Transfusing a Jehovah’s Witness during surgery

I was in practice about five years and was about to do a radical nephrectomy on a patient.

I met with the patient and his son in my office and the son informed me that he and his father were Jehovah’s Witnesses and that he didn’t want his father to receive any blood or blood products before, during, or after surgery. I asked the father if that was his wish and he sheepishly agreed that it was his decision as well. I had him sign a consent form, with the appropriate documentation, that would absolve me of any negligence if he should require a blood transfusion and didn’t receive it.

The night before surgery, I met with the patient alone in his room. He confided in me that he was not as “religious” as his son — if he needed blood, he wanted to receive it. However, he requested that I shouldn’t tell him or his son if he received a transfusion.

I thought that was a prudent plan of action, and I documented our discussion in the patient’s chart. I then made calls to the laboratory and the blood bank, to type and hold several units of packed cells.

The surgery was a little more difficult than I anticipated and the patient lost several units of blood — he had signs of hypovolemia in the immediate post-operative period. At the end of the procedure I ordered that the blood be given to the patient in the recovery room. I told the nurses not to allow any family members into the recovery room while the transfusions were being given. I also had the nurses change the IV tubing after the transfusions were given so that there would be no tell-tale signs of blood in the IV tubing that could be seen by the family. I thought I had covered all of my bases.

I then walked out to meet with the family in the family lounge. The son asked me about the surgery and I told him about the difficulty of the operation but that his father was stable and doing well in the recovery room. The son then asked me, “Did my father receive any transfusions or any blood products?” Pow! I know I had the look of a deer stunned by the headlights. There were so many thoughts that raced through my mind in the interval between his questions and my response.

I responded, “Why do you ask?” as I was hoping to have just a few more seconds to gather my thoughts. The son said that someone from the blood bank had come into the family lounge during the surgery and asked if anyone in the family would consider donating blood, as their father was going to receive blood. I thought I had taken care of everything but I didn’t give the blood bank a heads up on my agreement with the patient. I thought, do I tell the truth and risk rupturing rapport between the father and the son and/or between the patient and myself? To give an adult patient blood against their will or wishes could be considered an assault with battery. I was truly scared about the legal ramifications the truth would subject me to. Or do I lie and protect the patient? I decided that my responsibility was to the patient and that the patient deserved that I protect his wishes and preserve his relationship with his son.

I said, “There must have been a mistake as your father did not receive any blood.” The son gave a sigh of relief and I know that inside I, too, was also relieved that the rapport was not blown between the patient and me, or between the patient and his son.

I ask, if you were the doctor in this situation, what would you have done? Would you be perfectly honest and tell the son about your discussion with the father the night before? Or would you do as I did, and lie to the son in order to protect your patient, his father?

We have all taken the Hippocratic Oath, which admonishes us “To do no harm.” I believe this dictum refers to more than just clinical harm to the patient, but also to psychological harm. I believe that had I been forthright about the transfusions, I would have harmed the patient — the lie protected the patient.

A certain moral goodness is expected in physicians, and if goodness is not present, education probably will not create it. Superior moral reasoning can enhance moral behavior, and we only have to look at the lessons of the great physicians who preceded us for the answers and the advice that can guide us in the practice of our profession.

This was one of the scariest days in my professional life and I believe, to this day, that I behaved in the best interest of my patient.

Addendum: I have researched this issue and the legal implications associated with blood transfusions in Jehovah’s Witness patients. The advice is that “medical providers should take care that each patient presenting as one of Jehovah’s Witnesses has ample opportunity to express their personal preferences of treatment outside the presence of any other member of the faith, including close family members.” And that is exactly what I did.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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  • medstudent

    As a med student – this was fascinating to read. Ethics in action. I agree with your actions, and from what we’ve learned in school – it is our job to take care of our patient, and their family’s knowledge of the procedures/decisions they make regarding their medical care is really up to them. If they didn’t want their family to know about it – well, our job is our patient’s medical care – not worrying about what the family does or doesn’t know. Thank you for posting your story – it is good to see how to use what we’ve learned in real practice.

  • http://www.confutata.com Squillo

    Not a physician, but from the layman’s perspective, you did the right thing. Your first duty is to your patient, and you exercised it appropriately, both by respecting his wishes to receive medically appropriate treatment and by maintaining confidentiality he specifically requested.

