UK Royal College of Surgeons: Caring for patients who refuse blood

by darkspilver 10 Replies latest watchtower medical

  • darkspilver
    darkspilver

    FYI - don't think this has been posted here before

    In November 2016 The Royal College of Surgeons of England issued the following 40 page booklet:

    https://www.rcseng.ac.uk/library-and-publications/college-publications/docs/caring-for-patients-who-refuse-blood/

    Caring for patients who refuse blood - a guide to good practice

    This document provides guidance on the surgical management of Jehovah’s Witnesses and other patients who withhold consent to blood transfusion. It takes into account and expands on the principles set out in Good Surgical Practice (RCS, 2014), Consent: Supported Decision-Making – A Guide to Good Practice (RCS, 2016) as well as guidance from the GMC and NICE, to enable surgeons and their teams to provide high-quality care to Jehovah’s Witness and other patients who refuse blood transfusion while respecting their right to make autonomous decisions about treatment.

    It offers information on the current requirements for patient communication and supported decision-making and practical advice to support surgeons in complying with their legal, ethical and regulatory obligations.

    Although this guide has been developed primarily for surgeons, most of its recommendations are applicable to other medical specialties.

    READ MORE: https://www.rcseng.ac.uk/library-and-publications/college-publications/docs/caring-for-patients-who-refuse-blood/

    See also: https://www.rcseng.ac.uk/library-and-publications/college-publications/docs/consent-good-practice-guide/

    Clayton O'Neill comments on these guidelines in the article below from February 2017 (Clayton O'Neill is a Lecturer at the UK's Nottingham Trent University. His research interests are in medical law and human rights, particularly the relationship between medical law and the manifestation of religious belief.)

    https://theconversation.com/blood-transfusion-refusals-why-new-guidelines-arent-up-to-scratch-70237

    Blood transfusion refusals – why new guidelines aren’t up to scratch

    Blood transfusions are a common and often lifesaving procedure. However, some groups, such as Jehovah’s Witnesses, forbid blood transfusions on religious grounds. Recently, the Royal College of Surgeons issued new guidelines on what to do when a person rejects a transfusion based on religious belief. However, these guidelines need further clarification to make it easier for surgeons to act fully in line with developments in English law when it comes to children.

    In recent years, there has been a move away from paternalistic medicine, where the doctor always knows best, and a move towards “shared-decision making” – a process that is enshrined in English law. This means that the patient is informed of all the risks and, together with the doctor, they make an informed decision.

    The issue of transfusion refusals is becoming increasingly important because the population of Jehovah’s Witnesses is growing, as well as people who refuse blood transfusions for reasons unrelated to religion. And the guidelines make a good attempt to give direction to surgeons who have to grapple with potentially life-threatening situations involving the refusal of blood transfusions using a patient-focused approach.

    READ MORE: https://theconversation.com/blood-transfusion-refusals-why-new-guidelines-arent-up-to-scratch-70237

    Slightly off-topic, not sure if this has been posted here before, so thought I'd just tag it on the bottom here.... rather old and two versions of the same document

    The Association of Anaesthetists of Great Britain and Ireland have the following 32 page booklet:

    Management of Anaesthesia for Jehovah's Witnesses

    The first edition of this guidance was published in March 1999 and was received by the members of both the Association of Anaesthetists of Great Britain and Ireland (the Association) and the Watch Tower Bible and Tract Society of Britain (the official organisation for British Jehovah’s Witnesses) with some acclaim.

    Since then there has been a continuing debate surrounding the ethical and practical consequences of consent for medicine as well as developments in the areas of ‘Oxygen Therapeutics’, blood transfusion medicine and alternative blood sparing technologies.

    In his Report for 2003 entitled On the State of Public Health, the UK Department of Health’s Chief Medical Officer, Professor Liam Donaldson, stated that he believed too many unnecessary blood transfusions were being given in England. He added, “The gift of blood is too often squandered by unnecessary and inappropriate use”, and expressed concern at the fall in the donor pool (down by one fifth in 4 years). He further suggested that transfusion is unnecessary unless the haemoglobin falls below 7 g/dl, and proposed that only consultants, and not junior staff, should be allowed to order blood and blood products.

    READ MORE - 2005 version: https://www.aagbi.org/sites/default/files/Jehovah's%20Witnesses_0.pdf

    READ MORE - 1999 version: https://www.aagbi.org/sites/default/files/Jehovah's%20Witness%201999.pdf
  • steve2
    steve2

    Yes, there is an observable - and welcome - trend in hospitals to place at centre clients' rights. Gone are the days when you were told what was going to be done to you in hospital - and if you questioned and/or refused it, you were treated either like a pariah or an imbecile who needed to have unwanted procedures and care imposed upon you against your will.

    Hospitals however, still make distinctions between "adults" having the right to choose their care and "minors" who can become temporary wards of the state should parents refuse life-saving procedures.

  • Phizzy
    Phizzy

    The problem is made more difficult though because it is not simply a matter of communicating the risk/benefit information to the JW patient, they are not basing their decision on this.

    The JW patient imagines that she or he knows "what the Bible says" on this issue, and therefore they believe they are doing god's will by avoiding the use of blood in a transfusion to save a life.

    Of course, the Bible says nothing at all about the clinical use of blood to save life, it does tell 1st Century Gentile christians to avoid eating blood so as not to offend their Jewish christian brethren. Elsewhere Paul says, in effect, "don't ask questions" about blood in food.

    So even the dietary advice is not 100% clear.

