Jehovah’s Witnesses and BLOOD

We are a group of Jehovah's Witnesses who sincerely believe that the decision to refuse or accept blood transfusions is a purely personal matter which should be decided individually based on our own conscience rather than the mandate coming from our organization, the Watch Tower Society (WTS). We believe that the Bible, which is the ultimate guide of our Christian life, does not forbid the medical use of blood. We also believe that the current policy of banning certain blood transfusions, as enforced by the WTS, is plagued with in-consistencies and contradictions with no Scriptural support. We are appealing to the organization to reform this outdated policy in view of rapidly changing medical technology. At the same time, we are asking the medical community to support our effort.

We are fully aware of the potential risks involved in blood transfusions, and we request that bloodless treatment and alternatives to blood transfusions be used whenever such treatments are available without undue risk. However, when there are no such alternatives, such as when we have massive and uncontrollable hemorrhage, and bleeding to death appears inevitable, we believe physicians should be permitted to make every effort to stabilize our condition, including the use of blood transfusions.

When you encounter a Jehovah's Witness patient the next time, please remember he or she might agree to accept blood transfusions despite their status as an active Jehovah's Witness. If you have established a belief that every Jehovah's Witness patient will universally refuse blood transfusions, it is time to reconsider this notion. Please investigate the individual JW patient's understanding of the WTS blood policy, including components they may not be aware that the WTS now permits, as well as the risk versus benefit analysis of blood transfusions, and the degree of commitment. We request that the refusal of blood transfusion be determined in each case only after such a thorough and private conference with the Jehovah's Witness patient.

Please consider this approach . . .

Although most Jehovah's Witnesses are still unaware of our group, many Jehovah's Witnesses are joining us when they are informed of the inherent problems of the current blood ban. Still, many Jehovah's Witnesses may say they adamantly refuse blood transfusions, but a primary reason for this refusal is because it is the policy of the WTS, not because it is his or her personal decision based on a full understanding of the doctrine and the risks and benefits of the particular treatment. Other Jehovah's Witnesses may refuse blood transfusions because of the peer pressure from fellow Jehovah's Witnesses, even if they may personally disagree with this policy.

The next time you see a Jehovah's Witness patient who refuses blood, please share with them the brochure, "Do Jehovah's Witnesses Really Abstain from Blood?" and discuss the activity of our group. Please discuss the many contradictions and inconsistencies of the doctrine. Such private discussions have brought some Jehovah's Witness patients to the realization that the policy is wrong, but at the very least it will provide them with the in-formation necessary to make a truly autonomous decision.

We believe the following questions will be helpful in getting the Witness patient to stop and think about their position:

• "Could you, as a Jehovah's Witness, please explain to me which blood therapies you can accept, which you cannot, and why the difference?"
• "I am especially interested in knowing where the Bible explains which parts of the blood you may or may not accept." [Omit this sentence if you are uncomfortable with it but understand that it will cause the patient to seriously reflect on why they are supporting these mandates from the WTS]
• "Please do not give me a publication that I'm too busy to read, or ask me to speak with an elder from your congregation. It’s important that I understand what you are thinking and why you are prepared to die over this issue."

It is also important for the physician to understand that the average Witness patient has been taught many misconceptions regarding the use of blood. We encourage you to emphasize the following points:

1. Blood therapies are not necessarily bad medicine. The risk/benefit ratio is usually very low, especially in trauma situations.
2. The chance of contracting AIDS is much lower than Jehovah's Witnesses are led to believe. About 1 in 676,000 in the U.S, much less than the chance of a fatal accident in the ambulance enroute to a hospital.
3. In some situations there are no alternatives to medically necessary blood transfusions other than to die.
4. The Watchtower Society has a long history of doctrinal reversals about what God requires of its members regarding medical care. The WTS previously prohibited vaccinations from 1929–1952. Organ transplants were banned from 1967–1980 under threat of judicial sanction and excommunication by the organization, as well as for accepting many of the blood components that are now considered acceptable by the WTS.

Please consider the potential legal problems . . .

If the Witness patient is unable to explain the rationale underlying the Watchtower Society’s stance on the use of blood components, then to what extent can it be said that their decisions relating to the matter are taken freely and rationally? If their behavior amounts to complying with instructions, which they do not fully comprehend, is their decision truly autonomous? Does the refusal of blood by the Witness patient have all the necessary elements of informed consent, particularly, voluntariness and unbiased understanding? How might this affect the liability of medical staff either complying with or overriding a patient's instructions? The mat-ter is surely worth raising within the context of medical ethics and law.

It should be noted that thousands of Jehovah’s Witnesses have elected premature death in order to support this policy. At the same time, it is well established that membership in the Jehovah's Witness faith is very transitory with many members being inactive or leaving the religion each year. Each of those members have various degrees of commitment and under-standing of the blood policy. It seems prudent to consider how a family upon leaving the religion might view a medical professional who failed to make a reasonable effort to try and establish the necessary elements of informed consent.

