allaboutmusic

I'm not sure if this belongs in GD or in Tilted Philosophy, but mods of course feel free to move if appropriate.

I saw this in the news this morning.

http://news.bbc.co.uk/1/hi/england/s...re/7078455.stm

Firstly, I didn't realise that Jehovah's Witnesses weren't allowed to receive blood transfusions. I did a bit of further reading and learned that it stretches beyond just blood transfusions... any kind of medical treatment involving any blood component is also a part of this, including vaccines and treatment for hemophiliacs.

http://www.ajwrb.org/basics/abstain.shtml

Much to my surprise, the premise of the belief according to that page is the simple three words in Acts 15:29 which are "abstain from blood" (on an aside, the issue of whether that would include blood donated by that same person at an earlier date is unclear to me, but it seems logical that since the blood was okay while it was in their body, re-introducing it shouldn't be an issue... a possible way around this?).

Anyway my question wasn't really one of beliefs - I don't agree with their position, but respect their right to hold it - but one of ethics for the doctors involved. Let's say in this case it had been the twins that had needed the blood, and the parents had refused the treatment. The twins would die if a blood transfusion did not take place. The parents are bound by their beliefs, but should the doctors be bound more by their oath to do what is best for their patient (against the wishes of the guardians of the parent), or should they respect the wishes of their patient's guardian (or their patient) even if they know that medically it's condemning them to death?

I'm still formulating my position on this, but I will say that this case makes me quite sad. I'm sure the widower father of the twins must be going through a hard time having just lost the mother of his newborn twins, and if he's anything like me he will be questioning whether they made the right decision. At the same time, I suppose if their beliefs were that important to them, they would have lived in guilt had they chosen to go ahead with the transfusion.

bhamv

Well, the article also says:

So it sounds like the parents would've let one of the newborn babies receive blood if it'd been necessary.

The question of what the doctors should do is interesting though. Most societies these days place a lot of emphasis on respect for the individual, including his or her religious beliefs and attitude towards life/death. Thus, if a person chooses to refuse treatment for himself or herself, then doctors generally respect that. (Hospitals have Do Not Resuscitate agreements for people who want them, right?)

I don't believe people should have the right to refuse treatment for other people though, even for their own children. So if one of the kids had needed a blood transfusion, I would support the doctors if they chose to give the child blood over the parents' objections.

Kadath

The only problem is the father isn't dead, so he'll be able to pass the stupid superstitious beliefs onto the children. He's not going to question it; it's God's will that she died. I don't respect the right to hold certain religious beliefs: women as inferiors, no medicine, human sacrifice, etc. Religion is fine as long as it doesn't get in the way of society, and when people die because of a religion, it is getting in the way.

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ratbastid

So, are you going to go tell them how wrong they are, Kadath? Really think that'll accomplish much?

The reality of this is that doctors require consent from the patient or their legal guardian for every medical procedure, from drawing blood to open-heart surgery. When you go to your doctor for a checkup, your consent is implied for everything they do, but they DO have your legal consent. The minute treatment starts getting invasive, they have to start getting your consent on paper.

Partially, this is just good medical practice--it's been regularly ruled by the courts, in cases alleging negligence or malpractice, that patients should be informed of their status and allowed to make their own decisions about their care. In one famous case, a british surgeon was doing a routine operation on a woman when he noticed cancerous tissue in her uterus. He took it on his own initiative to perform a hysterectomy. In the ensuing court case, it was ruled that her informed consent rights outweighed any possible need for medical expediency.

The other thing is, malpractice insurance requires it. If there is legal documentation that the patient or their guardian is informed about the procedure and its risks, and knowingly consents, then their butts are covered for a broad range of the things that can go wrong during the procedure. Not everything, but things in the normal range of risk associated with the procedure.

Incidentally, saying "I don't think a parent should be able to refuse treatment on behalf of their child" is an emotionally compelling thing to say, but it goes in the face of centuries of guardianship law.

allaboutmusic

On the other hand, there was the case here recently where the doctors wanted to switch off life-support for a child, but the parents wanted it kept on. Eventually the courts ruled in favour of the doctors. Presumably the doctors' medical expertise here in saying that "nothing more could be done" outweighed the parents wishes for the child to be kept alive. It just seems a little inconsistent.

The_Jazz

There comes a point where parents stop being rational about their childrens' treatment. I'm sure any medical professional can back me up on that.

As far as religion goes, mark me down as someone who thinks that everyone should be able to raise their kids however they want. I've seen enough folks that have been raised with one particular set of beliefs that later rejected them. I can think of 9 TFP members off the top of my head that fit that exact description.

