What makes Jehovah's Witnesses tick? What motivates practitioners of medicine? How is benevolent human behaviour to be interpreted? The explanation that fear of censure, mind-control techniques or enlightened self-interest are the real motivators of human conduct is questioned. Those who believe that man was created in "God's image", hold that humanity has the potential to rise above selfishly driven attitudes and actions, and reflect the qualities of love, kindness and justice that separate us from the beasts. A comparison of general (...) medical ethics and disciplines, and those of the Jehovah's Witness community, is made in this context. The easy charge that frequent deaths result from refusal of blood transfusions is examined. The central source of antipathy towards Jehovah's Witnesses, namely the alleged imposition of extreme and even harmful refusal of blood therapy on our children is addressed. Of course, "...few dilemmas are likely to be resolved wisely or satisfactorily by a blinkered adherence to abstract principles alone. Solutions to most cases will be dictated by a combination of factors. The support of medical ethics by Jehovah's Witnesses, and their willingness to share in reasoned and ethical debate, while at the same time holding firm to their religious and conscientious principles are emphasised. (shrink)

Jehovah’s Witnesses should be required to sign transfusion contracts in order to be eligible for transplant.Human donor organs continue to be in short supply, and many potential transplant recipients die while waiting for an allograft to become available.1 Because the organ supply is so limited and the offering of organs is based on the generosity of patients and families, proper stewardship of these organs is an ethical obligation for transplant teams, as well as organ recipients. Preventable graft loss must (...) be protected against, and factors that foster preventable graft loss—for example, non-compliance must be proactively contemplated when patients are reviewed as potential transplant candidates. Post-transplant treatment refusal is one example of behaviour that can compromise transplant success.JEHOVAH’S WITNESSES AS TRANSPLANT RECIPIENTSIt is widely known that one of the most significant teachings of the Jehovah’s Witness church is abstinence from receiving blood transfusions.2 Believers derive this tenet from the Bible verse: “You are to abstain from …blood”.3 While blood loss is a risk of transplant surgery, some centres do not view patient refusal of blood transfusion as a transplant exclusion criterion. The first published case of transplantation of a Jehovah’s Witness appeared in 1986 from the University of California Los Angeles heart transplant team.4 Since then, numerous other cases have been published, including liver,5 kidney,6 pancreas,6 and lung.7 For experienced centres with superior blood management skills, transplant can indeed be a surgical success; however, optimal blood management before and during surgery are only two thirds of the patient’s clinical time clock. In the remaining third, the post-transplant period, the patient has received his/her organ, yet the potential for clinical need of blood transfusion remains.THE DILEMMAWhether due to postoperative complication, or future illness or trauma, all transplant recipients have …. (shrink)

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might (...) cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

Chagas disease or American trypanosomiasis is an important health problem in Latin America. Due to the mobility of Latin American population around the world, countries without vector presence started to report disease cases. We developed a deterministic compartmental model in order to gain insights into the disease dynamics in a scenario without vector presence, considering congenital transmission and transmission by blood transfusion. The model was used to evaluate the epidemiological effect of control measures. It was applied to demographic data (...) from Spain and sensitivity analysis was performed on model parameters associated with control strategies. (shrink)

Granulocyte transfusions have been administered to patients with life-threatening infections for more than five decades. However, to what extent this should be the case is far from established. On the one hand, the clinical effects of these transfusions are difficult to prove in clinical studies, and the donors of granulocytes may be exposed to certain risks. On the other hand, clinical experience seems to support the idea that granulocyte transfusions do play an important role for severely ill patients, and the (...) donors are primarily motivated by altruistic reasons. In this paper, we first discuss the ethical issues that arise from the fact that there is a conflict between clinical experience and the results from the attempts to perform randomized control trials, and second, the risk/benefit assessment that has to be made between two different parties, namely the recipient and the donor of granulocyte transfusions. (shrink)

