Diana EscobarAzusa Pacific University

Current restriction over blood transfusion is based on the church’s belief that blood serves as a body nutrient, & that life is contained within blood ◦ Genesis 9:4 “But you shall not eat flesh with its life, that is, its

blood.”◦ Acts 15:29 “You must abstain from eating food offered to idols,

from consuming blood or the meat of strangled animals, and from sexual immorality. If you do this, you will do well. Farewell”

◦ Leviticus 17:10 “And if any native Israelite or foreigner living among you eats or drinks blood in any form, I will turn against that person and cut him off from the community of your people.”

◦ Awake!, August 2006 p. 11, "He also gave them his reason, equating blood with the soul, or life, of the creature. He later said: 'The soul [or life] is in the blood.' In the eyes of the Creator, blood is sacred. It represents the precious gift of life that each living soul possesses.”

(West, 2014, p.170-171)

In 2000 JW administration officially changed the consequences of receiving blood transfusions, members would not be automatically disfellowshipped, but the choice of transfusion would result in voluntary disfellowship (West, 2014)

Current legislature upholds the decision to refuse treatment of a rational JW adult, who has been informed of the consequences & treatment options, and mandates that alternative treatment be explored (Effa-Heap, 2009).

In cases where a patient is under 18yrs parents/legal guardians make treatment decisions◦ Patients older than 16yrs who desire autonomy over their

care can bring the case before an ethics committee/court (Hivey et al., 2009).

1999,‘No Blood’ cards developed◦ Signed advanced directives, power of attorney used to ensure

refusal of transfusion (Effa-Heap, 2009).

JW Caucasian male admitted to ED in 1990

He was in hypovolemic shock & undated but signed “No Blood”

card was found in his wallet. Attending physician proceeded

with transfusion despite card, claiming clinical duty to save

life. Patient’s daughter arrived and

requested the discontinuation of the transfusion

Physician refused & was eventually prosecuted and

convicted of battery.(Panico et al., 2011)

Nursing Implications:◦ Respect for Patient Autonomy◦ Be informed: Patient Rights, Current Judicial

Hospital Policy, JW doctrine, & treatment options◦ Patient Education ◦ Patient Advocacy: Communication Medium◦ Identify and Report Coercion◦ Provide psychosocial & spiritual resources & support◦ Support, encourage, & care for patient◦ Protect Patient Privacy◦ Nonjudgmental care

My Position: JW bloodless beliefsshould be respected◦ Respect Patient Autonomy

When a patient is deemed rational/mature◦ Religious liberty

Given there is no coercion ◦ Justice

JW patients leading focus of research in bloodless treatment Future Research Options:

◦ Clearer definition of treatment rights for minors & pregnant women

◦ Expansion of Education & treatment option availability in hospitals

Effa-Heap, G. (2009). Blood transfusion: implications of treating a Jehovah’s Witness patient. British Journal of Nursing, 18 (3), 174-177.

Hivey, S., Garside, J.P., & Wolf, A.R. (2009). Pro-con debate: religious

practice, blood transfusion, and major medical procedures. Pediatric Anesthesia, 19, 934-946. doi:10.1111/j.1460-9592.2009.03139.x

Knapp van Bogaert, D. & Ogunbanjo, G.A. (2013). Ethics and medicine: Jehovah’s Witnesses and the new blood transfusion rules. South African Family Practice, 55(1), S6-S9.

Panico, M., Jenq, G.Y., & Brewster, U.C. (2011). When a patient refuses life-saving care: issues raised when treating Jehovah’s Witnesses. American Journal of Kidney Disease, 58(4), 647-653.

West, J.J.M. (2014). Ethical issues in the care of Jehovah’s Witnesses. Current Opinion in Anesthesiology, 27(2), 170-176.

Wong, D.S.Y. (2012). Blood transfusion and Jehovah’s Witnesses revisited: implications for surgeons. Surgical Practice, 16, 128-132. doi:10.1111/j.1744-1633.2012.00612.x