On the one hand, among all the tragedy and sadness of this story, I can find in myself a small amount of admiration for the mother for holding to her beliefs so strongly in the face of death that they killed her. I don't see much of that in myself, and when I see it in others, I generally notice it.

The doctors have the responsibility to respect the patient's wishes. If there are some treatments they just don't want, the the doctors have no right to force it on them unless it would impact the health of others. Once the babies were born, they couldn't force her to do anything.

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allaboutmusic

I suppose the natural question to ask then is... what if she had required the transfusion BEFORE giving birth, and if the refusal subsequently caused the death of her twins? Assuming she survived, would she be held responsible for the death of her children?

ratbastid

Well, that's different. The COURT has precedence over parents wishes AND doctor's wishes, and either party has the power to bring the case before the court.

She probably COULD be, yes. Whether or not she WOULD, I can't really say.

The_Jazz

There are so many "ifs" here that we've pulled away from reality and into an alternate universe. I'm comfortable with that, but want to acknowledge that what I'm about to say has little basis in the actual facts of this matter.

If she had required a transfusion prior to birth and if she had refused it and if one or both of the babies had died and if she had survived (that's 4x removed from reality), then I suppose that she could have been held legally/criminally responsible. I'm not familiar enough with the British legal system to tell you one way or the other. To add another diversion, if she had been in the US, I suppose that an overzealous prosector could have put her on trial, but I cannot really envision a guilty verdict since I imagine that most conceivable juries would have at least one member that would think she'd been punished enough by the death of her child.

Just because she was a Jehovah's Witness doesn't mean that she didn't love her unborn children and want to be a part of their lives. In her mind, she put her life in God's hands. As an uninterested agnostic, I would say that she played the odds and lost, but what I think is simply Monday-morning quarterbacking.

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Kadath

No, I'm not going to bother to seek out the father (not sure who they are in this case since the mother is dead). I stated an opinion on an internet message board, which is pretty much the definition of not accomplishing much. Let me ask you: at what point should the state step in to protect the child?

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Ustwo

Yep.

Yep.

The keystone to todays medicine is informed consent. You tell a patient the risk of doing it, the risk of not doing it, and let them decide. If they decide to be a dumbass, its their problem, not yours.

Lets pretend the doctors forced her to get a blood transfusion. Lets say the blood was tainted with a blood born disease (as can happen). Now what?

She picked a stupid choice, she died, sucks to be her, or more likely sucks to be her kids, but again her choice.

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ratbastid

It was sort of a rhetorical question. My point is: saying to people, "Hey! Your beliefs are stupid, and aren't helping anything! Stop believing them!" is about 99% as dumb as them having those beliefs in the first place.

I recognize the irony of saying this to you about your beliefs, of course.

Well, I don't really know. It's a good question. I'm a computer programmer, not a medical ethicist. I do think people's right to religious expression should include their right to opt out of medical treatment if they so choose. Obviously it gets more ambiguous when they're making those decisions on behalf of those incompetent to give their own informed consent (let's not forget, for instance, adult children with mental retardation).

Legally, it's a state law issue, and here's how things stand:
So, 36 or 37 states say that there's NO point the state should step in to protect the child. Or at least, in those states the law hasn't been put to constitutional test.

Willravel

It's all right there.

analog

Yep. The sucky thing is, it's not always as easy as saying they're bad parents, or idiots, or have some "odd" (to us) religious/cultural thing. Most of the time, it's as simple as panic, or plain old "not wanting to let go".

As for the OP, it's just one of many things to deal with, regarding patients.

For treating children whose parents have wishes that may interfere with proper medical treatment, the standard way in emergent cases is just explaining that you respect their beliefs, but the child is in peril of death. No one wants to die- but as an adult, your beliefs are firm and you're prepared to die to honor them. Do you think your child really understands that, and why you're letting them die?

It may sound harsh, and that's because it kind of is- and must be. As a person charged with helping people and saving lives, I can't allow the beliefs of one person to allow another person to die. Children don't understand their beliefs- but most importantly, the consequences of having them.

In an emergency situation (meaning there's no time for things like court orders), the parents' word is still law, but we will do everything in our power to try and convince the parents to let the child be treated. This includes throwing out all notions of caring for the parents feelings and speaking bluntly about letting the child die. Whatever it takes to save the child, that's what has to be done.

Plan9

Muthafawkin' informed consent! Yes.

Here, here. The epitome of a free society.

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Borla

I like how they automatically condition the statement so that the reader assumes the only negative factor was a rejection of a blood transfusion, and that the statement almost assumes it is 100% certain there would have been no other complications if she had had one.

