Blood transfusion and Jehovah's Witnesses: Medical and legal issues in obstetrics and gynecology

doi:10.1016/0002-9378(86)90586-7

American Journal of Obstetrics and Gynecology

Volume 154, Issue 3, March 1986, Pages 483-486

https://doi.org/10.1016/0002-9378(86)90586-7 Get rights and content

Abstract

Jehovah's Witnesses are members of a religious denomination whose beliefs prohibit the use of blood or blood products. Plasma volume expanders and extracorporeal hemodilution of the patient's own blood are theologically acceptable. Acute massive hemorrhage in which only blood is lifesaving may be encountered in obstetrics and gynecology. Either withholding or administering blood in such circumstances may have legal consequences for the physician and hospital. Factors to be considered include fetal viability, the presence of dependent children, and rules of informed consent. Whenever possible, the potential for transfusion should be anticipated and clearly discussed with the patient. When appropriate, the physician and hospital should move rapidly to obtain judicial resolution.

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There are more references available in the full text version of this article.

Cited by (19)

Bloodless surgery in geriatric surgery
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Citation Excerpt :
Although these verses and others are not stated in medical terms, Witnesses see them as precluding the transfusion of allogeneic whole blood and its four chief components (ie, red blood cells, white cells, platelets, and plasma) [2]. As a rule, Jehovah's Witnesses will accept most medical treatments, surgical procedures and administration of fluids such as crystalloids, colloids and starch [3]. The treatments that are viewed as unacceptable are the transfusion of whole blood, packed red cells, platelets, white cells or plasma [4].
In bloodless surgery a series of measures has to be implemented to reduce the perioperative need for transfusion of whole blood or its components. Jehovah's Witness are the most representative group of patients opting for bloodless surgery as their faith follows strict believes that prohibits receiving blood.
Geriatric patients requiring bloodless surgery are even more delicate and represent a challenge for surgeons. The physiological response of the over 65 year population to decreased hemoglobin level is slower and less effective than in young and adult patients.
Herby we describe the perioperative protocol implemented in our surgical Department offered to geriatric Jehovah's Witness patients. Preoperative optimization of the patients is the key step in the preparation period. Intraoperative anesthetic and surgical measures are also required along with a strict postoperative follow-up.
From our experience, bloodless surgery is feasible in the geriatric population as long as it is performed in specialized centers where a multidisciplinary team is prepared to specifically manage this scenario. Rigorous patients selection and preparation are mandatory.
Pregnancy in a Jehovah's witness with cervical cancer and anemia
1998, Gynecologic Oncology
A 34-year-old Jehovah's Witness presented with vaginal bleeding and anemia at 23 weeks gestation. She was diagnosed with a FIGO Stage IB₂squamous cell carcinoma of the cervix. The patient refused transfusion of blood products and strongly desired to continue the pregnancy. She was hospitalized and at 33 weeks gestation underwent a Cesarean–radical hysterectomy with measures that minimized blood loss.
Blood conservation, obstetrics, and Jehovah's Witnesses
1998, Anesthesiology Clinics of North America
Caring for the female Jehovah's Witness: Balancing medicine, ethics, and the First Amendment
1994, American Journal of Obstetrics and Gynecology
Blood transfusion has been doctrinally forbidden for Jehovah's Witnesses since 1945. Despite serious theologic consequences for its violation, this proscription may not be observed universally by members of the denomination. When a patient declines a lifesaving transfusion, a conflict is generated between the physician's autonomy-based and beneficence-based obligations to the patient. This conflict is intensified when the patient is a woman who has minor dependent children, either in utero or already born. A spectrum of opinion exists regarding the resolution of this conflict. As one of society's repositories of moral and legal values, the court is the most appropriate forum in which religious, medical, and ethical viewpoints may receive a fair and impartial hearing. (AM J OBSTET GYNECOL 1994;170:452-5.)
The role of the emergency physician in the management of Jehovah's Witnesses
1989, Annals of Emergency Medicine
Patients presenting to the emergency department who refuse recommended treatment present substantial management and medicolegal problems for the emergency physician. Members of the Jehovah's Witness religion, who number approximately 700,000 in the United States, create specific medical, ethical, and legal challenges when they require but refuse necessary blood component therapy. Appropriate management involves timely medical intervention, an awareness of the religious rights and beliefs of Jehovah's Witnesses and a sound understanding of the ramifications of their emergency care. A protocol is presented for responding to opposition to transfusions by Jehovah's Witnesses. The protocol should increase the likelihood of an effective medical and ethical response by emergency physicians and should help to protect against potential legal actions.
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^☆: The opinions expressed are those of the authors and not those of either Kaiser Foundation Hospitals, Southern California Permanente Medical Group, or the State of California.

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Blood transfusion and Jehovah's Witnesses: Medical and legal issues in obstetrics and gynecology☆

Abstract

Handbook of denominations in the United States

Immovable for the right worship

The Watchtower

Meeting the surgical and ethical challenge presented by Jehovah's Witnesses

Jehovah's Witnesses: the surgical/ethical challenge

JAMA

Blood transfusion in adult Jehovah's Witnesses

Arch Intern Med

Jehovah's Witnesses and the question of blood

The preoperative treatment of severely anemic patients with a perfluorochemical blood substitute, Fluosol DA-20%

Anaesthesiology

Use of a whole blood substitute, Fluosol-DA 20%, after massive postpartum hemorrhage

Obstet Gynecol