  • Celeste

    I would have kept it from the son under HIPAA. But would the blood products show up on a hospital bill? If the father required a lot of care at home, it seems like the son may have been privy to the paperwork.

  • http://SteinWellness.com Sara Stein MD

    You did the absolute right thing – the patient having surgery was your patient. The family member was not a legal guardian but was attempting to direct care to meet his own preferences. The blood bank, on the other hand, violated HIPAA, by discussing the patient’s care in a non-emergent setting with other people.

    And in terms of do no harm, the man might have lost his family and his community if they knew he was transfused. I’d say you prevented ALOT of harm with your actions.

    Best, Sara

  • http://drsamgirgis.com Dr Sam Girgis

    I think each patient should be talked to in private and away from family members so that their genuine wishes can be determined without the pressure of others. In this particular case, the father needs to discuss with his son his personal beliefs and ask that his son respect those beliefs. In the end, the patient’s wishes should be respected, and that is exactly what you did.

    Dr Sam Girgis
    http://drsamgirgis.com

  • ninguem

    If anything went wrong, the lawyers would have had a field day with that.

    • JWReader

      No lawyer would have a leg to stand on if the release was signed by the patient in advance. In fact, the purpose of that release is so that the patient cannot come back later and sue the doctor for upholding their wishes. If the patient were to change his/her mind, the doctor would have been prudent to get that in writing.

  • JWReader

    As one of Jehovah’s Witnesses, I believe you did the correct thing in respecting the wishes of the patient. We strongly believe that every person has the right to determine what goes into their body – and no well-intentioned friend or relative should be allowed to interfere. But this needs to work both ways, as you showed in this case. The father has a right to determine what is done to his body. The prohibition against blood transfusion is not an organizational dictum; we make that personal decision for ourselves based on scripture. (Acts 15:28,29)

    Of course, we usually experience this problem from the other side, where a relative wishes to force a blood transfusion on us against our will or behind our back. In those cases, we fight for our personal right to determine what is best for ourselves. In fact, we even go so far as preparing advanced directives and durable power-of-attorneys and assign a health-care agent in case we are incapacitated and cannot vocalize the stand we have already made in our minds and hearts.

    As for whether you did the right thing by lying, that is indeed a harder question. In the eyes of the law, you are bound to maintain a certain level of privacy between you and the patient. (Even Jehovah’s Witnesses understand that just because someone asks for the truth does not mean that the person asking always has the right to the truth.) Sometimes a higher law must be respected above all others. That’s fine line to balance, and in this instance, you did admirable. After all, it is not the son’s job to judge his father on this issue as each of us must answer to God for our choices.

    • anonymous

      During residency, I was told that Jehovah’s Witnesses normally refuse blood transfusions but will accept solid organ donations. Is this true? Is there a logical explanation for this seemingly odd distinction? Where would you categorize bone marrow? (The year before I started my residency at this hospital, a Jehovah’s Witness died slowly in the ICU of aplastic anemia.) Thanks in advance for the clarification!

      • JWReader

        This is a good question and one I get asked often. The Bible, on which we base our decisions, only prohibits the use of blood (out of respect for the sanctity of life). Scripturally speaking, an animal must be bled before eaten – again out of respect for God’s law. However, this does NOT mean that trace amounts of blood can never be ingested; indeed, if that were the case, then all forms of red meat would be off-limits. This is not, however, the case since the Bible speaks of many people – including Jesus – eating meat. Also, the Bible speaks of marrow being eaten along with the flesh.

        However, in many cases where a marrow transplant must occur, the patient is often given whole blood or one of the four main components of blood. This would be unacceptable to us, even if the individual’s conscience permitted the marrow transplant itself.

        This applies too with an organ transplant of any kind. Some, but not all, Witnesses will accept organ transplants. Since there is no specific law in Scripture prohibiting an organ transplant (how could there be?), it would be up to each individual Witness to decide what to do. The foremost thing doctors should understand about us is this: we believe our relationship with God is most important. Therefore, instead of trying to apply some man-made law, we try to make decisions based on how it will impact our relationship with God. In this matter, there is much room for individual preference since the only thing that is really condemned in the Bible is blood. Therefore, organ transplants, marrow grafts, and fractions derived from blood are for each individual Witness to decide. This is why a doctor should not make automatic assumptions when they find out a patient is a Witness but find out personally what is acceptable and what is not.

