Sure they are. Been proven time and time again. The evidence will mount as time goes by. Blood transfusions ARE NOT necessary to save lives. That is like thinking that we have to bleed patients to give them proper medical care. It was popular in the 1700's, but we know better now. George Washington died because the medical standard of his time was incorrect. (George Washington) It would be interesting if we could find statistics - accurate, honest statistics, as to how many people have died BECAUSE a blood transfusion was given. The risks far outweigh the benefits, and that has been proven as well. Educated physicians know this and practice within the bounds of bloodless medicine. It makes them better. It's easy to pump blood into someone. It's hard to use procedures that keep blood from being needed. Do we want doctors that take the easy way, becasue it's what has been done for years? No, we want quality bloodless medical care. Simple.

Thinking blood transfusions are necessary is a state of mind, a way of thinking that can and should be overturned.

I've already covered in this thread a situation where bloodless alternatives do not adequately provide enough of a solution. From what I've read, no-blood alternatives have one major flaw working against them. Time.

If you have time, no-blood solutions are definitely the way to go. Drugs/supplements, self-donation, diet, etc are all excellent treatments.

But when you have no time to build up a reserve of blood to transfuse yourself with, when your condition is deteriorating so rapidly that encouraging the body to produce more blood won't work fast enough (or perhaps your body is currently unable to produce enough of it's own blood), what then?

And please stop using that blood letting analogy. Blood letting was based on the flawed assumtion that they could just bleed out the disease. Perhaps if you were comparing to the old blood-transfusion assumption that blood was blood, before Rh(D) factors, blood-types, and blood-born diseases were known about, you'd have a valid comparison. Nowadays they know a lot more about how blood interacts with blood, they know about proteins, prions, genotypes/phenotypes, and how they all affect the interaction. (Citing a risk of blood-born illness is easily comparable to the risk of catching any number of transmissible diseases while at the hospital...)

Without such knowledge, no-blood solutions would never have been developed. But as I said, until they come up with a synthetic blood that replicates *all* the features of real blood (and not just most of them), there will still be situations (as I said above, mostly when time is of the essence) in which a transfusion does more good than a no-blood alternative.

"But when you have no time to build up a reserve of blood to transfuse yourself with, when your condition is deteriorating so rapidly that encouraging the body to produce more blood won't work fast enough (or perhaps your body is currently unable to produce enough of it's own blood), what then?"

What you need is VOLUME. Many currently available bloodless alternatives can be used to restore volume AND carry oxygen. I can't remember the name of the product, but one is available that has many, many more times the oxygen carrying capacity of blood. It's not blood that is needed. It is the volume of oxygen carrying fluid that is needed, and those alternatives ARE available.

"Blood letting was based on the flawed assumtion that they could just bleed out the disease." Blood transfusions are based on the flawed assumption that only blood can save a patient in certain circumstances. That is false.

It boils down to what the doctor understands, is trained in, and is capable and willing to do. Again, that has been proven time and time again.

"(Citing a risk of blood-born illness is easily comparable to the risk of catching any number of transmissible diseases while at the hospital...)" It's hard to see how you can make that assertation. Blood is forced into the body via the transfusion. It does not naturally go in, since the body contains it's own blood supply. Without making the substance enter the body, the disease contained in the blood will not enter the patient. Airborne viruses and bacteria need not be forced into the body to cause disease. They enter via natural body processes - breathing is one way. You simply cannot equate something that is introduced via unnatural processes to something that is introduced via natural processes.

It's obvious that there are some who refuse to "step out of their comfort zone" and accept that there are life saving alternatives to blood. That is why this kind of thing keeps happening, and why this thread is soooo long. No insult intended to anyone.

I'd like some more info on these products if you can find them pls. As well as whether they've been approved by organizations like the FDA and the Cdn equivalent. Doctors usually avoid un-approved treatments unless there's no other medical alternative.

edit: I've found 3 products that act as you describe. Hemopure, Oxygent and PolyHeme, all of which are described as "oxygen therapeutics" aka fluids that behave like hemoglobin.

Hemopure is still in clinical trials inside the US, although due to FDA concerns, human trials were suspended, they are back to animal testing. The US Navy is partnering with Biopure to address the health concerns the FDA had. It has been approved by South Africa since 2001.

Oxygent has not been approved by the FDA (there are lingering concerns about the health effects of perfluorochemicals... namely that they cause cancer in lab rats)

PolyHeme uses treated human hemoglobin, and is clinical trials (although there are concerns about it's health effects, but they could be statistical anomalies)

Consider the following scenario. A patient is advised by doctors to have a particular proceedure done. We'll assume that such surgery is optional, and can be done using bloodless techniques. Now opening up the body bypasses many of the natural defenses, thus exposing the patient to the risk of many infections which would not be a threat should the patient have sought other remedies that did not involve surgery. Does the risk of infection nullify the surgery option? Or is it merely another factor to consider when weighing the options?