    What is clear from Scripture is that the saving of life by blood is all important, all be it the blood of the Christ.

    If JW's were aware of how doubtful the Bible is as to translation, and transmission, and how their Doctrine on blood came about, they would not needlessly throw away their lives.

    To risk their children's lives is both immoral and obscene, it is on a par, morally, with strapping explosives to a child and using them as a bomb.

  • Doubtfully Yours
    Doubtfully Yours

    I am happy that 'minors' get awarded to the 'State' so that the pressure is off the parents. It's tough to make such decision for a loved one, even more so for a beloved child.

    Having said that, I feel so deeply indoctrinated that if right now I needed blood or an organ transplant to continue living, I would turn both propositions down.

    By the way, a lady at my workplace is dealing with extra healthcare issues newly acquired since having a series of blood transfusions.

    The blood thing is a complicated matter. No wonder even people, not at all for religious reasons, are turning down using blood.

    DY

  • OrphanCrow
    OrphanCrow
    Doubtfully yours: Having said that, I feel so deeply indoctrinated that if right now I needed blood or an organ transplant to continue living, I would turn both propositions down.
    By the way, a lady at my workplace is dealing with extra healthcare issues newly acquired since having a series of blood transfusions.

    I understand the indoctrination and I have a question for you.

    If the lady at your workplace was dealing with extra health care issues newly acquired since having a regime of antibiotics that did not agree with her, would you refuse antibiotics for your own personal health care?

  • steve2
    steve2

    DY, you raise good points about risks associated with blood transfusions. But there is a fuller picture that perhaps JWs and possibly even former JWs are unaware of.

    I am aware of a recent meta-analysis of research on survival outcomes comparing current and distal use of blood transfusions. The broad conclusion was as follows: Blood transfusions are now safer than they were up to two decades ago. Risks of complications have reduced and survival rates increased. I do not have the citation at hand - but I understand there is a website devoted to health outcomes from blood transfusions. Perhaps other posters will know the citation?

    There has been some "research" on survival outcomes for certain health conditions comparing a no-transfusion-group with a transfusion-group whose results suggested the no-transfusion group had the higher survival rate. However, the study was very small and it appeared that the transfusion-group were sicker at the outset compared to the no-transfusion group - a non-matched sampling procedure that was virtually ignored when the results were discussed.

    Moreover, most medical procedures carry some risk; that circumstance is no reason to criticize or avoid those procedures (as JW organization relentlessly stirs up fear regarding blood transfusions). But it enables informed decisions. Besides, even if blood transfusions were the safest of procedures, JWs would still refuse them. Perceived or actual safety of blood transfusions is a straw man argument designed to engender fear and edge people towards refusal for reasons other than JW organization's unique interpretation of Bible passages.

    Lost in this sort of Pros and Cons discussion - and needing to be heard - is the fact that, following massive loss of blood volume, death is a certainty in the absence of blood transfusions. There is no substitute other than blood when individuals have lost litres of blood. For example, blood loss following traumatic accidents or pregnancy complications virtually hinge on transfusing blood into the victims ASAP.

    By contrast, with elective surgery or surgery that can be planned ahead of time, alternatives to blood transfusions may well be available. Of note, JW organization has most to say about elective surgery, very little, if anything, to say about refusing blood following massive blood volume loss.

  • OrphanCrow
    OrphanCrow
    steve2: By contrast, with elective surgery or surgery that can be planned ahead of time, alternatives to blood transfusions may well be available. Of note, JW organization has most to say about elective surgery, very little, if anything, to say about refusing blood following massive blood volume loss.

    The WT doesn't tell the JWs that not everyone is eligible for alternatives to blood transfusions. Alternative treatment is not suitable for many patients. You have to have a certain level of health and age to undergo bloodless treatment.

    That is one of the reasons that the many retrospective studies that have been done that compare no-blood to blood are misleading. Those who can have bloodless treatment are generally in better health than those who get blood. As well, those studies fail to take into consideration that elective bloodless surgery is often a two stage process. The studies only take into consideration the first bloodless surgery and not the second one that the patient has to complete the procedure.

  • steve2
    steve2

    "Those who can have bloodless treatment are generally in better health than those who get blood."

    YES - so true.

    This is a classic case of the 'third' explanatory variable talked about in any 101 research paper; a third unacknowledged variable explains the correlation between two other variables that have been wrongly construed as causally linked..

    In the absence of knowing about the existence of the third variable, all sorts of erroneous conclusions are drawn about a correlation such as the erroneous causal link between bloodless surgery and higher survival compare with those who receive blood transfusions.

  • OrphanCrow
    OrphanCrow

    Exactly, Steve.

    That is one of the problems with a recent paper published by Dr. Aryeh Shander. That paper is discussed in this thread here:

    https://www.jehovahs-witness.com/topic/5203241044279296/canadian-medical-doctor-exposes-dr-aryeh-shanders-faulty-bloodless-research

    Not only did Shander and his research team drop out the patients who died in the first 24 hours but they also did not include the second surgery those bloodless patients may have had. The results of that study are useless because the methodology is flawed.

    *to add-

    another flawed research paper about bloodless surgery:

    https://www.jehovahs-witness.com/topic/5766535769489408/lessons-learned-from-outcome-bloodless-emergency-laparotomies-on-jehovahs-witness-women

  • steve2
    steve2

    Predictably, JWs love to cite these flawed studies and view any expressed reservations or criticism of findings as "opposition" to the "truth". Sheesh!

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