The standard approach to parental refusal of transfusion on religious grounds in many newborn intensive care units and paediatric services is to override the refusal and provide the transfusion, usually with court intervention if time allows. This approach is justified by the child's right to effective treatment, seen to outweigh the parents' right to religious freedom and their right to decide for their child. That justification, however, may be limited by the predicted effectiveness of the transfusion (or (...) any proposed treatment) in preventing significant harm to the child. A case where parental refusal was appropriately respected is briefly discussed. (shrink)

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject.Method: We analysed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the key (...) concepts in the Islamic ethical framework regarding organ donation and blood transfusion.Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation.Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity. (shrink)

Individuals suffering from anorexia-nervosa experience dysmorphic perceptions of their body and desire to act on these perceptions by refusing food. In some cases, anorexics want to refuse food to the point of death. In this paper, I answer this question: if an anorexic, A, wants to refuse food when the food would either be life-saving or prevent serious bodily harm, can A’s refusal be valid? I argue that there is compelling reason to think that anorexics can validly refuse food, even (...) in these extreme circumstances. (shrink)

This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent.

In this issue of the journal “Lee Elder”,1 a pseudonymous dissident Jehovah's Witness , previously an Elder of that faith and still a JW, joins the indefatigable Dr Muramoto2–5 in arguing that even by their own religious beliefs based on biblical scriptures JWs are not required to refuse potentially life-saving blood transfusions. Just as the “official” JW hierarchy has accepted that biblical scriptures do not forbid the transfusion or injection of blood fractions so too JW theology logically can and (...) should permit the transfusion of whole blood when this is medically required.Few doctors would argue that they should override the adequately autonomous decisions of Jehovah's Witnesses to refuse blood transfusions even if they are likely to die as a result of such transfusions. However, there is a case to be made for doctors asking such patients to reflect on their potentially fatal refusal of blood and for drawing to these patients' attention the reasoning of members of their own faith that justifies acceptance of potentially life-saving blood transfusions. What is that case? Simply that doctors' primary professional duty to try to benefit the health of their patients entails trying to save their patients' lives when and if doing so will benefit their patients' health. Of course this is not an absolute duty overriding all other duties; in particular if patients who are adequately autonomous to do so refuse such life-prolonging treatment doctors must generally accept such refusal, however sadly. This editorial endorses that view in the case of adequately autonomous legally competent JWs. (In another paper in this issue of the journal Professor Shimon Glick argues that ethics committees should be empowered—as they now are in Israel—to override even competent refusals of life-prolonging treatment where the committee judges that …. (shrink)

Refusal of blood transfusion is often framed as a conflict between competent patients’ refusal and clinicians’ responsibility to prevent death or serious harm. In Japan, many hospitals have adopted relative non-transfusion policies, which seek to avoid transfusion where possible while reserving emergency transfusion when necessary. Existing debates have asked whether such policies are ethically or legally justified. This study examines how they structure access and responsibility as hospital policies. We conducted a document analysis of publicly available (...) transfusion refusal policies from all designated advanced treatment hospitals in Japan (n = 88), using qualitative content analysis and ethical interpretation. Publicly available institution-wide policies were identified in 50 hospitals (56.8%). Three approaches were identified: structured relative non-transfusion policies specifying thresholds, emergency transfusion provisions, and the clinical or institutional locus of decision-making (41/50); transfer-first or standard-care prerequisite policies (5/50); and low-specification or deferred policies (4/50). Emergency transfusion override provisions appeared in 45/50 policies, thresholds in 47/50, decision-making locus in 46/50, elective–emergency distinctions in 25/50, and transfer or referral recommendations in 33/50. These findings suggest that relative non-transfusion policies do more than specify whether emergency transfusion may be undertaken despite refusal. They organize conditions under which patients access care, emergency transfusion may be reserved, referral or transfer may be recommended, and institutions retain, redirect, or leave under-specified responsibility. Ethical evaluation should consider meaningful access, transparent thresholds, feasible referral pathways, case-specific assessment, and institutional support for bedside judgment before emergencies arise. (shrink)