        Speaking personally, I really appreciate it when doctors make the extra effort to abide by our wishes. I know it must be difficult not to understand entirely the basis for our choices, but every single one of us does not insist that you understand – just that you respect us. That is all we can ever ask.

        • gzuckier

          I recall a Star Trek episode where the doctor (not sure if it was McCoy or one of his successors) performs some life saving treatment on a kid despite the family’s beliefs that it will destroy the kid’s soul; the treatment succeeds but the family ends up euthanisizing the kid. I recall that because it was such a question-raiser.

          Of course, we all have similar ethical requirements at some level. For instance, most people (maybe…) would refuse to receive an organ transplant which they knew was harvested from an involuntary “donor”, although that practice is a plot point in a lot of dramatic fiction.

  • http://Www.drmartinyoung.com Martin Young

    You respected the father’s requests on both counts. Even had the son found out, that argument would apply.

    You risked more by not transfusing.

    Just another example of how we doctors can be ‘damned if we do, damned if we don’t.’

    • JWReader

      Actually, if the patient were to sign the release that absolves the doctor of any fault, there is little risk to the doctor’s standing financial or professionally.

      I cannot think of a recorded incident where one of Jehovah’s Witnesses sued a doctor for refusing to give them blood. If anything, the doctor can be sued by ignoring the patient’s wishes. The right of self-determination should be a protected right of all human, regardless of reason for doing so.

      • ninguem

        A “release that absolves the doctor of any fault”…….

        Can you tell me where to get one of those? There are about seven hundred thousand doctors in the United States who will give you thanks for this magic document.

        • JWReader

          The legal non-profit corporation used by Jehovah’s Witnesses has a legal department and prepares Advanced Medical Directives that we all carry with them in case of emergency. In the document, which is notarized and witnesses, completely absolves the doctor of any liability – provided of course that the patient’s wishes are respected.

          • ninguem

            And I have a bridge for sale.

  • Cynthia

    Well handled!

  • Denise

    Lie like a rub baby! The son was out of line to begin with.

    • JWReader

      This is strictly your opinion. As far as the Supreme Court of the United States is concerned, all U.S. citizens have the right to determine their own medical care, even if the doctor or other people disagree or do not understand the reason. The son was then not out of line but merely protecting what he believed to be his father’s wishes. That the father did not confess his true beliefs to his son is another matter entirely.

      • Denise

        Ridiculous comment by JWReader noted. The son can “protect” til the cows come home and it matters nada. The son has no right to decide anything for his alert and oriented father. The father as a U.S. citizen was determining his own medical care at the moment that he spoke to his physician in private. What the son did or didn’t know about his father’s wishes didn’t matter since the matter was about Dad and what Dad wanted.

        • ninguem

          It is, indeed, about what Dad wanted.

          As long as he’s alive.

          If he’d died, who knows. Loss of consortium. The trial bar is nothing if not creative, they’d think of a whole bunch of ways to make it the doctor’s fault. And that well-intentioned lie won’t look so good in front of a jury.

          I don’t get it with surgery, but I still get it with primary care and especially with substance abuse treatment. I can talk with mom but not dad, or vice versa. Multiple relatives nosing in, some I can talk with, some I can’t.

          One thing I don’t allow in my office is drama. If I get too much of it, I ask them to find another doctor, play out the drama at another theatre.

          • gzuckier

            yeah, that’s a good point; the basic problem here is not so much religious as it is family dysfunction, as crops up all the time in medical biz.

            Consider this hypothetical: (as i mentioned elsewhere i watch too much tv and this is such a frequent plot advancer) what it the son was not so much concerned with saving the father’s soul as he was with getting the father’s estate and life insurance?

            As with the infamous death panels which, as we are so frequently assured by overwrought internet scrivenings, will involve murderous liberal medical personnel browbeating the elderly into eschewing simple life-saving treatment in order to preserve their money for their soon-to-be heirs.

