|BIOETHICS OF THE REFUSAL OF BLOOD BY JEHOVAH'S WITNESSES:
PART 2. A NOVEL APPROACH BASED ON RATIONAL NON-INTERVENTIONAL
Most physicians dealing with
Jehovah's Witnesses (JWs) who refuse blood-based treatment are
uncertain as to any obligation to educate patients where it concerns
the JW blood doctrine itself They often feel they must unquestioningly
comply when demands are framed as religiously based. Recent discussion
by dissidents and reformers of morally questionable policies by the JW
organisation raise ethical dilemmas about "passive" support of this
doctrine by some concerned physicians. In this paper, Part 2, I propose
that physicians discuss the misinformation and irrationality behind the
blood doctrine with the JW patient by raising questions that provide
new perspectives. A meeting should be held non-coercively and in strict
confidence, and the patient's decision after the meeting should be
fully honoured (non-interventional). A rational deliberation based on
new information and a new perspective would enable a certain segment of
JW patients to make truly informed, autonomous and rational decisions.
(Journal of Medical Ethics
Religion; Jehovah's Witnesses; blood transfusion; medical ethics;
physician-patient relations; informed consent
In the companion paper, Part 1,(n1) I
suggested that physicians faced with ethical dilemmas related to
treating Jehovah's Witness (hereafter "JWs") patients who refuse blood
products should consider, not only the official position of the
controlling religious organisation (Watch Tower Bible and Tract
Society, hereafter "WTS"), but also dissident and reform views on the
doctrine of blood refusal. A growing body of evidence from current and
former members, supported by WTS publications, suggests that unethical
practices, such as breaching JW patients' confidentiality, are
encouraged. According to dissidents the doctrine is based on
inconsistent and contradictory teachings and policies, and Jehovah's
Witnesses are given misinformation and steered away from correct
information and rational reasoning. Unless only marginally associated,
they are well aware of the consequences of not holding to
organisational policies and that their privacy is subject to invasion.
It is likely that principles of patient autonomy and informed consent
(or refusal) are compromised. The critical perspectives of dissidents
and reformers suggest that the medical community's supportive attitude
towards the blood doctrine should be reconsidered.
questioned the attitude of physicians who accept patients' decisions
without making their own moral judgments. He proposed the notion of
"rational non-interventional paternalism" which recommends that
physicians form conceptions of what is best for their patients and
argue rationally with them. This approach to ethical decisions retains
the old-style paternalist's commitment to deciding what is, all things
considered, best for the patient, but rejects compelling the patient to
adopt that course. More recently, Savulescu and Momeyer(n3) argued that informed
consent should be based on rational beliefs. They used the case of JWs'
refusal of blood transfusions as an example of choice based on
irrational beliefs. They further argued that if physicians are to
respect patient autonomy and help patients choose and act rationally,
they must not only provide information but should care about the
theoretical rationality of their patients. They proposed that
physicians act as "critical educators" and concluded that a physician's
failure so to act would ultimately be viewed as abandoning patients to
"autonomy-destroying theoretical irrationality".
In this paper I will expand on
this argument and propose that medical professionals familiarise
themselves with the inherent flaws of the blood doctrine, and provide
JW patients with new perspectives and rational reasoning by posing a
few simple questions which can be presented in "non-interventional"
fashion and without outside pressure. These questions may enable
patients to view their doctrine from new perspectives and give them a
chance to make a more informed, autonomous and rational decision.
Jehovah's Witness patients who
refuse life-saving blood transfusions may not only be irrational, as
Savulescu and Momeyer(n3) argue, but may also be misinformed, misguided and,
to some degree, coerced, according to the information, based on direct
knowledge and experience, provided by dissidents and reformers. Knowing
the basis for the blood doctrine and how it is enforced, physicians
face this question: should we ignore this information and respect the
patient's decision no matter how irrational and misguided we think
he/she might be, or should we pursue in-depth discussion to encourage a
rational and truly autonomous decision? I argue that the latter course
should be taken so far as circumstances permit. Physicians may not be
in the position of judging the validity of religious doctrine in an
ultimate sense, but they should still examine the rationality and
morality of decisions their patients make. I will first discuss reasons
why physicians should explore further.
