodActs 15:19-21
Accepting a blood transfusion willingly and without regret is seen as a sin. The Witness concerned would no longer be regarded as one of Jehovah's Witnesses.
This refusal to accept blood makes some operations more dangerous and causes some doctors considerable anxiety. Witnesses are willing to absolve doctors of responsibility by signing forms with appropriate wording such as:
As a member of the religious body of Jehovah's Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery. I am aware that the planned and needed procedure thus has a higher risk due to bleeding complications. After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components.
Doctors generally feel that respect for the patient's autonomy requires that this wish should be obeyed. They have sound legal reasons for this too, as to administer blood in the face of refusal by a patient may be unlawful and could lead to criminal and/or civil proceedings.
Many Jehovah's Witnesses carry a signed and witnessed advance directive card absolutely refusing blood and releasing doctors from any liability arising from this refusal.
There have been cases where doctors have gone to court to get permission to give blood to children against the wishes of parents who are Jehovah's Witnesses.
Cell-free blood products, containing haemoglobin but not red blood cells have recently become available and may be acceptable for some Jehovah's Witnesses.
Although Jehovah's Witnesses cannot accept blood, they are open to other medical procedures. Jehovah's Witness Hospital Liaison Committees maintain lists of doctors who are prepared to be consulted with a view to treatment without the use of blood transfusion. This has eased many of the tensions related to the issue.
In 2000 the Witnesses changed the rules on blood transfusions so that the Church would no longer take action against a Witness who willingly and without regret underwent a blood transfusion. Some people wrongly interpreted the change as meaning that Witnesses could now accept blood. But the actual change was just that the Church would not take disciplinary action against that Witness.
This was because the Church had no need to take action; the Witness concerned would no longer be viewed as one of Jehovah's Witnesses because he no longer accepted and followed a core tenet of the faith - i.e. the act of accepting a blood transfusion stopped a person being a Witness, without any further action by the Church.
If the Witness later changes their mind and repents of their action they can return to the Church.
Of course, if a Witness is transfused against their will, this is not regarded as a sin on the part of the individual. Children who are transfused against their parents' wishes are not rejected or stigmatised in any way.
Debating the medical ethics
A case involving a Witness with acute myeloid leukaemia is discussed by a panel of experts from clinical ethics committees in hospitals around the UK.
The standard treatment is high dose chemotherapy to kill the cancerous blood cells. A crucial part of this involves replenishing the blood system, which is destroyed as a side effect of the chemotherapy. But Jehovah's Witnesses do not accept blood products and are prepared to die rather than compromise their belief.
The patient, rather than refusing treatment entirely, he asked for the chemotherapy to be administered with alternatives to blood products, which are more expensive. The nursing staff were extremely distressed by the situation. They felt that it was unethical to give him chemotherapy because in the absence of blood support it was likely to fail, and could even hasten his death.
- Can a patient demand a partial treatment that the doctor considers futile and could even cause them harm?
- Patients have the right to refuse a treatment, but does he have a right to refuse part of it?
- If the patient's wishes are paramount, is the emotional impact on the nursing staff as important?
- Should a patient, on religious grounds or otherwise, have the right to more expensive treatment than others?