        • JWReader

          I didn’t say the son had the right to decide anything for his alert and oriented father. From his point of view, he was trying to protect what he believed to be his father’s wishes. The reason for his vigilance is simple: too many people have opinions about what sort of care people should receive. Nurses and doctors may also not be informed that the Supreme Court has ruled on the matter regarding self-determination. My own mother-in-law was harassed by a nurse who wanted to force a blood transfusion on her. So there was a good reason why the son acted the way he did.

          That said, since the father was being disingenuous with his son, the son had no legal leg to stand on. He was just acting in what he believed to be his father’s best wishes.

  • Dave Miller

    I can’t help but notice that no one has suggested that, rather than lying to the son (which I suggest ALWAYS is unethical for a physician – if you lie about one thing, how can the patient or their family trust that won’t lie about something else?), the doc could have (I argue, ought to have) simply told the son that his father’s wishes were followed, strictly and specifically. If the son pressed further, the doc could simply have suggested that the details of his father’s care are protected and he needs to talk to his father about this.

    Everyone seems worried about “harming” the relationship between the father and son in this case. However, their relationship is already damaged as evidenced by the fact that the father doesn’t feel safe enough to discuss his religious beliefs with his son. If the son became aware of his father receiving blood products, that just might be the catalyst needed to get them to finally open up and have a real conversation. It just might lead to a deepening of their relationship.

    Just my $.02 worth ($.05 CAD),

    DAVE

  • Drashish

    If I could have thought on my feet fast enough, I would have said “I’m sorry but because of hippa, I’m not allowed to discuss the details of the case but I can assure you wenhonored your fathers wishes”

    • Oda

      I think it would have been pretty obvious you were lying and he’d gotten a transfusion if you suddenly claimed HIPAA (two As, one P) when before you talked about the same subject without that prohibition.

      I’d say you did the right thing. You followed your patients wishes. That’s the one to whom you have a duty. End of story.

  • Muddy Waters

    Dr. Baum illustrates the dangers of physician blogging. The details of this case and the treating physician make it pretty easy to identify the patient if an invested individual were to come across this site. Doctors need to be careful about divulging too much information…

  • Jackie

    A young lady of Jehovah Witness has been visiting me every couple of months since 1993, merely three years after I had had a 23-hour surgery to resect a 4x5x6.5 cm Central Neurocytoma in the right Lateral Ventricle. Initially we discussed the blood transfusion thing quite a bit, and I was surprised one day to talk to one of the ladies who came with her. This lady is an OR nurse in a local hospital!

    They insisted that there are ways to help patients without giving ‘blood’ transfusion. I wondered if the taboo originated from the time when science was not advanced enough to distinguish blood types…

    I’ve had 5 more major surgeries since the young lady knocked on our door that spring 18 years ago. She’s still a dedicated Jehovah Witness. I’m still kicking… :)

    • JWReader

      The taboo originated when the Bible said to abstain from blood. No amount of medical advancement will make blood transfusions acceptable to us. That is why we are grateful that so many advances have been made in bloodless techniques.

  • conzag

    If the patient had not agreed to accept blood transfusions, I would have refused to operate, considering the risk too high, both to the patient as well as to the surgeon. Withholding of blood could well be considered malpractice, no matter any pre-op release signed. The acceptance of religious dictates are certainly the individual’s right, but so is the physician’s right of refusal.

  • Molly Ciliberti, RN

    Your first obligation was to your patient not his son and you did right by him. It really is none of the sons business what you did since it isn’t his life or choice. Thank you for not only giving the man the chance to speak to you in private, but also in honoring his wishes.

  • http://Buckheadinternalmedicine.com Nan monahan

    I agree with Dave Miller; once you start lying, you’re apt to get into trouble! As an internist, I am used to seeing complicated family relationships; I find it much easier to say less, and keep your pts confidence, and privacy—abroad use for HIPPA!

  • DrB

    It may not be a valid assumption that he was “required” to lie to the family due to HIPAA. The father may have listed the son as one who has access to his PHI (Protected Health Information). Under HIPAA, in that case, the doctor would be “legally entitled” to tell the son all the details, and not doing so would be deceptive. So lying to him at that point would just be honoring someone’s personal wishes, not withholding HIPAA protected information.

    The real issue here is purely ethical, in my understanding. I think in this unusual case, if other family members are designated by the patient as being allowed to hear/discuss HIPAA-protected information, and then the patient asks us to NOT do just that, then we are in a bind. Hindsight being 20/20, I think I would have asked the patient to revise his HIPAA documents immediately. That way, when asked, I could politely decline to answer.