ARE JWS TRULY "INFORMED"?
It is established practice to
discuss procedures and treatments with patients and disclose all
benefits, risks and alternatives in order to obtain an informed
consent. It is uncommon to discuss the basis for a patient's decision,
out of a desire not to infringe upon patient autonomy and privacy, or
as in this case, religious freedom. The question I present here is
whether we should leave the patient's decision unchallenged if there is
evidence that it is based on misinformation or information-control
enforced by covert or, in some cases, overt coercion.
DO JWS TRULY HAVE "AUTONOMY"?
Do JWs have true autonomy in
making decisions? There is considerable documentation that JWs can be
subject to psychological coercion, as shown in Part 1. If we suspect
that a patient may be under such coercive persuasion, should we ignore
this possibility and simply comply with his or her request? I argue
that such an attitude borders on patient abandonment under the guise of
DOES CONSULTATION WITH CHURCH
(WTS) OFFICIALS PROMOTE PATIENT AUTONOMY?
It is common for JWs and treating
physicians to consult with church officials and members of their
hospital liaison committee for guidance on the blood doctrine, as to
what is prohibited and what is allowed. Such consultation is
recommended by well-established guidelines for blood transfusion.(n4) By
obtaining such help can the physician become biased in favour of the
doctrine and make his decision based more on WTS policy than protection
of the patient's health and life? How can such consultation promote
patient autonomy when organisational rules make the position of the
committee non-negotiable, so that the patient must always refuse blood
and the physician must always treat without blood?
The decisions of a physician which
is based solely on information provided by the church becomes ethically
questionable when there are serious questions about the ethics of the
church itself. In many reported cases the elders of the church
organisation applied pressure to a patient to conform to its blood
policy, often causing reversal of an earlier patient decision.(n5-n9)
Can we take the patient's decision after consultation with such an
"advisor" as being autonomous, given the information-control and
coercive practices of this religion?
CAN RATIONAL DELIBERATION CHANGE A
There are anecdotal reports of
individuals who made confused decisions and changed their minds after
discussion with medical professionals.(n6,n10-n12) Not all
persons who belong to a religious organisation conform to its
doctrines. If JWs always acted identically, their wishes, beliefs and
answers would all be known from doctrines and official publications,
and there would be no need for deliberation. Yet many decisions made by
physicians caring for JW patients are simply cut-and-dried. Most
physicians spend little time inquiring about the patient's decision and
the circumstances under which he made it. However, individuals vary in
commitment to and interpretation of WTS policy. Certain treatments may
be acceptable to one JW but not to another.(n13,n14) Some JWs may show
ambivalence or even willingness to be forced to receive blood-based
treatment as long as it is officially noted as contrary to their
Some JWs are willing to receive blood under the condition of complete
confidentiality.(n16) Such cases show that failure to explore
individual JWs' views may cause physicians to let JWs die
unjustifiably, whereas rational deliberation on an individual basis can
CAN IRREVOCABLE LOSS OF LIVE BE
JUSTIFIED, BASED ON THE. INCONSTANT DOCTRINAL SYSTEM OF JWS?
Although the basic blood doctrine
has been in place for 40 years, details have undergone many
modifications, as shown in Part 1. There have been several doctrinal
reversals on life-saving medical treatments such as organ transplants,
vaccination and allowance of certain blood components. Should
physicians ignore this potentially unstable ground and stand idly by
while a patient dies?
PHYSICIANS MAY INADVERTENTLY
PROMOTE IRRATIONALITY AND UNETHICAL PRACTICES BY GIVING UNQUESTIONING
SUPPORT TO JW PATIENTS' DECISIONS
Respecting patients' decisions and
supporting their beliefs when these manifest inconsistent reasoning are
two different things. By cooperating with a JW's request for heroic
effort, do "sympathetic doctors" inadvertently advance the church's
cause, which may involve practices morally repugnant to most
physicians? Physicians tend to confine themselves to a narrow role,
staying within the framework of patient autonomy and religious freedom.