Physicians and hospitals concerned about the potential medico-legal consequences of deaths due to misunderstandings about transfusions can limit their liability by making a diligent effort to establish the existence of a more com-prehensive informed refusal of blood than has been previously obtained. In this regard, serious consideration should be given to use of a form like: "Informed Consent and Statement of Understanding regarding Blood Transfusion Therapy." This form is available from the Associated Jehovah's Witnesses for Reform on Blood, as is a brochure designed for use with Witness patients.

It is recommended that Witness patients be assured that if they decide to proceed with the use of a blood therapy that is currently prohibited by the WTS, strict confidentiality will be maintained. That access to the patient will be limited so that other Witnesses and WTS repre-sentatives (H.L.C. or Hospital Liaison Committee members) will not be able to learn that they have disobeyed WTS instructions. This is essential since the WTS’s policy is to impose “enforced shunning” upon any member who conscientiously chooses medical therapies they have not approved. This results in a complete cutting off of the member from the WTS and isolation from Witness family members and friends.

Frequently Asked Questions

Q: Who are you?
A: We are the Associated Jehovah's Witnesses for Reform on Blood (AJWRB), a group of dissident Jehovah's Witnesses who petition for a reform in the WTS's current policy banning certain types of blood transfusions. Because of the necessity of strict confidentiality (see below), our group is organized mainly on the Internet. Currently we are in over 25 countries, including Australia, Bolivia, Brazil, Canada, Chile, Columbia, Costa Rica, El Salvador, England, Finland, Germany, Guatemala, Honduras, Italy, Mexico, Netherlands, Paraguay, Peru, Sweden, Portugal, Russia, Spain and the U.S.A.  Our members include congregation elders, former overseers and members of the Hospital Liaison Committee, (a specialized group of elders who mediate between physicians and Jehovah's Witness patients) and other interested persons, family members and physicians.

Q: Why do you propose a reform of the blood policy?
A: We believe informed consent or refusal of any medical treatment should be based on personal decision after consideration of risks, benefits and, in our case, religious consideration. The Bible mentions that we should not eat blood under certain conditions, but nowhere in the Bible are blood transfusions prohibited for the purpose of saving human life and treating disease. Moreover, the policy has numerous contradictory rules that have no biblical basis. For example, we believe it is absurd to refuse plasma while accepting every component of plasma as long as they are taken separately.

The WTS has recently shown a public posture that each Jehovah's Witness patient has a freedom to choose their medical treatment without sanctions from the organization. The reality is that the WTS continues to threaten the penalty of expulsion and ostracism of any Jehovah's Witnesses who conscientiously make a decision to receive blood transfusions, and thereafter do not confess repentance of their actions. We believe deeply that such religious sanctions are wholly unjustified and are imposed to coerce every Jehovah's Witness to refuse blood, even at the cost of their lives. We believe that the WTS should allow all Jehovah's Witnesses to decide what medical treatment they may accept or refuse based on their Bible-trained conscience and that none of us should be punished because of such a personal decision.

Q: Why are you anonymous?
A: It is the policy of the WTS that any member who questions the organization has betrayed God and should be expelled from our religion and ostracized by our community. Since our purpose is to influence reform of this ill-fated doctrine as members from within the organization, we are forced to remain anonymous.

Q: How can I support your reform movement?
A: We believe that many Jehovah's Witnesses can be helped to critically examine this policy in life-and-death situations where blood transfu-sions could make a crucial difference in their health. In that sense, physicians are in the best position to assist them. We would appreciate your discussing the problems of the WTS partial blood ban with each patient, and allowing him or her the opportunity of considering the position of AJWRB. We would also greatly appreciate it if you would contact the headquarters of our organization, the WTS, and urge them to consider the reform of this policy by pointing out the many contradictions. The address of the WTS is as follows.

The Governing Body of Jehovah’s Witnesses
Watch Tower Bible and Tract Society
25 Columbia Heights
Brooklyn, NY 11201

Thank you very much for your attention and support.

References

Elder L. Why some Jehovah’s Witnesses accept blood and conscientiously reject the official Watchtower Society Blood Policy.
J Med Ethics 2000;26:275-380.

Muramoto O. Recent developments in medical care of Jehovah's Witnesses. West J Med 1999;170:297-301.

Muramoto O. Bioethics of the Refusal of Blood by Jehovah's Witnesses: Part 1. Should bioethical deliberation consider dissidents' views? J Med Ethics 1998;24:223-230.

Muramoto O. Bioethics of the Refusal of Blood by Jehovah's Witnesses: Part 2. A novel approach based on rational non-interventional paternalism. J Med Ethics 1998;24:295-301.

Migden DR, Braen GR. The Jehovah's Witness blood refusal card: ethical and medicolegal considerations for emergency physicians. Acad Emerg Med 1998; 5:815-824.

Doyle JD. Informed Consent and "Reform" Jehovah's Witness Patients. Anesthesiology 1998;89:537
 

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