I was banging my head on the wall by the end of the day sorting this problem out! The most frustrating thing was the relatives could not understand its importance to us and that we need to see the medical directive as the patient was unconsious! There as also been an article on a website asking us to think about are J.W patients who die due to not reciving blood is this some form of suicide? I am not quite sure about that but it does make you think. I work very closely with the J.W's and respect there religon, but it seems such a waste of a life when alot of these patient could be saved if only they had blood. I just can't get my head round it!!!

Dear haywoodm,

I for one appreciate what you went through with this single patient.

Your comment about the JW's and suicide show you have some disconnect with this population. I caution you about believing things you read on the Internet. For some reason there is much disinformation concerning them.

I have a question and observation - Did you or anyone else contact the local branch of Jehovah's Witnesses concerning this case? They have special committees called Hospital Liaison Committees for Jehovah's Witnesses. They are set up to give guidance on issues such as you have described.

As you noticed from the responses here at NoBlood the decision pathway was very well defined. In my opinion the situation you faced is due to your hospitals lack of understanding and lack of preparation. For example, I work at a hospital that has seen fit to contact the local Jehovah's Witness leadership, Hospital Liaison Committee for help in understanding the needs of this fast growing population. Our comments here about the JW Advance Directive etc. isn't really on topic with your dilemma. You yourself said you work closely with Jehovah's Witnesses yet you didn't know how to handle what to us was a simple situation. You also said you worked all day with this issue and were frustrated. This seems to indicate that your hospital has not take the initiative to explore what resources were and are at your disposal. You must encourage your hospital administrators to take responsibility in this matter and work out some arrangement to provide care that accommodates this special population.

I notice another post by you where you say you would like to come to the States to learn more. Good. However you have resources down the block that should be explored first.

Keep up the good work.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

I did ring the hospital liaison committee and they did come to the hospital and help me with this case. I do work closely with J.W but have only been in post since May and had never been in this situation! I am getting in touch with St James hospital and hope they can help, but it still seems the UK is a bit behind America. Intra-op Cell Salvage only started in our trust in January 2005, so I still have a lot to learn it would seem!!

Good show! Keep up the good work. Feel free to contact me directly any time.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

It is appreciated when the medical field cooperates with the stand that Jehovah's Witnesses take. This may help. It's called integrity to God and Scripture.

I appreciate your frustration. But at moments like this you have to pull back and realize that the Jehovahs Witness community is well educated about thier personal responsibility to fill our thier DPA and have it readily accessible. If one chooses not to fill it out and have it accessible, than they may have to face the consequences of that action. It is very unfortunate when someone has to pay with thier life..I agree. But it is not something that you should hold yourself personally responsible for...

I agree with Amelia and also understand your frustration. Try to remember that "informed consent" is exactly that, an "informed consent". We inform the patient of the options available to them and then they get to choose. There are many times when patients make a choice about something that is not the same choice that the medical profession would make. If we were making the decision for them then it would not be informed consent. I have to tell myself that on a daily basis and then act accordingly. As medical professionals, we are always taking care of patients with various cultures, ethnic groups, educational background, etc., and everyone has a different idea about how they should be treated. People refuse all kinds of treatments and blood transfusions should not be looked at any differently.
Sometimes in a trauma situation we give patients blood and they still die so we have to remember that blood is not a guarantee that the patient will live.
We give our patents the highest quality care with the choices that they make. We are only responsible for giving them the choices. We are not responsible for the outcomes. That always makes me feel better.

__________________
Elora Thorpe RN BSN
Coordinator
Blood Conservation Program
St. Luke's Hospital of Kansas City
Kansas City, MO. 64111
816-932-6183

Great points dear Nurses!

These two posts should be coupled with previous comments about the hospital assuming responsibility to become informed on how to handle subgroups whether cultural or religious.

Unfortunately I can't claim to be a nurse. However, as a program administrator I have learned a great deal from my nurse colleagues.

I remember a talk by an ICU Nurse Manager in California. She said a native American came to their facility gravely ill. The family called in the tribal practitioner. In their culture they believed that it was necessary to build a fire in a wigwam and have the ill person breath vapors from various leaves placed on the fire. In their culture this was necessary to facilitate healing. What did the nurses do? Along with the tribal practitioner they build a makeshift wigwam and used Sterno in the place of wood. The practitioner put strips of leaves on the fire. Security stood by during the ceremony along with the nurses.

This story made a very powerful impression on me and underscores the need to work with the patients personal choices and beliefs. From this and other nurses I learned that; Ours is not to dictate - ours is to facilitate (whenever possible). Imagine the nurses standing by the bedside trying to talk this patient out of their closely cherished belief and then saying eat your jello it will help you heal and here take this Tylenol.

In the end it is up to the adult patient to decide and up to us to provide.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

From a Legal standpoint doctors and hospitals can provide treatment to an unconscious patient based on what the courts have backed as implied consent. It is assumed that if you are unconscious and in peril you would want to receive needed treatments. This is an assumption of a choice that would more than likely agree with patient wishes, were they able to voice those choices. Once this assumption, for whatever the reason is disputed, implied consent is no longer a basis for treatment. This can happen by anyone informing the hospital staff that the patient is one of Jehovah's Witnesses. This happens all the time when patient families inform hospital staff that a patients wishes are not to have life prolonged in a vegetative state, through personal conversation and no written declaration. After being established as one of Jehovah's Witnesses. Doctors and Hospitals no longer have the legal right to use blood or blood products, despite the wishes of anyone else. This is still a sticky situation without a written declaration of what the patient would accept. It becomes the next of kin’s decision as to what the patient would except as far as fractions or other medical procedures. The family’s decisions, however, cannot go beyond what is established as patient wishes. For example an unbelieving spouse or child cannot direct a blood transfusion be given when it is established that the patient would refuse if able to do so. Of course Doctors may have a problem understanding the law in this regard. So it is best to get HLC involvement ASAP. The hospital attorney may be of assistance in this matter as well.

Hope you find my thoughts interesting,
Todd McLean

That is a good point. We don't have to 'take on' their choice... just support it.

__________________
Michelle Thomas, RNC