However, this passivity or one-sided effort to accommodate "no-blood"
treatment, has further "standardised" the treatment of JWs with little
regard for the ethical question of the patient's decision-making
Some physicians feel that the some
of the expensive alternative, intense and high-technological treatments
could be allocated more efficiently.(n17,n18) For them, allocation
of limited health care resources is as important an ethical principle
as are autonomy and religious freedom.
A suggested approach to JW patients based on rational
To lessen the ethical dilemmas, I
suggest an approach using principles of rational non-interventional
paternalism.(n2) Before discussing this approach I should emphasise
that this type of ethical deliberation is necessary only when there is
no reasonable alternative to blood-based treatment, or when so-called
"no-blood" treatment would incur significantly higher risk and cost.
For obvious reasons the
deliberative approach cannot be used in emergencies. In these cases
automatic acceptance of printed instructions on the so-called "blood
card" most JWs carry is potentially dangerous and may violate the
rights of JWs who are ambivalent or who have recently changed their
belief. There are anecdotal cases of invalid "blood cards", which are
used as a form of advance directive. Particularly important is the
card's date. A card with no date or an old date should not be
automatically accepted since former members and current members who are
considering leaving the organisation may carry outdated cards. Some JWs
are under extreme pressure to carry a card even though they disagree
with the policy. A former JW might continue to carry a blood card for
the sake of peace with a JW spouse, considering the strife it would
cause if the believing mate discovered the true views of the dissident
On the other hand, emergency
conditions do not allow physicians to verify "blood card" status or
discuss the patient's conviction. It is this author's opinion that if
there is any doubt about the patient's wishes the physician should
first take whatever steps are necessary to stabilize and remove the
patient from immediate danger of death or severe disability until a
court ruling or other independent assessment of the applicability of
the card can be obtained. This view is also supported by others. (n12,n19,n20)
In a Canadian court case, a doctor was found guilty of battery when he
treated with blood transfusions an emergency patient who carried an
undated and unwitnessed card.(n21) This ruling was criticised by the
medical community in Canada.(n22-n24)
In the United States,(n25)
the validity of a "blood card" was discounted in the case of an
incompetent patient. In another the court ordered a transfusion for a
comatose patient despite the card.(n12) Similar court rulings
involving incompetent JW patients under emergency conditions have been
reported.(n26) Despite assurance from WTS officials that a
physician is absolved from legal and ethical responsibility for
withholding blood transfusions, wrongful death suits were brought
against physicians by the families of JWs who died after they refused
blood transfusions.(n25,n27) One may view this situation from
the perspective that if we can be sued either for treating or not
treating with blood, we would rather it be for saving the patient's
In the case of stable patients
requiring elective transfusions, I propose that each physician first
validate the patient's status as a JW. In one case a woman was
presented as "a fervent JW" by her JW mother(n28) but her status was
later officially denied by the WTS.(n29) This shows that we
have reason not to accept at face value the word of anyone other than
the patient regarding his or her status as a JW, particularly family
and friends. After the status is confirmed with a competent patient, I
propose that each physician have a confidential meeting with the
patient about informed refusal of blood products. A most important
condition of this discussion would be an atmosphere in which the
patient could feel free from influence by church officials or peers,
including family members. Just as the physician does not intervene in a
family and church-based discussion, so it is important that the
physician himself be able to speak with the patient without influence
As mentioned before, a number of
case reports exist in which a patient's initial decision was reversed
to conform to WTS policy after church officials visited the patient.
Therefore, it is recommended that consultation with church officials be
made only when requested by the patient, and only when he is free from
outside pressure and has normal mental status. The consultation should
be limited to the information needed for immediate patient care.
Otherwise, such consultation would complicate the doctor-patient
relationship and invade the privacy of doctor-patient decision making,
allowing further outside intervention. A private meeting between only
the physician and the patient is preferred.
In this meeting the prognosis of
each scenario should be explicitly discussed. This should include not
only the possibility of death, but prolonged disability and suffering
along with a burden on the family and society. The WTS has repeatedly
emphasised that death due to lack of blood transfusions is nothing
compared to the eternal life they can obtain by refusing blood. But JWs
have given little consideration to the prolonged suffering and
disability that can result.
