When obtaining informed consent from a Jehovah’s Witness for treatments involving blood products, incongruent, inconsistent and uninformed behavior may be observed. This article provides background on why this population may refuse treatment and suggests ways to approach the patient that will optimize outcomes. A licensed psychotherapist and former Jehovah’s Witness weighs in on beliefs, inner turmoil and outside pressures experienced by those refusing blood treatment.
Caring for a Jehovah’s Witness patient, who refuses to allow a blood transfusion presents ethical challenges for medical professionals. However, understanding the refusal of treatment from the patient’s point of view can provide a window of opportunity to reach those who initially refuse treatment.
You may meet a patient who outwardly appears to stubbornly refuse blood products at all costs. But in all likelihood, the person is experiencing a values conflict (conscious or unconscious), which causes considerable emotional turmoil.
Background and Beliefs
The Jehovah’s Witness parent organization, called Watchtower or JW.org, propagates material citing Bible verses to justify their policy that sacredness of blood should influence medical treatment. At the same time, the organization controls members’ access to medical facts, including benefits of blood transfusion therapy and limitations of alternatives. The organization’s policies on blood products shift from time to time. Remarkably, many Jehovah’s Witnesses are oblivious to recent policy shifts that allow administration of 100% of blood in fractionated form, and without spiritual consequence.
It can be safely assumed that any Jehovah’s Witness (JW) patient, who refuses to accept a blood transfusion, has been subjected to a steady routine of calculated indoctrination over a period of years. Most born-and-raised members have assimilated these beliefs, policies and expectations as the organizing principles of their lives.
If a physician’s dominant organizing principle is to preserve life and minimize suffering, a JW devotee’s dominant organizing life principle is strict obedience to God and His organization (JW.org), which demands loyalty, even to the death. Considerable thought-control has been imposed to arrive at this position.
Declining blood, and martyring themselves, they are taught, assures God’s favor and blessing. JWs believe that even if they die, they are stay alive in God’s memory and will be resurrected to life on a paradise earth soon after the impending holocaust they call Armageddon.
JWs experience information control through isolation from alternate, balancing perspectives. They are dissuaded from associating with non-believers, or viewing material that may contradict JW dogma. Because their friendships and family are limited to those who are practicing JWs, defying this authority could result in a complete loss of their social support network, becoming disapproved, and ultimately being shunned.1
They know that if their church becomes aware they accepted a blood transfusion (usually due to posting “support persons” on location at the hospital), they will either experience a physical death by refusing life-saving treatment or a social death if they accept it. Threats of condemnation, expulsion from their church, shunning and public shame are a certainty if JWs defy expectations for their behaviors and choices.
Due to this pervasive control, and since their identity, worldview and spiritual hopes are woven into all the repetitive indoctrination, any contradictory information that causes discomfort and anxiety may be dismissed from their mind and blocked out. Facts may not be considered due to fear and strict black and white thinking. Many will automatically label what the doctor tells them as misguided, ignorant of Biblical principles, and a temptation from The Devil to abandon their obedience to Jehovah God and His chosen organization.
JW patients may be difficult to connect with in a conversation, appearing resigned to their “fate.” They may be reluctant to discuss options, feeling it is useless to even try and explain to ‘outsiders’ what will happen to them if they disobey their God and accept the blood treatment.
JW patients are caught in a terrible bind. If they refuse the life-saving treatment offered, they will likely die. If they flout their beliefs and accept the blood transfusion, they will be shamed and shunned by most, if not all, their friends and family. They risk their relationship with Jehovah God and believe that abandoning their beliefs will lead to everlasting destruction. As well, these patients have already sacrificed a normal life to be a member of a strict, high-control group. All this investment makes it much more difficult to abandon beliefs.
At this point, the JW patient is in the middle of a full-blown existential crisis. Most join and remain in the organization to avoid the angst related to normal human fears and insecurities. Belonging to a group that provides all the answers and offers immortality, they may not feel able to make their life meaningful through their own choices and efforts.
Now, in spite of efforts to hide and protect themselves from having to deal with ultimate concerns of human existence, if they want to prolong their life now, they will have to go against one of their acquired beliefs about how to ensure eternal life.