Anyone whose done much medical research, or ever had family deal with major operations, transplants, or transfusions, realizes that there are often severe side effects that cause a negative outcome even when the "right" procedure is followed.

Many major medical centers are opening up entire "bloodless" wings or hospital units because of the growing belief that blood transfusions do more harm than good, religious beliefs aside. I think it is possible, maybe even probable that, within our lifetime, that that particular procedure will go the way of "bleeding" people to remove toxins and infection.

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Ustwo

In case you weren't following the woman died so any blood transfusion complications are rather trivial by comparison.

So while I think it was her right to make the wrong choice, lets not cloud the issue here. She didn't do something which could have saved her life and she died because of it. The fact that it was a blood transfusion is only a small part of the issue.

Now who knows if thats really what killed the woman in this case, being there are not a whole lot of details, but if it is as is claimed then, well oops.

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Borla

My grandfather died of a type bone cancer. His body could not generate enough white blood cells, and he had numerous transfusions the last two years of his life. We became quite familiar with the benefits and drawbacks of blood transfusions. Complications some patients suffer are similiar to a body rejecting a transplanted organ. In a weakened state, or while the body is fighting to live with multiple other problems going on, sometimes those side effects are enough to cause (or contribute) to death.

Like I said, there is an entire medical school of thought today that blood transfusions are better replaced by other volume expanders that do not cause such side effects. There are many, many major hospitals in the US that have bloodless medical wings now, due to that.

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Ustwo

I do find this an interesting side note, I just have to wonder though. How much of this is due to real medical need and how much is due to limiting legal liability?

For example, until very recently C-sections for pregnant women went through the roof, not due to a need but due to lawsuits placed by a handful of high profile shysters like John Edwards (yes the presidential candidate and he was the worst of the lot). These were not in the patients best interest, were unnecessary and even resulted in patient deaths, BUT it was required to avoid major lawsuits in the millions and to keep their malpractice insurance.

So while there are issues with blood transfusions, I am curious to know if the primary motive for not doing them at all is medical or liability.

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randygurl

Speaking as someone who was raised as a Jehovah's Witness, I would like to help clarify the family's position on this matter - if only to help further discussion in this thread.

Alongside their deeply held belief that they should abstain from blood because it is against God's Will, is the belief that all faithful Jehovah's Witnesses will one day be ressurected to a paradise earth. So you can imagine how this mother was feeling - being told that in order to live she would have to violate her faith by receiving a blood transfusion. Would it not be better, in her eyes, to remain faithful and accept whatever the consequences - knowing that she will be rewarded in a paradise earth? She would hold the same beliefs for her children because she as a parent is the one responsible for their life. Both spiritually and physically - until they come of an age to make the decisions themselves.

There have been many many cases in the courts of Jehovah's Witness children as young as 14 who refuse blood transfusion. The doctors and courts argue that they are not old enough to fully understand the situation and therefore cannot make the decision for themselves. And depsite the fact that they are underage, and there legal guardians support this decision, the doctors still try and take it upon themselved to force a blood transfusion because they feel it is in the patients best interest. But the patient believes otherwise. Who is in the right and who is in the wrong? I don't think that's for any of us to decide, unfortunately when these cases go to court, its up to our judicial system to decide. But at the end of the day - both the parents and their children have every right to fight until their dying breath to avoid something they feel so strongly about. Because they feel they will be rewarded for remaining faithful (and who are we to say they're wrong?).

I feel like maybe I may not have explained myself clearly enough - and for the most part it may be because I have left the religion I was raised in - I no longer wanted to follow their 'rules' (most specifically in regards to sex before marriage and dating outside of the religion), but my beliefs on blood and blood transfusions will never waver. Even if I never return to being a Jehovah's Witness - I will always maintain this belief and abide by it. Not because I think that I will be rewarded by being resurrected to a paradise earth (lets face it, I think I'm screwed in that department) - but because I still firmly belive that to knowingly comply to a blood transfusions is one of the gravest sins you can make against God. That may make my a bit of a hypocrite, but so be it...

Here's an interesting article that it actually gleaned from the Watchtower Society's offical website (the Watchtower Society being the equivalent of the Vatican for Jehovah's Witnesses):

http://www.watchtower.org/e/hb/index...article_02.htm

Please...continue discussion...

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analog

Yes, but that's probably also partially due to the fact that in the last few years they've developed and been testing a new blood replacement fluid. The component inside the fluid can actually carry oxygen like real blood does. Older blood-replacement fluids (and I don't mean normal saline or lactated ringers) were based on animal hemoglobin and thus not all people could use it, and it was still a blood product of sorts so it still carried some risks.