The liberty of the woman is at stake in a sense unique to the human condition and so unique to the law. The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. That these sacrifices have from the beginning of the human race been endured by woman with a pride that ennobles her in the eyes of others and gives to the infant a bond of love cannot (...) alone be grounds for the State to insist that she make the sacrifice. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman's role ….For years, Jehovah's Witnesses have posed a challenge to the medical profession. Bound by religious belief to refuse blood and blood products, they can frustrate physicians who, since World War II, have utilized transfusions when indicated in the course of treatment. (shrink)

It is not unusual for a devout member of the Jehovah’s Witness faith, even one who has expressed a strong preference to not receive blood products transfusion, to have a change of heart. Many gener...

This article argues for a ban on the performance of medically unnecessary genital normalizing surgeries as part of assigning a binary sex/gender to infants with intersex conditions on the basis of autonomy, regardless of etiology. It does this via a dis/analogy with the classic case in bioethics of Jehovah Witness (JW) parents' inability to refuse life-saving blood transfusions for their minor children. Both cases address ethical medical practice in situations where parents are making irreversible medical decisions on the basis of (...) values strongly held, identity, and relationship-shaping values—such as religious beliefs or beliefs regarding the inherent value of binary sex/gender—amidst ethical pluralism. Furthermore, it takes seriously—as we must in the intersex case—that the restriction of parents' right to choose will likely result in serious harms to potentially large percentage of patients, their families, and their larger communities. I address the objection that parents' capacity to choose is restricted in the JW case on the basis of the harm principle or a duty to nonmaleficence, given that the result of parent choice would be death. I provide evidence that this is mistaken from how we treat epistemic uncertainty in the JW case and from cases in which clinicians are ethically obligated to restrict the autonomy of nonminor patients. I conclude that we restrict the parents' right to choose in the JW case—and should in the case of pediatric intersex surgery—to secure patient's future autonomy. (shrink)

John R. Spencer; A Point of Contention: The Scriptural Basis for the Jehovah's Witnesses' Refusal of Blood Transfusions, Christian bioethics: Non-Ecumenical Stu.

SIRThere is nothing wrong with Dr Gillon's suggestion to doctors that they ask Jehovah's Witness patients why they refuse a blood transfusions and present alternative viewpoints. ….

sirI have been following with interest the series of articles in the Journal of Medical Ethics on the subject of Jehovah's Witnesses and the refusal of blood transfusions. There are a couple of aspects which have not been covered and which I would like to raise.Most of the discussion has centred around adult Jehovah's Witnesses. However, where children are involved the issues become more complex and emotive. I feel that there is a need to examine the rights and responsibilities of (...) parents in the making of life and death decisions on behalf of their …. (shrink)

In the mid-1870s, the experimental therapy of lamb blood transfusion spread like an epidemic across Europe and the USA. Doctors tried it as a cure for tuberculosis, pellagra and anemia; proposed it as a means to reanimate seemingly dead soldiers on the battlefield. It was a contested therapy because it meant crossing boundaries and challenging taboos. Was the transfusion of lamb blood into desperately sick humans really defensible? The book takes the reader on a journey into hospital wards (...) and lunatic asylums, physiological laboratories and 19th century wars. It presents a fascinating story of medical knowledge, ambitions and concerns – a story that provides lessons for current debates on the morality of medical experimentation and care. (shrink)

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject. Method: We analysed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the (...) key concepts in the Islamic ethical framework regarding organ donation and blood transfusion. Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation. Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity. (shrink)