QUESTIONS THAT MAY BE ASKED
The physician can then ask several
questions about the basis for the refusal of blood. If the physician is
versed with the appropriate Bible passages, he may discuss the
difficulties with WTS Bible interpretation. Although JWs may be
generally prepared to answer a few common questions, they invariably
are unaware of the fundamental contradictions as pointed out in Part 1.
Physicians who are not interested in Bible discussion may still pose
many questions regarding the irrationalities of the doctrine. The
following three points give examples that might be presented to the
patient in a non-coercive fashion. A small brochure has been prepared
to assist physicians and could be used in this session.(n30)
Since initiating such an approach
may come across to the JW patient as a frontal assault on his belief
system, it would be appropriate to preface the discussion with some
introductory remarks, such as:
"I respect sincerely your concern
for conscience and your desire to do what is right according to your
belief. And I hope you will believe me when I say that I am also guided
by my conscience and a concern to do what is right based on what I
believe. There are certain things that are worth dying for. At the same
time I want to feel assured that a patient has considered matters with
full information and is satisfied that his or her decision has a solid
and stable foundation. It would help me feel more free from concern in
my effort to preserve your health if I could hear your thoughts on
certain points that, at least to me, seem difficult to reconcile."
Then the following questions may
- "I am concerned by my knowledge that there have been
a number of significant changes in related understandings by the WTS.
Probably you know that vaccination and organ transplants were for some
time ruled unacceptable and morally wrong. These are now considered
acceptable. But I think you would agree that the previous rulings may
have had some quite serious effects - illness, disability, even death -
while they were in force. It would seem that a person would want to
consider what the future might yet bring in further changes of
viewpoint. If holding to some present policy were to result in
disability or even death in your own case, and that policy were
reversed next year or some years from now, do you feel that such loss
would have been worthwhile and justified? I understand these changes
are viewed as `new light' and I wonder if you have given any thought to
the possibility of `new light' on any of the policies regarding blood?"
- [The physician mentions different blood components
and asks if the JW patient knows which are allowed and which are
prohibited. Many would not know. The division of acceptable and
non-acceptable components could then be stated and then the physician
asks:] "Could you clarify for me why immunoglobulins, albumin and
clotting factors may be accepted but plasma must not be accepted, when
plasma is basically the combination of water plus those acceptable
components? I read the WTS explanation that `abstaining from blood
means not taking it into our bodies at all'. Could you help me
understand how it is that many components of blood are allowed to be
taken into the body, some of which require the storing of very large
amounts of blood to extract the specific blood components involved?
Could you show me anything in the Bible that actually discusses such
matters as acceptance or non-acceptance of specific blood components?
Since this is not directly considered in the Bible, is it not a case of
an organisational policy involved rather than actual biblical teaching?
If that is so, and since there is certainly no scientific basis for
such policy, have you considered the possibility that the component you
are refusing now could later be determined by the WTS as acceptable,
perhaps even in the near future?"
- "I think you recognize that blood transfusions are
nowhere specifically discussed in the Bible, although it does say we
should abstain from eating blood. Do you think eating blood and blood
transfusions are the same? Do you know what happens if you eat blood?
It will be digested and broken down to small molecules and no longer
function as blood. By contrast, if the blood is introduced into your
blood stream, it will continue to function as blood and carry oxygen.
Therefore, eating and transfusion have an entirely different effect on
your body. Red blood cells are a type of organ that carries oxygen, and
blood transfusions are a transplantation of this cellular organ into
the blood stream. The transplanted blood cells function as blood cells,
and are not digested and absorbed as nutrients. Therefore blood
transfusion is a form of organ transplant. I understand the WTS
considers organ transplants a matter of conscience and that they may be
accepted, am I correct? If I told you that you should abstain from meat
because you have a heart disease due to high cholesterol, do you think
I would have meant to abstain from heart transplants? Just like the
difference between eating and transplanting an organ, there is a
complete difference in effect on your body between eating and
Additional points of contradiction
and irrationality may be discussed at the physician's discretion.
Sample questions are presented in the appendix to this paper. In
discussing those questions, I suggest the following three precautions
be carefully heeded.
First, this discussion should be
held when there is no imminent danger to the patient's life, and he or
she is neither in any great distress nor has impaired mental status.
