I read with great interest the recent article by Kerridge et al [1] on the first documented case of the use of peripheral blood stem cell autografting in a Jehovah's Witness. This case has a profound bearing on the medical ethics of treating Jehovah's Witnesses. As new technologies evolve around blood-based treatments, whether such treatments are acceptable to Jehovah's Witnesses has become a complex issue. One of the most difficult aspects of caring for Jehovah's Witnesses in recent years is that such decisions are often arbitrarily made by local church officials on hospital liaison committees or high officials at the headquarters of the Watch Tower Society in Brooklyn, NY. Although guidelines are published by the Watch Tower Society, officials often rule on the acceptability of uncommon treatments on an individual basis. As a result, medical articles sometimes report inconsistent practices. For example, despite the frequently used guidelines [2] that clearly state that Jehovah's Witnesses do not accept predeposited blood, reports show that some are willing to accept treatments involving predeposited autologous blood or blood components.

The case reported by Kerridge et al illustrates this point. In this case, peripheral blood stem cell autografting was determined by church officials to be acceptable, even though it is a form of autologous white blood cell transfusion, which has been explicitly prohibited by the Watch Tower Society. [2] Although the Watch Tower Society once condemned organ transplantation as "cannibalism" based on biblical arguments similar to those it has used to condemn blood transfusions, it now considers all transplantations, including bone marrow transplants, to be a "matter of conscience." [3] This means that individual Jehovah's Witnesses can decide on their own whether to use this treatment, and more significantly, that they will not be ostracized by the Watch Tower Society for challenging its mandates. Given this background, it is likely that the Watch Tower Society considered peripheral blood stem cell autografting to be permissible as a form of organ transplantation. It is not clear how this was balanced against the fact that peripheral blood stem cell autografting is also a form of autologous blood transfusion.

Jehovah's Witnesses prohibit blood transfusions because they view them as a form of eating blood, which they say is prohibited in the Bible. The Watch Tower Society teaches that eating and infusing blood are similar because nutrients can be "eaten" intravenously. It illustrates this by arguing that drinking alcohol and infusing alcohol intravenously have the same result. [4] However, it ignores the fact that transfused blood cells are not digested or absorbed, but rather remain biologically and functionally intact. The Watch Tower Society's argument ignores the fact that blood transfusions are comparable to organ transplantation with cellular organs, and that organ transplantation is acceptable. The use of peripheral blood stem cell autografting in Jehovah's Witnesses is noteworthy in this regard because the treatment involves both transplantation and transfusion, 2 procedures that are virtually impossible to separate conceptually.

I believe this case report is a landmark in the history of the medical treatment of Jehovah's Witnesses. First, another option may be added to the list of acceptable treatments for Jehovah's Witnesses. Second, and more importantly, it is about time the medical community demanded that the controlling Watch Tower Bible and Tract Society codify its rules into a simple consistent whole that the medical community may easily follow.

Osamu Muramoto, MD, PhD

Portland, Ore

The views expressed herein are personal and do not reflect those of Kaiser Permanente health maintenance organization or Pacific Northwest Permanente PC.

1. Kerridge I, Lowe M, Seldon M, Enno A, Deveridge S. Clinical and ethical issues in the treatment of a Jehovah's Witness with acute myeloblastic leukemia. Arch Intern Med. 1997;157:1753-1757. Ovid Full Text Bibliographic Links [Context Link]

2. Dixon JL, Smalley MG. Jehovah's Witnesses: the surgical/ethical challenge. JAMA. 1981;246:2471-2472. Bibliographic Links [Context Link]

3. Questions from readers: could a Christian accept a bone-marrow transplant since blood is made in the marrow?. Watchtower. 1984;5/15:31. [Context Link]

4. Watch Tower Bible and Tract Society of Pennsylvania. Reasoning From the Scriptures: 1989. Brooklyn, NY: Watch Tower Bible and Tract Society of Pennsylvania; 1989:73. [Context Link]

Autograft; Christianity; Ethics, Medical; Jehovah's Witnesses; Stem Cells; Transplantation, Autologous