    Another thought: It also would be important to spell out these wishes in an advanced directive, which could be kept private from the family. In the case noted, what if the father had done well for a few days, then tanked and was comatose in the ICU? If he needed more blood products later, the doctor knows his wishes are to give them, correct? However, in the absence of a clearly stated advanced directive, since he is in a coma, his family now has some say in the matter. What then?

    What this boils down to is a patient asking a physician to lie for him. He may not have been able to foresee how it played out, but going to all that trouble to cover up is above the call of HIPAA, to say the least. When a patient asks me not to tell someone a detail, I usually agree but would want to review their HIPAA documents to make sure that the same someone does not already have “legal” access to his/her records. I have no problem with refusing to answer questions or just referring a family member back to the patient for any answers.

    But I try to draw a line when it comes to lying, as another poster stated, since then it tarnishes my profession and my own ethical standards.

  • Molly Ciliberti, RN

    Remember your first obligation is to your patient. Can’t you see what a terrible situation he was in? I count this is the kind of lie that is permissible like lying to the Nazi’s hunting Jews and saying you haven’t seen any when in fact you are hiding Jews in your basement. A lie can sometimes be good.

    • Dave Miller

      With all due respect, Molly, this is not at all like the situation you noted. In that case, they were without ethical recourse and did whatever they had to do quell the tide of evil.

      You are exactly right in saying that our first obligation is to our patient. Once you start lying to your patients, you quickly get onto a slippery slope that causes multiple problems. First off, lies tend to multiply. You have to tell other lies to cover up the first lie, which can quickly get out of hand. Being the father of two toddlers, I would refer the astute reader to the excellent morality play, “Larry Boy and the Fib From Outer Space” as an example. :-D Of course, this plays out in the clinic as well. A lie makes informed consent difficult, if not impossible. Informed consent requires the doctor to tell the patient the truth. If there are details other parties wish to know but are not entitled to know, there is no reason to lie, simply politely suggest that they need to take it up with the patient.

      The other problem with lying to a patient (or their family and loved ones) is that suddenly everything you have said and will eventually say becomes suspect. Our patients need to know that we’re going to be able to tell them hard things, that we’re in this with them and willing to stay the course. Once we start lying, however well-intentioned we may be, we soil our credibility and damage the trust that is absolutely necessary to the therapeutic relationship. We are quitting on our patients simply because we find something about the truth to be distasteful or uncomfortable. My ethics are worth enough to withstand a bit of discomfort and my patients certainly deserve nothing less.

  • Molly Ciliberti, RN

    I disagree Dave. Both lies are to protect the person to whom you have an obligation to protect. Personally, I would rather have someone who would protect me from my chiildren spying on my business by telling a white lie. He wasn’t lying to his patient.

    • DrB

      Nope, not the same at all. You are right in that both lies protect a person, but the way they are protected is critically different. The first lie protects a person from certain death, (ie. the jew is protected from going to a nazi concentration camp.) The second lie (in our case study above) “protects” a man’s relationship with his son, (which ironically is already based on a lie) and has nothing to do with our sworn duty to protect his life.

  • gzuckier

    “The blood bank, on the other hand, violated HIPAA, by discussing the patient’s care in a non-emergent setting with other people.”

    It occurs to me that this is a rather glaring and frequent violation of HIPAA.

  • Molly Ciliberti, RN

    The lie protects his life with his son and all of us have told lies from time to time rather than hurting someone. I prefer never to lie, but life would be quite cruel if we all were so rigid as to never lie. Read Sylvia Bok “Lying: Moral Choice in Public and Private Life”, good food for thought.

  • Jackie

    Has anyone thought about how the medical professional organizations and universities/academics should try to educate the public about how to separate (or ‘incorporate’)science and religion?

    Several of my biology teachers are Christians, one even explained in class how there’s no conflict between the Bible and modern biology at all. The Bible (as well as any other religious texts) needs to be read in its historical/cultural context. God has endowed us with love and wisdom, which is the essence of any religion. Many tragedies in human history have been done in the so-called ‘God’s name’. It’s 2011! What a shame that there are still people using the Bible as excuse to justity their refusal of the vaccines and blood transfusion!