They cope with this while feeling physically weak and emotionally distraught, and may have difficulty thinking rationally. It is much easier to rely on programmed beliefs and well-rehearsed rationale, rather than facing inner chaos.
Some conflicted JWs may be secretly relieved if they are given a life-saving blood transfusion before the hospital discovers their “no-blood card”. This is a card kept in their wallet as an advance medical directive.2 Since there is disparity in the commitment each individual
JW.org has instituted a policy of sending a 3-elder Hospital Liaison Committee to the hospital when a JW is in medical crisis. JWs who don’t notify their local elders about anticipated or actual medical emergencies for themselves, or other believers, are viewed as spiritually negligent. This committee’s presence and prayers serve to remind the patient of what will happen if they are disobedient. Any patient or family of an unconscious JW will surely feel they are being torn between competing information from the medical community and the JW dogma.
While there are no quick fixes to this dilemma, there are resources such as Advocates for JW’s Reform on Blood (AJWRB.org), tasked with supplying up-to-date references, informational tools and studies online as a life-saving counterpoint to JW doctrines on blood refusal.
Breaking through manipulative mind-control takes time and the ability to reason, reflect and entertain new information; most medical emergencies do not afford the luxury of time, and there is minimal ability to learn something new in a high-stakes situation.
Considerations in Obtaining Informed Consent
The physician’s efforts at this point to provide life-saving information, which outweighs primitive beliefs, may fall on deaf ears. Physicians can only hope that repeated explanations of the risks of refusal to treat may pierce through the religious programming and dread of ensuing punishments. In this case, remember that you are not offering life-saving information and interventions to a typical patient with an open, reasonable mind. You are working urgently to convince people under the effects of mind-control of the seriousness of their situation.
Higher order thinking (analysis, evaluation, organization, synthesis, complex reasoning, critical thinking, problem-solving, applying concepts to novel situations, etc.) may not yet be developed or permitted in people conditioned to receive information from a single source and who unquestioningly obey. JWs may be baptized in youth and held to the same standards as adults prior to any capacity for critical thinking. Moreover, JW culture actively discourages higher learning; the majority of JWs do not have education beyond high school (considered a needless use of resources that can be redirected to volunteering for the organization).
Nevertheless, there are individual differences in the way JWs have absorbed the beliefs of their church. Like cars in separate traffic lanes, the pace of the extremism does vary by individual in the organization. It is to be hoped that there are already doubts in place that may be accessed when a person’s life is threatened.
JW.org frequently changes the guidelines for what blood products and derivatives are allowed and not allowed. So, the patient may not have a clear understanding of what they are accepting or rejecting, and the lack of good alternatives. They may overestimate the effectiveness of blood transfusion alternatives, or lack clarity on logistical and spiritual permissibility of advance donation of their own blood, or blood fractions. There may be earnest or paternalistic clouding of this information by the JW Hospital Liaison Committee (HLC).
All one can do is present the case for life-saving care and hope that some measure of reason prevails. Most hospitals have policies and procedures in place to advocate legally for children under the control of this undue influence.
Regardless of whether the JW patient maintains their refusal or accepts a blood transfusion, the patient will suffer considerable emotional pain. They will ultimately need to debrief with a professional. This must take place out of earshot of the controlling HLC or other visiting JWs – tasked with ensuring compliance and reporting variances. Talking (if they are able) will allow them to benefit from the cognitive reorganization that takes place when one can tell their story of crisis and inner conflict.
A medical professional who cares for a patient who expires due to their refusal of blood, should be offered therapeutic support or counseling.
Efforts to engage JWs in productive informed consent conversations (several may be required) is worthwhile. The more the JW patient knows their options, the more likely they are to exercise them, or at least find some peace in their decision-making process.
Bonnie Zieman, M.Ed.
Licensed Psychotherapist (retired)
Board Member of Open Minds Foundation
Exiting the JW Cult: A Healing Handbook
Cracking the Cult Code for Therapists
Shunned: A Survival Guide
1. Kerry Louderback-Wood, Journal of Church and State. http://ajwrb.org/jehovahs-witnesses-blood-transfusions-and-the-tort-of-misreprersentation
2. These “no blood” cards are often signed during group meetings where it is not difficult to imagine that some sign under “duress”, especially as they know their cards will probably be inspected by JW elders at the meeting.