Jehovah's Witnesses and blood transfusion
I had forgotten that the Jehovah's Witnesses (JW) forbid blood transfusions, but this article in last Sunday's New York Times reminded me. It's about physicians who are performing bloodless operations to accommodate the JWs who can't receive blood.
The piece starts with the tale of Rebecca Tomczak, a JW who needed a lung transplant because her own lungs had been destroyed by the disease sarcoidosis. After shopping around, she finally found a hospital that would operate on her without giving her extra blood.
The article discusses the refusal of JWs to accept blood, a stand that is, of course, based on scripture:
The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah's Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one's own, at the risk of forfeiting eternal life.
. . .in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.
"I wanted to be around and be a part of their lives," Ms. Tomczak recalled, dabbing at tears.
She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.
"I know," she said, "that if I did anything that violates Jehovah's law, I would not make it into the new system, where he's going to make earth into a paradise. I know there are risks. But I think I am covered."
. . . Founded in the late 19th century and best known for door-to-door evangelism, the Jehovah's Witnesses first published a position on transfusions in 1945, as the blood donation system expanded after World War II. It grew out of edicts in both the Old and New Testaments that forbid the consumption of blood, which is revered as a life source. The church, based in Brooklyn, takes the position that there is no distinction between oral consumption and intravenous feeding.
The Witnesses' hard line does have its soft spots. The church declared in 2000 that it was up to members to decide whether to accept blood fractions like clotting factors that are extracted from plasma. It has also left to individual conscience whether to accept synthetic proteins that stimulate red cell production or to use mechanical techniques that conserve and salvage blood.
Based on various biblical texts, such as Genesis 9:4 , Leviticus 17:10 , and Acts 15:29 , they believe:
- Blood represents life and is sacred to God. After it has been removed from a creature, the only use of blood that God has authorized is for the atonement of sins.When a Christian abstains from blood, they are in effect expressing faith that only the shed blood of Jesus Christ can truly redeem them and save their life.
- Blood must not be eaten or transfused, even in the case of a medical emergency.
- Blood leaving the body of a human or animal must be disposed of, except for autologous blood transfusions considered part of a "current therapy".
- A baptized Witness who unrepentantly accepts a blood transfusion is deemed to have disassociated himself from the religion by abandoning its doctrines and is subsequently subject to organized shunning by other members.
Here are the sections from Acts 15 (the passages cited most often by JWs to support their position) are used to prohibit transfusion (all passages below from King James Version):
19 Wherefore my sentence is, that we trouble not them, which from among the Gentiles are turned to God:
20 But that we write unto them, that they abstain from pollutions of idols, and from fornication, and from things strangled, and from blood.
. . . 29 That ye abstain from meats offered to idols, and from blood, and from things strangled, and from fornication: from which if ye keep yourselves, ye shall do well. Fare ye well.
And whatsoever man there be of the house of Israel, or of the strangers that sojourn among you, that eateth any manner of blood; I will even set my face against that soul that eateth blood, and will cut him off from among his people.
But flesh with the life thereof, which is the blood thereof, shall ye not eat.
There's one upside to all this: because of the cost of blood, and rare negative effects of transfusion, surgeons are developing ways to operate without the need for extra blood. The Times reports:
The latest government data show that one of every 400 units transfused is associated with an adverse event like an allergic reaction, circulatory overload or sepsis [JAC: note that those reactions are probably not always fatal]. Even so, the share of hospital procedures that include a transfusion, usually of two or three units, has doubled in 12 years, to one in 10.
Yet at dozens of hospitals with programs that cater to Jehovah's Witnesses, a million-patient market in the United States, researchers have found that surgical patients typically do just fine without transfusions.
"They are surviving things that on paper were not expected to go well at all," said Sherri J. Ozawa, a nurse who directs the long-established bloodless medicine program at Englewood Hospital in New Jersey.
The economy is also helping the blood management movement. Processing and transfusing a single unit of blood can cost as much as $1,200, and many hospitals are trying to cut back.
Well, that's the good part, I suppose, but the bad part is this:
Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.
In addition, as the National Post reports, Jehovah's Witnesses have fought to keep their children from getting transfusions (they lose in Canada; I'm not sure about elsewhere), but many members have died because of this policy. The Independent recounts one in a story from last year called "Lawyers tell of agonizing scenes as doctors forced to let Jehovah's Witness, who wanted to live, die.:
Robert Tobin, a partner in the London law firm Kennedy's, was called in by an unnamed NHS Trust when the man, a Jehovah's Witness who was critically ill with sickle cell anaemia, refused a blood transfusion which could have saved his life.
Over three weeks the man gradually deteriorated as the crisis progressed, before eventually dying.
"Medical staff were understandably upset at seeing a patient deteriorate before their eyes knowing a simple procedure could have been provided that would have saved his life," Mr Tobin said.
The man's mother, also a Jehovah's Witness, was at her son's bedside, and an elder from the man's church also attended. The trust was concerned that they were unduly influencing him but a doctor from a neighbouring trust who was called in to assess him said he had full capacity and was making the decision on his own.
Yes, there are down sides to transfusion, but shouldn't people have the option of weighing the risk of bleeding to death against the 1/400 chance of an adverse reaction per unit of blood? After all, at present not all surgeries can be "bloodless", and if you die from refusing blood you leave behind grieving family and friends-all in service of a bizarre interpretation of a work of fiction.