Citation: BJOG: An International Journal of Obstetrics & Gynaecology. 20091001. Vol. 116, Iss. 11; p. 1540-1540
Free and informed choice in medical treatment:
making it safe to choose for Jehovah’s witnesses
Sir ,
The article by Van Wolfswinkel et al. concerning elevated
risk of maternal mortality and morbidity in some of Jehovah’s
witnesses concludes by suggesting that care for such
women be centralised and that an obstetrics protocol be
developed. We suggest that the protocol include strategies
to permit informed and free choice.
The mini-commentary by Watchtower Society worker,
P. Wade, incorrectly implies that all of Jehovah’s witnesses
agree with the Watchtower Society policy on blood transfusion.
This is as likely to be true as the claim that all Catholics
agree with the Vatican’s statements on condom use.
Not all Jehovah’s witnesses refuse blood transfusion.1
We recommend that physicians, and particularly those
whose patients are at risk from blood loss, familiarise
themselves with the website created by ‘Associated Jehovah’s
Witnesses for Reform on Blood’. This group of Jehovah’s
witnesses provides questions that a physician might
helpfully ask a patient at risk of morbidity or mortality
www.ajwrb.org/physicians/index.shtml
Further, we note that patients under the influence of the
Watchtower Society tend to have very poor information
about the safety and efficacy of blood2 and that they are
subject to coercion: choosing blood transfusion can subject
them to shunning, a severe form of social ostracism that
can lead to suicide.3 One survivor of postpartum haemorrhage
without transfusion told us that her real choice was
between the living death of losing her family and friends if
she chose blood transfusion, or actual death caused by
blood loss. The latter seemed preferable. Developers of protocols
to manage Jehovah’s witnesses obstetric and gynaecological
patients ought to invite dissident adherents to
participate. They have insight into, among other things, the
role of the Hospital Liaison Committees which monitor
patient choice. Non-orthodox Jehovah’s witnesses can assist
hospitals in making it safe for patients to choose religiously
unauthorised medical treatment.j
References
1 Elder L. Why some Jehovah’s Witnesses accept blood and conscientiously
reject official Watchtower Society blood policy. J Med Ethics
2000;26:375–80.
2 Louderback-Wood K. Jehovah’s witnesses, blood transfusions, and
the tort of misrepresentation. J Church State 2005;47:783–822.
3 Alter S. Jehovah’s Witnesses: Disfellowshipping and Shunning,
Research Branch, Library of Parliament, Canada, September 15, 1992.
[www.culthelp.info/index.php?option=com_content&task=view&id=
289&Itemid=8]. Accessed 15 June 2009.
J Guichona & I Mitchellb
aSenior Associate, Office of Medical Bioethics, and Department of
Community Health Sciences, Faculty of Medicine, University of
Calgary, AB, Canada
bProfessor, Department of Paediatrics, Faculty of Medicine,
University of Calgary, Calgary, AB, Canada
Accepted 16 June 2009.
DOI: 10.1111/j.1471-0528.2009.02303.x
The author of the mini-commentary ‘Blood Transfusion Refusal in
Jehovah’s Witnesses’ was invited to respond to this letter, but
declined.