Otherwise, the physician's attitude may be viewed by JWs as coercive
and abusive of his authority.
Second, the patient should be
assured from the outset that doctor-patient confidentiality will be
strictly observed and whatever decision the patient makes in this
meeting and thereafter will not be made known to the family or
congregation members. Again, integrity with regard to basic principles
of medical ethics and patient confidentiality is crucial because of the
existence of medical personnel informants among JW peers, and the
patient should be reassured that special care will be taken in his or
Third, I suggest not debating any
religious convictions, such as the nature of God, the doctrine of the
end of the world, moral conduct and so forth, that are beyond what is
necessary for the immediate treatment. The physician should keep
uppermost in mind that these questions are to give the patient
different perspectives from what he has been taught by the WTS, and to
draw the patient into rational thinking with correct information.
Note the crucial difference
between classic paternalism and this new approach of rational
non-interventional paternalism. It is not the purpose of the meeting to
win an argument with the patient, using the physician's authority. A
peaceful and rational discussion, avoiding argument, followed by
suggestion that the patient think about the questions before giving a
final decision should be most effective. Then the final decision made
by the patient must be fully respected.
To my knowledge this is the first
article in medical literature that addresses the need of physicians to
understand and deal with the fundamental problems of the JW blood
doctrine. Traditionally most physicians are uncertain of their
obligation to educate patients about the doctrine itself, because such
activity may be viewed as invading the patient's religious freedom.
Physicians often feel that they must unquestionably comply when any
demands or refusal of certain treatment from the patient is framed as
Such "passive" support in the
medical community, with little critical evaluation of the religious
practice itself, has created in many parts of the world an atmosphere
of automatically accepting the martyrish request of JW patients that
physicians make heroic efforts, which may involve greater risks and
costs. A physician's alternatives are to transfer patients to a
"sympathetic doctor" or let them die due to lack of any other
alternatives. In this and the companion paper, I suggest that
physicians should reconsider the "status quo" of "passive support" by
carefully evaluating dissident views and critical information, and
thereby take a more active role by exploring patients' decision making
in rational and intelligent discussion.
Some may argue that these
questions make a value judgment of religious beliefs under the guise of
medical discussion, and that this should be beyond the scope of the
doctor-patient relationship. Another argument would be that posing
those questions is manipulative towards the patient's religious faith.
However, a WTS lawyer blamed physicians who transfused a JW patient for
not exploring the patient's value system and religious conviction.(n31)
This indicates that at least some JWs would welcome such discussion.
The purpose of asking pointed questions is to separate out the JWs who
might reconsider the doctrine once they are presented with viewpoints
they had never considered. These are not questions of whether their
faith itself is true or false; rather, they concern the facts and
rationality on which the blood doctrine is supposed to be based.
To illustrate the difference,
consider a hypothetical religion whose leader is believed to be the
reincarnation of Jesus. Questioning a member as to whether the leader
is truly the reincarnation of Jesus would be a direct challenge to the
faith itself; questioning if he knows the facts about the leader's
immoral behavior which are not disclosed to the followers may give him
new information. Continuing to believe the leader is the reincarnation
of Jesus after learning of his immoral behavior is irrational, but
still can be held as "truth" by some followers. Others may reevaluate
their belief system in light of the new information, and abandon the
Another argument would be that
"no-blood" treatment is beneficial in most cases, and that the
physician's focus on the blood doctrine may bias him away from such
safer treatment. As stated previously, I do not suggest that this
proposed approach is necessary when a "no-blood" option is readily
available for the treatment of a particular JW patient, without
significantly greater risks and costs. However, at the present time,
there are still many medical and surgical conditions which can be
treated only with blood products, or which can be treated without blood
products but only with expensive, risky and high-technological
interventions that put the patient, the physician and the hospital in
What would be accomplished by this
type of discussion? Because it is non-interventional, the final outcome
will be up to individual JW patients. In reality, I do not expect any
significant number of JWs will easily change their stance after one or
two private meetings with a physician. However, in view of emerging
developments taking place in this religion, as more adherents are given
a chance to review their religion objectively, I expect that some JWs
will be impacted by this approach and will avoid unnecessary death and
Aside from the lives saved by
reevaluation of the blood doctrine, this approach will also fulfil the
moral obligation of physicians, whose values should be as much
respected as the patients'. Savulescu(n2) argued that medicine
should have a commitment to some value. Automatic acceptance of
religious policy that contradicts a physician's values, particularly if
that policy is based on irrationality and unethical practices, should
be challenged. Savulescu wrote that, while attempting to convince a
patient that he is wrong in choosing some course may threaten his
autonomy, using rational argument will enable a patient to act and
choose more autonomously. In order to have rational discussion with a
JW patient, both the use of misinformation and contradictions inherent
in the blood doctrine need to be presented and corrected. Provided with
new perspectives, the patient's choice will become more spontaneous,
and more an expression of his autonomy.