    [Although I do wonder if their 'objections' have helped push science forward and made everything safer.]

    • Dave Miller

      Jackie,

      That’s an excellent point. In my medical training, we spent a good deal of time on taking a “spiritual history” on our patients to ferret out just such issues. I believe this is becoming more common in many medical schools.

  • gloria p

    You did the right thing. A good friend’s brother (not a Witness) died after a car accident because his wife (a Witness) refused to let the doctors transfuse.

  • Lise

    One reader made a point that the father son relationship was damaged. I don’t think so what is the problem is the religion.
    Unless you have been raised in the religon it is hard to understand the dynamics of fear if found out that man who most likely have been disfellowshiped. Which means he would be shunned by all and no one would even look his way or talk to him.
    Even if he was forgiven months later and brought back into the fold he would always carry the stigma of having been formerly disfellowshipped and he would always be looked at as being weak in that religon and that takes a toll of people in that religon.
    .
    One of the issues that scared me most growing up in the JW religon was my parents letting me die if I was in an accident.
    Kids do die because they love their parents and want to do the “right thing” for their religon all in the name of love or they are too scared to speak up as was my case.

    I almost bleed to death from head trama as a young child. I I asked my parent if I was going to die. They said they did not know that I might.
    The doctor told my parent I almost lost all my blood and that it was a good thing they got me to the hospital so fast.
    Little did he know they waited a half hour before taking me they were worried they would give me blood. I never trusted my mother again.

    A year ago I had surgery and I knew they could give me blood it was so scary getting over the fear what had been drilled into my head for years. They did not need to give me blood but I’m glad I had the voice to make my own decsion and the courage to get over my fear of doctors.
    .My sister inlaw is still a practicing Jehovah witness and was grateful a doctor got a court order taking away her parental rights so that her baby could recieve blood and live. It is the only way around that Jehovah wittness rule. her father an “Elder” was grateful too. Many JW think like me but they are so affraid of getting disfellowshipped. My nephew is now 20 years old and doing well

    That father you read him right you did the right thing. A very moral decision, you did not lie to the patient but to a family who had their own “best Interests” at heart first do no harm that is what you did bravo!

  • Alceysia

    The man who chose to receive a blood transfusion was within his rights and the doctor was merely carrying out his patient’s wishes. This doctor didn’t owe an explanation to any member of his family. It’s unfortunate that this doctor felt compelled to lie to the family, but I firmly believe that he was doing whatever it took to carry out his patients’ wishes. This was his patient’s choice.
    While being one of Jehovah’s Witnesses for the past 32 years, I’ve had 2 very serious surgeries: a Pan-hysterectomy and a Cholecystectomy, both performed without Blood or Blood products. I went to a “Bloodless Hospital”, where a patient is required to sign a medical directive papers if they WANT to have a blood transfusion. That was my choice.
    (The cholecystectomy was an emergency surgery because I had just checked myself out of a ‘teaching hospital’, against doctor’s orders. The anesthesiologist had decided that he “knew what was best” for me and he ‘was going to give me a transfusion’, whether I wanted it or not. So, I went to a “bloodless” hospital, where my wishes were respected.)
    For this reason, we sign an Advance Medical Directive, with legally empowered agents who have Power of Attorney, to see to it that our wishes are carried out. We have taken this medical directive all of the way to the Supreme Court and we have been the right to decide for ourselves what type of health care procedures we will or will not submit to.
    Many doctors, nurses, surgeons and healthcare personnel have found that patients who don’t receive transfusions have had, (on the whole) faster recoveries, less post-op complications, and the patient feels that his/her doctor takes his/her beliefs and health care choices seriously. A doctor who does not use blood or blood products while treating a Witness patient who has a legally signed Advance Medical Directive, CANNOT be sued, even if the patient dies. This was the patient’s choice.
    God’s word, the Bible tells us ‘not to eat blood’.
    (Quoting King James Bible @Leviticus 7:27:
    “Whatsoever SOUL [it be] that eateth any manner of blood, even that SOUL shall be cut off from his people”.)
    We know doctors don’t hand a critically ill or injured person a bag of blood and tell them to ‘drink up’; the blood is administered via an IV tube. Well, when a patient is unable to ingest food or water as nutrition, they are fed through an IV tube. They are eating their food, as a patient receiving a transfusion would be eating the blood. The King James Bible also says@ Acts 15:20: “But that we write unto them, that they ABSTAIN from pollutions of idols, and [from] fornication, and [from] things strangled, and [from] blood.” If someone were an alcoholic and were told to “abstain from alcohol”, he couldn’t hook up an IV and transfuse himself with his favorite ‘drink’; this would not be “abstaining” from alcohol.
    When a patient submits his physical, mental and emotional self to the care of surgeons, anesthesiologists and others, for emergency care or surgery, he his entrusting his health, his potential quality of life, his entire person to health care professionals, under the promise that they will “do no harm”. We dedicate ourselves to Jehovah God under the promise that we will obey all of His laws, including the mandate against “eating blood”. This is our choice.
    We know that persons within the medical profession believe they know what’s best for this ‘patient’, in the long run. Some are convinced that the only thing of importance is stabilizing this patient.
    For doctors to avoid “needing to give blood transfusions”, they will have to prevent excessive blood loss, close off all blood vessels properly, using blood substitutes, cell-saving techniques or building up the patient’s ability to manufacture red blood cells. This is the patient’s right. Period.

