The Watchtower Society's blood doctrine raises important ethical issues for physicians. It is common practice for physicians to automatically respect Jehovah's Witnesses' policy of no blood transfusions. This leads to no discussion on the benefits of blood transfusions, but is this really acceptable medical practice?
Is adhering to the common practice of simply accepting a Jehovah's Witness' belief in the blood doctrine and not providing an explanation of the benefits of blood transfusions truly acquiring informed consent? Is leaving out the benefits of blood transfusions truly informing the patient? Is it right to assume that all Jehovah's Witnesses are against blood transfusions and do not wish to have this important discussion with their physicians?
Informed Consent Includes Discussion of Blood Transfusions with Jehovah's Witnesses
While bloodless alternatives are often available to patients, there are times with blood transfusions are necessary. It is in these situations that a physician should fully inform his or her patients on the risks and benefits of blood transfusions as well as those associated with not accepting this treatment.
In the October 1998 Journal of Medical Ethics article, "Bioethics of the refusal of blood by Jehovah's Witnesses: Part 2. A novel approach based on rational non-interventional paternalism," Osamu Muramoto explains that, "individuals vary in commitment to and interpretation of WTS policy. Some may show...willingness to be forced to receive blood-based treatment as long as it is officially noted as contrary to their wishes," or, "under the condition of complete confidentiality." Muramoto argues that, "rational deliberation on an individual basis can save lives."
Medical Ethics versus Watchtower Society Policies
Informing a coherent patient is an easy task and protects the physician under the law. Emergency situations may vary, however. Muramoto raises the issue that some Jehovah's Witnesses carry blood cards not because they believe in and follow the blood doctrine, but to appease their religious communities and their families. It is likely that those who do not agree with the blood doctrine or who are thinking of leaving the faith may carry outdated blood cards.
Emergency physicians are often faced with ethical decisions that must be made very quickly on behalf of the unconscious patient. In Canada, an emergency physician was sued for battery for treating a Jehovah's Witness with a blood transfusion. In the United States, courts have ruled in favor of saving patients' lives with blood transfusions rather than adhering to the strict guidelines of the blood doctrine. Muramoto suggests that many physicians would rather be sued for saving a patient's life rather than being sued for allowing the patient to die, which may occur when a family sues.
The Importance of Patient Confidentiality for Jehovah's Witnesses
It is very important that the physician and patient have a one-on-one, confidential meeting. It is not uncommon for church members to get involved, influencing the patient to change his or her mind to follow church guidelines. Physician consultations with church and family members should only occur at the request of the patient, and the physician should keep the patient's decision in the strictest confidence.
In the August 1998 Journal of Medical Ethics article, "Bioethics of the refusal of blood by Jehovah's Witnesses: part 1. Should bioethical deliberation consider dissidents' views," Osamu Muramoto discusses an article from The Watchtower that told a story of a hypothetical healthcare worker who found out that a fellow Jehovah's Witness had an abortion. The article proceeded to explain to the reader that the healthcare worker continued to do the right thing by sacrificing patient confidentiality to tell the elders of the patient's offense. Muramoto said, "Where JWs are employed as medical workers, JW patients have no assurance of doctor-patient confidentiality..."
While Jehovah's Witnesses generally do not believe that blood transfusions are a morally-acceptable choice, it follows medical ethics to fully inform the patient of the benefits and risks of blood transfusions and alternative procedures. By doing so, the patient can truly give informed consent; even if their decision is in favor of religious belief that contradicts what their decision may be otherwise. If the patient chooses a blood transfusion, then it is important to maintain the strictest patient confidentiality in order to protect the patient from the social pressures of his or her religious community.
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Diane Ursu - Diane Ursu joined Suite101 as a contributing writer in August 2009 and became a Feature Writer in January 2010. She is a freelance writer ...
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