The period in the history of blood transfusion that I discuss is roughly 1628, the date of publication of Harvey’s work on blood circulation, De Motu Cordis, and 1668, the year of the first allegedly successful transfusion of blood into a human subject by a French physician Jean Denis, and the official order to prohibit the procedure. The subject of special interest in this history is Robert Desgabets, an early defender and teacher of the Cartesian philosophy at St. (...) Maur, in the region of Lorraine, France. Desgabets’ Discourse de la communication ou transfusion du sang Communication or Transfusion of Blood contains a defence and description of the procedure. This three page manuscript is a lecture delivered at one of the meetings held at M. de Montmor in July 1658. Letters and documents which describe the events of these conferences during Desgabets’ eight month stay in Paris in 1658, indicate that he had numerous discussions with the Cartesian physicist Jacques Rohault and also with another leading Cartesian scientist, Gerauld Cordemoy. In addition, Desgabets is said to have frequently attended the meetings where he showed his interest in many scientific questions. I provide evidence that Desgabets was not an arm-chair scientist: he performed experiments, and he designed and created an apparatus to carry out the procedure of blood transfusion. I show how Desgabets’s Cartesian conception of mechanism and body had theological as well as epistemological underpinnings and consequences. For Desgabets, experiments on blood transfusion were as much demonstrations of the truth of the Cartesian metaphysics as they were demonstrations of the possibility of transubstantiation. The role of experiment was to provide demonstrations of the first principles or truths of physics and theology by connecting them to the way God actually made the world. The upshot of Desgabets's treatment of expérience is that it is integral to the knowledge of essences, and hence to the discovery of the truth of things. In placing expérience at the very foundation of true knowledge, Desgabets reconstructs Cartesianism on an empiricist foundation. (shrink)

This clinical ethics case examines whether to provide a blood transfusion to a severely injured Jehovah's Witness patient who initially agreed to the transfusion but changed her mind after speaking with a friend. The ethics committee analyzed several key issues: how to handle information from friends about a patient's religious beliefs when unconscious, the validity of advance directives, concerns about potential coercion in the patient's change of mind, and how to balance respect for religious beliefs against immediate medical (...) needs. The committee recommended that while unconscious, life-saving treatment should proceed given limited verifiable information about the patient's wishes. Once conscious, if the patient maintains a competent refusal after thorough discussion of risks and consideration of possible coercion, her decision should be respected even if it conflicts with medical recommendations. They emphasized the importance of consulting hospital Jehovah's Witness liaison services and documenting all discussions while exploring non-blood alternatives when possible. (shrink)

Summary Historians have devoted little attention to blood transfusion in the nineteenth century. In part, this neglect reflects the presentist assumption that, before Karl Landsteiner's discovery of blood types, this practice would have failed too often to gain currency. Yet, transfusion was in fact the subject of much debate, and was actively practised, primarily by obstetricians on haemorrhaging women. Examining this practice through the conceptual lens of ‘blood clots’, both as noun and as observation, I follow transfusors’ assumptions (...) about the nature of the blood and the problem of its coagulation. Tracing the medicalization of ideas about blood by the century's end, I map this shift onto changing notions about why transfusion was performed, what substance was best employed, and what instrument best fitted that substance's movement into the circulation. In this way, ‘Blood Clots’ reconstructs the discourse surrounding transfusion, extending that discourse to material culture in order to illuminate the rationale that guided transfusion's practice in nineteenth-century Britain. (shrink)

The aim of the study was verifying, whether speech development is conditioned by a preterm birth, multiple pregnancy or pregnancy complicated with TTTS. We examined 52 preterm children, 15 of which were born after a single pregnancy and 42 after a multiple pregnancy. 23 children came from a pregnancy complicated by TTTS. The average age of the subjects was 32.5 months (SD=5.54). The research methods used in our study were as follows: analysis of medical documentation, a structured clinical interview and (...) psychological conversation. Speech development of a child was assessed using BSID-III. An analysis of the results we obtained showed that there was a lower level of EC in the TTTS children in comparison to multiple-birth children without TTTS and single-birth children. We also found statistically significant relations between the EC scores and gender, age at the time of testing, disability, gestational age, birth weight. (shrink)

It seems obvious that blood itself is the most appropriate fluid to replace blood, and there is no doubt as to its efficacy. On the other hand, to my surprise, it has not shown itself, experimentally, to be so much superior to certain artificial solutions, such as gum arabic, as I expected.