  • conzag

    Alceycia–
    You are certainly allowed to quote bible selectively (what no stoning for blaspheming or non-observance of the sabbath?), but please refrain fro giving surgeons advice on avoiding blood loss. There are many situations requiring blood transfusion to prevent death, and to do less would be malpractice.

    • JWReader

      Given that the matter of bloodless medicine and alternative treatments to blood transfusions is so paramount to our faith, Jehovah’s Witnesses are actually well-educated about these techniques. To ask him/her to refrain from offering advice on avoiding blood loss is being pompous and arrogant. After all, you don’t know if Alceycia is a surgeon or not!

      As a side note (but because you asked as indicated by the question mark), we don’t quote the Bible selectively. The reason we don’t stone for blasphemy or non-observance of the sabbath is because the Bible explicitly states that such practices are no longer necessary since the Law given to Moses is invalid. However, the prohibition on eating blood was given to the first-century Christians apart from the old Law and so it is still in force.

  • Oda

    Everyone is focusing on the statement made to the son but if I read the post correctly, the patient also didn’t want to know himself. How can you respect that decision if you don’t also keep if from his family? Reading D. Miller’s comments, all I can think of is the old saying “God, save me from your zealots.” I think the doctor-writer went above and beyond in this case. He can doctor on me any day.

    • Dave Miller

      Oda,

      It’s interesting that you automatically assumed I was motivated by religious zealotry. In fact, there seems to be a lot of “religion bashing” in this thread. A bit disappointing, IMHO, for such a topic as this. Be that as it may, “truth-telling” is considered to be one of the core tenets of medical ethics. Physicians are expected to tell the truth, even when it’s not convenient. Patients come to them in vulnerable positions. For a physician to tell less than the truth is to violate the trust implicit in and critical to the therapeutic relationship.

      Once a physician starts telling “white lies” (however well-intentioned they may be) they are compromising their integrity. If a doctor is willing to lie about one thing, will they not lie about another? As a patient (or a family-member or a colleague) how can you know when a doctor is telling the truth or lying once the pattern is established? Would *you* like to be in the position of having to guess when *your* physician is telling *you* the truth or not? Hence, the best approach is for the physician to simply tell the truth.

      • http://warmsocks.wordpress.com/ WarmSocks

        Dr. Miller, oh so true. My response to your comment got rather lengthy, so it’s here: http://warmsocks.wordpress.com/2011/05/19/truth-telling/

        • Dave Miller

          Very nice post that hits the nail squarely on the head.

          Just to clarify on my end, I’m not quite a doctor yet (just starting 3rd year).

  • Julie

    al·tru·ism (al′tro̵̅o̅ iz′əm)
    noun
    1. unselfish concern for the welfare of others; selflessness
    2.Ethics the doctrine that the general welfare of society is the proper goal of an individual’s actions

    This physician did the right thing by respecting the wishes of his patient. He did not want to “lie”, but his behaviors were altruistic and benefited everyone involved. If he had claimed HIPAA there always would have been doubt as to whether or not blood products were received which WOULD have resulted in psychological harm to the patient. And yes, the person from the blood bank should have been in big trouble for violating confidentiality!