While this author uses the case of
JW refusal of blood transfusions to propose an approach using rational
non-interventional paternalism, the same approach can be applied to any
authoritarian religious groups that control the information its members
receive, or coerce by intimidation and promote irrational beliefs and
practices in medical care. These ethical dilemmas are not experienced
with members of more traditional religions. In his rebuttal to articles
that discussed a JW patient who did not make an autonomous decision, a
JW physician stated that "adherents of all religions do not make free,
autonomous decisions of conscience because of what their church
teaches".(n32) This generalisation ignores the fact that only
those members of "high-control" religious groups, such as the JWs,
experience much intimidation and coercion to accept misinformation.
While we value patient autonomy regardless of religious affiliation, I
propose that misinformation and coercion under the guise of
pseudo-autonomy should be challenged by each medical professional.
At the proof stage, an important
development in the blood policy of Jehovah's Witnesses was revealed in
the Internet. In an agreement at the European. Commission of Human
between the Watch Tower Society and the government of Bulgaria, the
society claimed that the members now "have free choice" to receive
blood "without any control or sanction". As of July 1998, there is
obvious confusion among the members; some view this as change in
policy, whereas the society denies such. It is unclear how this denial
could reconcile with the above public agreement.
Views and opinions expressed
herein are personal and do not reflect those of Kaiser Permanente and
Northwest Permanente PC.
References and notes
(n1) Muramoto O. Bioethics of the refusal
of blood by Jehovah's Witnesses: part 1. Should bioethical deliberation
consider dissidents' views? Journal of Medical Ethics 1998;24:223-230.
J. Rational non-interventional paternalism: why doctors ought to make
judgments of what is best for their patients. Journal of Medical Ethics
J, Momeyer RW. Should informed consent be based on rational beliefs?
Journal of Medical Ethics 1997; 23:282-8.
RK. Surgical red blood cell transfusion practice policies. The American
Journal of Surgery 1995;170, 6A:3s-15s
(n5) Oneson R,
Douglas DK, Mintz PD. Jehovah's Witnesses and autologous transfusion.
C. Jehovah's Witnesses and the refusal of blood. Journal of Clinical
(n7) Mann MC,
Votto J, Kambe J, McNamee MJ. Management of the severely anemic patient
who refuses transfusion: lessons learned during the care of a Jehovah's
Witness. Annals of Internal Medicine 1992;117:1042-48.
(n8) Lawry K,
Slomka J, Goldfarb J. What went wrong: multiple perspectives on an
adolescent's decision to refuse blood transfusions. Clinical Pediatrics
(n9) Rosen P
[editorial]. Religious freedom and forced transfusion of Jehovah's
Witness children. Journal of Emergency Medicine 1996;14:241-3.
C. Managing a Jehovah's Witness who agrees to blood transfusion.
British Medical Journal 1994;309:612.
Kerstein MD. Discussion: transfusion guidelines for cardiovascular
surgery: lessons learned from operations on Jehovah's Witnesses.
Journal of Vascular Surgery, 1992;16:829.
I. Written advance directives refusing blood transfusion: ethical and
legal considerations. The American Journal of Medicine 1994;96:563-7.
LJ, Redstone PM. Blood transfusion in adult Jehovah's Witnesses. A case
study of one congregation. Archives of Internal Medicine
P, Castelli P, Condemn AM, Santoli C. Blood saving in Jehovah's
Witnesses. Annals of Thoracic Surgery 1991;52:899-900.