The newest stuff they're testing out now (both in some hospitals and in some EMS crews) is completely synthetic, there don't seem (so far) to be any inherent risks in its usage because there is no chance of "something missed in screening" and it's not actual blood so there's nothing for the immune system to reject (no typing and cross-matching). It carries oxygen just like real blood does, only it does it better. The cells carry many times more oxygen than our human red blood cells do. It also has a really good shelf life- unlike blood, which has a terribly short shelf-life when thawed. I've read a bit about it, and it seems like it could end up replacing blood in a lot of volume-replacement circumstances. It's just a few years down the road before testing will be sufficient to see it in widespread use.

Ustwo

Now I know its polite to be respectful (aka don't say what you are thinking) when it comes to someones religious beliefs, but this to me is perhaps the most disturbing post I've read on TFP.

Its really quite horrifying to me to know intelligent people think this way.

I'd like you to put yourself in a doctors shoes here. You have been trained for a decade to do what you do, and thats just official training, not what you learn after. You have a bright young 14 year old patient, who has their whole life ahead of them. That patient needs a blood transfusion to survive. All they need is something thats been done routinely for 60 years, and their parent says 'no its against our religion'. You know you could save this childs life and that their parents just sentenced them to death over some idea that seems batshit insane to you. You seem bitter they went to court to try to over rule this, but to me I'd be more upset if they didn't try SOMETHING. I do believe in parents rights to raise their children but this is one of those times where doing so makes you feel dirty.

I don't really care what an adult does, thats there call, but its painful seeing an adult make a life ending decision on a child based on what seems a delusion to the rational mind.

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ratbastid

I find that absolutely fascinating. Can you elaborate on that? What's the theological reasoning for that position? What scriptures are involved?

opus123

Actually it is an easy choice. Live and go to hell or die and go to heaven. I see more admiration in people who break their blind dogma in the face of their community telling them to die. One door to door JW told me honestly that not sharing blood transfusion is a racist thing as the blood of any race could be transfused. There are hundreds of things in the bible that the JW don't do.

"We do not believe that every passage in the Bible is to be interpreted literally. "

http://www.jw-media.org/beliefs/beliefsfaq.htm

Yes, way back when, needles were probably unsanitary and going without blood transfusions may have been wise, but today having not questioned that will only decrease their numbers than they already have.

http://www.census.gov/compendia/stat...es/07s0073.xls

Jonathan

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Kadath

I read that and it's from 1990. Is there anything that WASN'T published at the height of the AIDS crisis? Maybe something that reflects the advances in medical technology, specifically blood screening, in the last 15 years?

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randygurl

http://www.watchtower.org/e/20000108/article_01.htm

I could explain the beliefs behind this but I haven't been a practicing JW since I was 16 (six years ago), so I don't feel I would be able to fully explain properly. The main scriptures though surrounding the belief are Acts 15:28, 29and Genesis 9:4

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Frosstbyte

The wikipedia article on JW's and blood transfusion (found here: http://en.wikipedia.org/wiki/Jehovah...sses_and_blood) provides a pretty good explanations.

The quick and dirty is that blood is sacred and can only be used outside the body to atone for sins, and then really only by Jesus's shedding of blood to atone for the sins of mankind. Abstaining from blood reflects the belief that Jesus's blood is the only blood that can or could ever "save" a person.

ratbastid

Acts 15:28-29
28 It seemed good to the Holy Spirit and to us not to burden you with anything beyond the following requirements:
29 You are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from sexual immorality. You will do well to avoid these things. Farewell.

Genesis 9:1-4
9:1 And God blessed Noah and his sons and said to them, "Be fruitful and multiply, and fill the earth.
2 And the fear of you and the terror of you shall be on every beast of the earth and on every bird of the sky; with everything that creeps on the ground, and all the fish of the sea, into your hand they are given.
3 Every moving thing that is alive shall be food for you; I give all to you, as I gave the green plant.
4 Only you shall not eat flesh with its life, that is, its blood.

They both sound like dietary prohibitions to me. At least the message in the first one, "abstain from blood" seems clear enough. Not being raised in those beliefs, the interpretation of a prohibition against blood transfusion seems like a bit of a stretch, but I can at least see the thinking.

In the Genesis verses, I don't see how the word "eat" could be interpreted to mean "receive through a needle in your arm". This one strikes me as wholly dietary. Presumably that's where the kosher blood-draining practice comes from. Although there is a big "blood = life" right at the end of the verse there, and I suppose a theologian could turn that into a whole big rule-generating moral code.