  • Dave Miller

    “Honesty is a core professional obligation and lying, even for a patient, is a breach of that obligation,” J. Fred Ralston Jr., MD, FACP, president of the American College of Physicians

  • Julie

    There are always exceptions to every rule in the real world and sometimes we have to use higher thought processes and higher “moral reasoning” as the author stated when presented with an unusual situation. I certainly wouldn’t want someone as uncompassionate and inflexible as you (as you are representing yourself to be by your responses) to be my physician. Part of being an innately good practitioner is being able to intuitively make judgment calls on the spot in tough situations. Telling this patient’s son or claiming HIPAA would have likely caused psychological harm to the patient and family. To look at all situations as black or white or to say “always/never this rule will apply no matter what” implies primitive thinking/child-like views. Do yourself and those around you a favor and start appreciating the shades of gray that are bound to come your way in life.

  • Jackie

    I wondered how many similar stories like this one has helped reinforce the belief of JWs that ‘there are ways to conduct surgery without blood transfusion’. It reminded me of the dialog in ‘A few good men’ where Jack Nicholson yelled “You can’t handle the truth!” when Tom Cruise was insisting on knowing the truth.

    Jesus sacrificed himself to show the world that only ‘love’ can save us, not Pharisee’s doctrines, not Moses Law… Paul had tried to reason with the followers about the ‘forbidden’ food… To paraphrase the teaching of Jesus: “It’s not what goes into one’s ‘mouth’ that makes one unclean, but what comes out of it.” (In this case, it’s not what goes into one’s blood vessels that makes one unclean…]

    What’s the difference between ‘witch-burning’ and killing by withholding blood transfusion? Personally I can’t see any difference, But as a two time brain tumor survivor and two time breast cancer survivor, I tremble at the thought of having a doctor who would sacrifice my life to satisfy others’ ‘wishes’.

  • Molly Ciliberti, RN

    Never is a word we should use sparingly. Rigidity isn’t a virtue. The willow bends and survives another day. I would not want Dr. Ralston as my physician; he is too rigid and that makes me wonder hasn’t he ever been in a situation where there is no clear choice? My obligation as a nurse is to care for my patient to the best of my ability whatever that takes.

  • Elizabeth

    Perhaps one of the Jehovah’s Witnesses can answer this question for me: I work in Day Surgery, and recently had a
    patient who was waiting to have her procedure. I had started an IV and she had a Heparin Lock in her right arm. A few minutes later she called me over to ask: ‘is that blood in that tube?’ (it was her blood in the Heparin Lock. We usually draw back when inserting an IV to ensure that the angiocath is in the vein, then flush the tubing with normal saline) When I told her it was her blood, she absolutely refused to keep the lock in. I tried to make her understand that it was her blood, to no avail. I had to change the Heparin Lock, all the while hoping that I would compromise the IV while doing this. Now, I understand about the tenet, refusing blood and blood products, but is this also a legitimate request? By the way, I applaud the surgeon. He did what his patient wanted, and tried to protect his patient and his patients relationship with his family and his religion.
    It’s a shame that a doctor who is genuine and does his very best in his patients interest, is forced to stretch the truth in carrying out that best interest.

    • JWReader

      The only hard-and-fast rule we follow on this issue is to abstain from blood, like the Bible says. Now, how that gets applied by each individual’s conscience is where this gets tricks. For example, clearly taking in blood from someone else (in any form) or taking in one’s own pre-stored blood would NOT be abstaining from blood.

      In the situation you described, most Jehovah’s Witnesses would not have objected; IV tubes and blood-filtering machines are typically seen as extensions of the circulatory system, kidneys, etc. However, ADDING blood of any kind would violate all of our consciences.

      The idea to remember in dealing with Jehovah’s Witnesses – and really ANY patient – is to respect their individual conscience. After all, the Supreme Court has secured the right of everyone to control what sort of treatment they will accept – for any reason. If doctors work hard to just respect their patients’ feelings (remembering that medical practice is also a service business) then they will truly do no harm.

  • Elizabeth

    ADDENDUM: I mean’t the above to read that I “wouldn’t” compromise the IV….sorry