Jehovah’s Witness and Blood Transfusions
Summary
This article focuses on the ethical issues involving Jehovah's Witnesses and blood transfusions. We begin by discussing the basics to understand why this belief is essential for them. We also focus on a basic step-wise approach for decision making and we also mention some popular cases.
Basics
A Jehovah’s Witness (JW) is a Christian denomination in which the members of the religion believe that it is against God’s will to receive a blood transfusion. This refusal is based on various biblical writings, namely Genesis 9:4, Leviticus 17:10 and Acts 15:28. These patients believe that they should not accept the transfusion of whole blood or its four primary components (red cells, white cells, platelets or plasma). Other types of treatments are not specifically contra-indicated, and may be used depending on the individual. In this case, from the four pillars of medical ethics, it is mainly autonomy and justice that is respected.
| Procedures | |
|---|---|
| Prohibited | Permitted/Individual decision |
|
|
This refusal may also occur even if the blood is their own blood. However, a small portion of Jehovah’s Witnesses may accept a blood transfusion, a blood product such as blood plasma or even their own blood. This is because this small portion of JWs believe that the bible is not against such action.
This means that a health professional should assess each patient individually and proceed with the most correct action. It is also important to state that their decision will be confidential and it will not be disclosed to anyone else. This discussion should occur in a private setting with the patient. The patient should also be educated on the benefits, risks and social implications of accepting or refusing the blood transfusion.
Take Note
It is important to keep in mind that the refusal of blood transfusion should not translate to refusal of general medical/surgical care.
Step-Wise Approach
1. An adult patient that is competent to accept or refuse a blood transfusion
- In terms of the Constitution, these patients may accept or refuse a life saving blood transfusion. An adult is a person > 18 years old.
- Elective Procedure: If it is an elective procedure in which a blood transfusion is required, the health care professional may refuse to perform the surgery. This applies if the JW has declined to receive the blood transfusion AND the health care professional is not yet involved in the ongoing management of the patient. However, it would be advisable to consult for other treatment options.
- In the case that the health professional professional refuses to perform the elective surgery, they should refer the patient to another health care professional who may take on the procedure knowing the risks involved. There should not be a break in the continuity of care.
- If the procedure is done without the required blood transfusion, the health care professional should request the patient to sign a legal form that absolves the health care professional from any liability arising from the failure of not receiving the blood transfusion.
- Emergency Procedure: A health care professional should not refuse treatment to a patient who declines a blood transfusion in an emergency situation.
Take Note
If there is any uncertainty, one needs to obtain legal advice.
2. An adult patient that is not competent to accept or refuse a blood transfusion
- First line: A person that has be assigned by the patient in written form may consent to accept or to refuse the blood transfusion on behalf the patient.
- Second line: If the patient has an Advanced Directive (AD), which was written when the patient was competent to do so, and they state that they do not wish to receive the blood transfusion then this decision should be respected provided that the AD is applicable to the current circumstances and there is no reason to believe that the patient might have changed their minds regarding the blood transfusion. However, it is still advisable to also follow with the “third line”, if both second line and third line do not agree then attempt the fourth line.
- Third line: If the “first line” and “second line” are not possible, consent should be obtained from the patient’s spouse or partner, a parent, a grandparent, an adult child or a brother or sister (NB: In this order)
- Fourth line: If the person in the “third line” refuses the blood transfusion, the health care professional needs to acquire a court order if they believe that the blood transfusion is required regardless.
Take Note
The order for consent: Spouse or partner, a parent, a grandparent, an adult child or a brother or sister. This order should always be respected.
3. Children < 12 years old or children < 18 with insufficient maturity or mental capacity to understand the benefits, risks and social implications of the treatment
- A child is a person under the age of 18 years old
- Medical treatment cannot be performed without the consent of the parent or guardian of the child.
- Elective: If the parent or guardian refuses the blood transfusion, then the health care professional should await for a court decision.
- Emergency: If the parent or guardian refuses the blood transfusion, the health care professional may ignore the refusal and may administer the blood transfusion (Children’s Act 38 of 2005). Unless the parent or guardian can show that there may be an acceptable medical alternative that is available.
4. Children > 12 years and with sufficient maturity or mental capacity to understand the benefits, risks and social implications of the treatment
- This patient may consent for their own medical “treatment” without the assistance of their parent or guardian. This patient may consent for their own surgical “operation”, ONLY if they are assisted by their parent or guardian.
- If the blood transfusion is regarded as a medical treatment, then the child’s refusal should be accepted unless it is unreasonable. In this case, the health care professional should consult the Department of Social Development.
- If the blood transfusion is regarded as a surgical operation, then the child will need the parent’s/guardian’s consent. The parent/guardian may not refuse to consent for the blood transfusion unless they can show that there may be an acceptable medical alternative that is available. If the child is the one that is refusing, but the parents are accepting the blood transfusion then the health care professional should consult the Department of Social Development.
Take Note
A health care professional should inform the parents/guardians that if a blood transfusion is required to save the life of the child then the blood transfusion will be performed without their consent.
This can only be prevented if the parents/guardians obtain a court order that prevents this action. For this reason, this discussion should occur as early as possible so that the parents may have sufficient time to obtain the necessary legal advice or a second medical opinion.
This can only be prevented if the parents/guardians obtain a court order that prevents this action. For this reason, this discussion should occur as early as possible so that the parents may have sufficient time to obtain the necessary legal advice or a second medical opinion.
- The New England Journal of Medicine: Case 23-2011: A 40-year-old pregnant woman with placenta accreta who declined blood products
- The Washington Post: Why doctors let a Jehovah’s Witness and her unborn baby die
- IOL: Jehovah’s Witness parents refuse blood transfusion despite court order
Notes
- All the discussions or consultations need to be correctly document.
- Always rememeber that according to the Children’s Act, a parent cannot refuse medical treatment for their child based only on religious beliefs. Unless they can show that there is a medically approved alternative.
- A health care professional may provide information to recommend/influence the patient’s decision based on medical/surgical knowledge. However, this information should not lead to intimidation or negative implications for the patient or the patient’s family.
- The step-wise approach was adapted from a very educational article named, The Challenges of treating Jehovah’s witnesses.
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