I'm not trying to run down your beliefs here, randygurl, I'm really just trying to understand the thinking that would interpret those two scriptures to mean that the single highest offense you can commit is to receive a blood transfusion. I mean, given that blood isn't even mentioned in the Big Ten, it seems like God has at least those items as a higher priority. I know it's been a while, but can you give us a sense, at least, of what the JW reasoning on the matter is?

randygurl

I would be more than happy to shed some enlightenment on this - don't get me wrong - its just that at this moment I don't have the time (I'm at work) but I will go home tonight, do a little bit of reading and formulate a more in depth response for you tomorrow...stay tuned

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analog

Yeah, the context of the whole passage is "what not to eat", which pretty much says to me, "don't drink blood"- and more specifically of animals. Everything listed is talking about what animals not to eat. I'm at a loss on how that can be interpreted as "human blood transfusion".

ratbastid

Awesome! Thanks!

Nimetic

This is a fairly common situation for the JWs I believe.

I wonder though... are they allowed to self-transfuse (this is probably the wrong term). For example could a unit or two of their own blood be taken in advance early in pregnancy.

That way, it would potentially be on-hand later in case of a life-threatening bleed. Ditto with plasma, which (and I'm not sure on this either) I think might last longer.

telekinetic

I am not saying this to be snarky, but is there a reason why you adhere more strongly to the vaguely interpreted "abstain from blood" portion of Acts 29, and not the very specific "sexual immorality" portion? (other than convenience, or not having an opportunity to fully internalize what rejecting a transfusion could mean) Is this a common way to 'weight' the offenses, so to speak?

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Kadath

Thank you for humoring me. The article I got to from there was this one:

http://www.watchtower.org/e/20000108/article_03.htm

It doesn't talk about specific medical reasons to abstain from blood, it just says that some doctors don't like to give blood transfusions and it's not a zero-risk procedure. I assume that the bloodless medicine they propose as an alternative is also not zero-risk. I don't think there is any medical reason to abstain from blood transplants -- it seems purely religious, and ratbastid is pursuing that line of inquiry, so my curiosity is sated. I have to admit though, this quote gives me pause:

"'Blood transfusions are basically no good, and we are very aggressive in avoiding them for everybody,' says Dr. Alex Zapolanski, of San Francisco, California."

I would be apprehensive about working with a doctor who describes a widely used medical procedure as 'basically no good.'

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Ustwo

Sometimes I want my wife to do something and she doesn't want to do it. If her reason for not doing it is one she doesn't want to admit to, she will find another reason for not doing it.

Me: "Hey such and such is having a party on Saturday lets go."
Her: "Well you know I have a spin class on Sunday and I don't want to be out to late because I'll be to tired to go."

The second reason is mostly valid, as it can happen at times, but the real reason is that she just wasn't in the mood to go. Whenever she gets in this mood I tell her shes using secondary reasons, and whats the real reason she doesn't want to do something.

Any blood born disease issues is obviously a secondary reason for a JW. Its trying to find something rational after the fact, but the real reason is still the same illogical reason, which I think is based on an obvious misinterpretation of the bible. To equate the drinking of blood with a blood transfusion takes some mental effort.

It doesn't matter if in the end, we no longer need to do blood transfusions, or even if it turns out they are were completely unhealthy. By current medical knowledge there are real and life saving reasons for a transfusion, and to let yourself or your child die based on a vague passage of an ancient and often retranslated text, is perhaps the ultimate illumination of the negative power religion has over some peoples lives.

Some day I'll figure out why so many people assume, god must be a total asshole.

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Kadath

Ustwo, agreeing with you makes my bleeding liberal heart hurt, but I guess it's bound to happen from time to time. That is acceptable to me.

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randygurl

I've got nothing but a simple response for you - I'm selfish and therefore want to have sex before marriage. End of story. LIke I said, I fully admit that I'm a hypocrite, but I also know that I'll never waver on my stance on blood transfusions. Some of my beliefs will never change. Others, I may take a more relaxed view on - for example, I only started celebrating my birthday when I turned 18 (but I had been out of the religion for two years already at this point) and I didn't celebrate Christmas until another two years after that. There's no rhyme or reason to how I feel, it just is what it is. Other people who have left the religion may feel completely different than me. As in, they may no longer be opposed to blood transfusions. To each their own...

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casual user

i personally don't understand how some people are THAT blind in their beliefs. it's like they have no level of free thought at all, they agree with every aspect of their religion, even the ones that contradict themselves. what she basically did was suicide, which in my opinion is morally worse than some vague phrase that occurs once in the bible.