P, Herbert M, Davies DP, Verrier Jones ER. Erythropoietin for anemia in
a preterm Jehovah's Witness baby. Early Human Development 1992;28:282.
Al. Cultural influences and patient behavior: some experiences in the
paediatric ward of a Nigerian hospital. Child Care, Health and
CD. NHS trusts and Jehovah's witnesses. Lancet 1992; 339:1302.
PJ, Rockwell JC. Patient's choices and the medical commons. Annals of
Internal Medicine 1992; 119:170-1.
AJ, D'Amico R, Caton D, Mollet CJ. And the patient chose: medical
ethics and the case of the Jehovah's Witness. Anesthesiology
S. Managing patients who refuse blood transfusions: an ethical dilemma.
Author's view. British Medical Journal 1994;308:1425.
D. Jehovah's Witness transfused without consent: a Canadian case.
Lancet 1989;2, 8676:1407-8.
WH. CMPA and Jehovah's Witness. Canadian Journal of Anesthesia
B. Jehovah's Witnesses and the transfusion debate: "We are not asking
for the right: to die". Canadian Medical Association Journal 1991;
Hoaken PCS. See reference 23:1380-2.
PB, Giorgio GT. Managing Jehovah's Witnesses: medical, legal, and
ethical challenges. Annals of Emergency Medicine 1991;20:1148-0.
[editorial]. Battery claim of Jehovah's Witness rejected by Michigan
Court. Hospital Law Newsletter 1992;9:47.
DA, Koppes RH. Caring for the female Jehovah's Witness: balancing
medicine, ethics, and tine First Amendment. American Journal of
Obstetrics and Gynecology 1994; 170:452-5.
[editorial]. Court says doctors were right to treat Jehovah's Witness.
British Medical Journal 1992;305:272. The case was referred as Re T
(adult: refusal of treatment)  4 A11 ER, 649 (CA).
JWA. Treating Jehovah's Witnesses. British Medical Journal
small brochure is being produced by the collaborating former JWs and
internal reformers. At the time of writing, it is being printed. This
brochure is also available and downloadable at the web page of the
reformers' website: http://www.visiworld.com/starter/newlight/abstain.htm.Availability
of the printed version will be posted in this website. Additional
useful information regarding biblical and historical aspects of the
blood policy which may be used in discussion with JW patients is also
downloadable from the same website.
(n31) Ridley DT Jehovah's Witnesses and
the refusal of blood. The Journal of Clinical Ethics 1990;1:254-7.
JM. Jehovah's Witnesses and the transfusion debate: "We are not asking
for fine right to die". Canadian Medical Association Journal
The following additional questions
can be used in the private meeting with JW patients.
- If storing your own blood for an autologous
transfusion is wrong, why does the WTS permit the use of various blood
components that must be donated and stored before being used by JWs?
Why can JWs accept those blood components and benefit from the blood
that others donate, but will not donate blood themselves? Would giving
blood to help save others' lives, including the lives of your spiritual
brothers and sisters (other JWs), be the loving and Christian thing to
- Have you ever seen the WTS publications discuss the
fact that the only effective life-saving treatment for rapid and
massive haemorrhage is emergency blood transfusions? [The answer should
be no.] Why does the WTS need to keep such critical information from
being made known to JWs, and why does it always emphasise the negative
aspects of blood-based treatment?
- I understand that JWs believe blood should not be
eaten because it is sacred as it symbolizes life. Then could you help
me understand how the symbol could be of greater value than the reality
it symbolises? When there is a massive and rapid haemorrhage and blood
transfusion is the only life-saving measure, is it a contradiction in
itself to let a person die by placing more importance upon the symbol
than the reality which it symbolises?
By Osamu Muramoto, Kaiser
Permanente Northwest Division, and Northwest Permanente PC, Oregon, USA
Osamu Muramoto, MD, PhD, is a
member of the ethics committee at Kaiser Permanente Northwest Division,
and a Neurologist at Northwest Permanente PC, Portland, Oregon, USA.
Address correspondence to: Kaiser East Interstate Medical Office, 3414
N Kaiser Center Drive, Portland, Oregon 97227, USA. E-mail: