As one of JW's, I believe that whether it is an impartially completed directive or a fully completed directive, it doesn't make any difference. A JW becomes a JW with the full and express acknowledgement of his belief in the Biblical principles of absention of blood. It is the governing body of JWs who are in the position to promulgate our unified principle as to what is Biblically acceptable in perioperational procedures and operations.

It does appear that many are having difficulty completing the newest version of the Power of Attorney for Health Care. No doubt it is because the form itself slants towards one refusing all fractions and procedures, or refusing all but.........where some fill in what they think is acceptable to them. The tricky part is when individuals select choice 'C', where they may be willing to discuss choices. Often those who make this choice put in line 6 that they will accept all fractions or procedures that do not involve stored blood. In the last year or more that this form has been available, the fact that there is no line to indicate that a person 'accepts all' seems to be the problem, and in practice, that is usually how people feel, they either refuse all or accept all, knowing that modern technology may continue to expand the list of what is conscientiously acceptable to Jehovah's Witnesses. In my local congregation, I would guess about 30 % of those needing to update the form have completed the new one, and the rest either rely on the validity of the old form or will wait until a crisis arises in their healthcare before doing what they've been instructed to do. Sad but true, this new form has caused alot of concern and anxiety for those who obey the bibles command to abstain from blood. If these patients go to a facility that has a Blood Conservation Program, then their wishes can be expressed on the hospital Medical Directive/Release form, but this only works for them in the hospital setting. So whether the POA/DPA form is filled out completely, or only partial choices have been made, those of us who work in the field can help 'draw up' what the individuals choices really are. In the end, it's really up to congregation elders to encourgage compliance and assist publishers in accurately and completely filling out this new form.

A concern of mine with the most recent revision to the JW DPA is that if a patient goes to a hospital without a "bloodless" program I doubt the doctors and nurses would even be aware of what a "fraction" is. I have a masters degree in nursing and have never once heard the term in any school. In an emergency one is at the mercy of the staff's knowledge of terminology as applied by JWs. I suggest that my patients may want to shrink a copy of the release/treatment option checklist they complete in our hospital and keep it with their advance directive for clarification in an emergency outside our facility. This is particularly important if one chooses 'C' since we can't give them anything until their choices are clarified. (And some admit they choose 'C' because they just don't know enough to make a decision as to whether or not to accept certain fractions or procedures.) I agree that patients may feel more comfortable if there were a printed selection to "accept all," but that still would not reduce the confusion of providers - or patients - who are not familiar with what is acceptable or strictly forbidden to Witnesses. In that respect, the old four-page document was much more user friendly.

Thanks for your observations, thus far. Of course, most of the witnesses do not have a great degree of medical knowledge about blood 'fractions' and are duly concerned about the broader 'blood' issue. By the same token, most do not have any knowledge about breakthroughs in the medical field relating to the use of said 'fractions' . One such is the development, from hemoglobin, of the 'blood substitutes' polyheme, hemolink etc. It would no doubt be useful to have some explanatory information on this and related matters in easy-to-understand language. In that case completing medical directives, and revising them in the light of developments in the field, would possibly cause fewer problems. Not sure what can be done, or how?

I have found in talking to patients that come to the hospital without any DPA or POA for healthcare that one of the main reasons they have not completed the form is that they do not have a clear understanding of their own beliefs. Often times, and it seems to be predominantly with older ones, they decline or refuse all options because they fear making the wrong decision. For such ones, taking a fraction is like the drop of poison in a clear, cool glass of water. Their fear of displeasing God is greater than their desire to use the many alternatives that could be used to extend or preserve their physical life. Others just plead ignorance and want someone else to make their decisions, and none of us can do that. As the 'No Blood, Medicine Meets the Challenge' tape brings out, each individual needs to be a 'prudent consumer' when it comes to choosing alternatives, so those of us that are in the healthcare field and/or elders in the congregation need to work with those who do not understand, or choose not to look at the choices available, and try to give them an unbiased explanation of what the choices are. We also need to give them the tools to make that decision, like the many articles we've had regarding products and procedures that are acceptable or unacceptable to a Christian in the WT societies publications. Ultimately, the individual needs to reach some kind of conclusion regarding these alternatives that they can live with, and does not offend their conscience in any way. So the challenge is often just getting the patient to dig down deep and acknowledge his/her true feelings and beliefs regarding what is and is not acceptable regarding their health care.

Remember the first NoBlood cards? They simply dealt with the issue of blood transfusion. Today's cards are reaching far beyond the original purpose of directing medical personnel NOT to transfuse whole blood, red cells, white cells, platelets and plasma. The onus for informing medical personnel about what the patient will or will not accept during their medical treatment should be placed squarely on the shoulders of the patient.

It's fairly simple. If one of Jehovah's Witnesses who is a competent adult decides not to take the time to understand the issues they and they alone must take responsibility for that decision. On the receiving end we as medical providers take what they give us and use it as best we can. We have had much discussion on this website about Jehovah's Witnesses coming to our care unconscious or incapable of decision and "what if they don't bring their directive"! How often has that happened to you? Once, twice, never? How often have you faced any unsolvable, irresolvable situation based on a similar scenario? For all the time spent on this topic the casual reader might think this is happening all the time. The truth is it rarely happens and unless disease and accident patterns change radically it won't become a major issue at our hospitals any time soon.

Let's face it, Jehovah's Witnesses and healthcare will always be awkward relatives. We can try and make the fit nicer and easier and more palatable for all and that is a worthy goal, but in the end it will never be perfect as long as blood products are used in treatment and Jehovah's Witnesses come to hospital.

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

I am trying to learn Spanish. It is frustrating. However, that has helped me understand the position many Jehovah's Witnesses are in. The medical world is a language of its own. The legal world is also a language of its own. Health Care Power of Attorney documents have the combination of both languages. It is not just Jehovah's Witnesses that struggle with theses documents. We have an Advance Care Planning Department here and have found the general public have problems with these forms. Therefore, the majority of patients hospitalized, do not have DPA's or HPOA. It just requires a lot of education with the public.

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Yvette Bunch

Jan, well put. Along the first No Blood directive that Jehovah's Witnesses had--it used the phrase no"blood products". That has not appeared on a JW. directive in close to two decades. Yet, it is a term that some JW and medical workers have hung on to. If a medical worker writes "no blood products", I correct it to say, "no blood transfusion".

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Yvette Bunch

Not trying to start an argument, but this is a term commonly used to describe blood components other than a blood transfusion. The definition of product is 'something produced'. Our card may not say blood product on it, but I know our hospital's Medical Directive/Release form does, and then it lists 'products' that contain blood fractions, such as erythropoietin, cryoprecipitate, fibrin glue, etc., which are created, or produced, by either recombinant methods or other processes. These items are 'produced' using a blood fraction. Also, if you look at the 6/15/04 WT article, pg 24, par 16, the word 'product' is used when describing fractions that may closely replicate the whole blood component. So if someone says they do not want any 'blood products', perhaps the statement needs to be clarified to see if they mean 'no blood transfusion', or 'no transfusions and nothing containing blood fractions'. Old verbage still has meaning.