There are times when only a transfusion of RBC's given immediately will save a life. There are times when only a transfusion of platelets given immediately will save a life.

From a medical point of view transfusions of blood components are not always good and they are not always bad. In the 1990's the balance of risk vs. benefit weighed heavily toward the risk side. Physician's really were using blood as a pre-ordered item on their treatment algorithm. Today due to the dedicated work of professionals like Shander, Spence, Goodnough, Hannon, Estioko, Spahn, Ford and Speiss physician's are more often questioning and challenging blood transfusion as a theraputic option. The rule "question every unit" is becoming more common.

To take the side of zero tolerance in the blood transfusion debate offers zero possibility of winning the point. The debate should not be No Blood vs. Blood. It should be When Blood vs. When Alternatives. The protagonists in this thread are as far as can be discerned from a glance at their username profiles NOT qualified to debate the When vs. When. The news articles I have reviewed do not provide clinical values time-lines or co-morbidities. Blood count was mentioned but that isn't enough to determine efficacy of treatment decisions. Even if the chart were opened medical opinion on treatment opinions would vary. To portray the physicians working for the interests of the infants as "bad" is shortsighted, naive and not at all fair. To portray the family or their religion as unconcerned with the life and safety of their children would be equally unfair and simplistic. Having spent many years working in hospitals I am certain both sides agonize over their course of action.

At the bottom of this debate and what should not be discussed on this website is the issue of belief and faith as they influence clinical choice and how far health care providers should go to accomodate these in their patient population.

As usual JulieM has nailed the ethical and legal issues. However, is man and his body of laws in harmony or out of harmony with God and his laws? Should man's body of representatives ever allow citizens to impress their choices however sacred on children who are incapable of informed decision? These questions at the root of the case in discussion are necessarily left to another forum.

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

Jan,
On one point you stated I can both agree and disagree with you. You stated "The protagonists in this thread are as far as can be discerned from a glance at their username profiles NOT qualified to debate the When vs. When." I agree that this is the case when such protagonists are a third person, but I disagree with your statement when such a protagonist is the party of the first part , i.e. if I for example were in the situation when this applied to me then there would be no one more qualified to make this decision than I, even the best educated doctor with the utmost experience and credentials would not be more qualified than I to decide for my body "When vs. When" as you say. The points I have brought out are only incidentally medical ones. Medical practice may or may not at any particular point in time harmonize with the broadest moral truths and principals. The end does not always justify the means.
Consider ,please, some points from the "Universal Declaration of Human Rights" :
preamble
"...recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,
Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,..."
Article 1.

• All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

If, to begin with, if I am equal in dignity and rights to another human being; to any other human being, and seeing that I am endowed with my own reason and conscience, then would it not follow that I have the right to exercise this same reason in accordance with my conscience to decide what risks I should or should not take and also what priorities are most important to me?
Article 2.

• Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Notice that these rights are without any distinctions and such distinctions include religion, social origin, or other status, and thus if a doctor did not share my religion or understand or agree with it, and even if I were of a very limited education, and especially compared to the highly educated doctor, then I would still be entitled to my unalienable rights to freedom of conscience and personal dignity.
Article 12.

• No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

In this case in particular the interference is not "arbitrary" but it can indeed be said that we are talking about attacks upon both honor and reputation, if fact some people, it would seem, are claiming that the majority of society is right for no other reason than because the majority is the majority (circular reasoning) and that a minority, therefore, is lacking in honor and deserving of no respect for the reputation. of that minority.
Article 18.

• Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Observing the Biblical command to "Abstain from blood" is one of the distinctive characteristics of Jehovah's Witnesses, and while each person of this group are free to leave, or change their religion, those who choose to be a part of this group and exercise the beliefs of the same in their own lives are exercising this right stated in article 18, and as article 18 states are manifesting their religion in practice and observance, and thus this observance can not be negotiable for to attempt to do so would violate freedom of thought and religion.
Article 30.

• Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.

I remember a conversation I had with a professor when I was attending a university. He told me that the purpose of a college education was not to teach a person how to do a job, since that was up to the employer who hired such a person. He said that the purpose of a college education was to mainstream each person into society, i.e. so that each person would have a common basis of thought, think alike, and look at situations in the same way. I told him that if you look at society historically and from the social perspective then it is readily apparent that, at least since the industrial revolution, society has been going downhill, and I had no desire to be mainstreamed into a sewer. He also stated that he didn't see moral distinctions as "black and white" but as different shades of gray according to circumstances. This would also be the view of society in general wouldn't it? In a literal way though if someone said this wouldn't they be describing a form of blindness?
I've heard that the Apache people had a saying regarding the conscience; they likened it to a wheel with sharp spokes, so that when a person did something wrong that wheel would move and beat against the heart, but if these proddings were ignored long enough then the sharp spokes would dull and the person could no feel their conscience. To me an educated conscience is more important than any other kind of education, though I am a big proponent of almost all forms of education, and for a person to live according to conscience without compromise is more important than the act of a coward who compromises, or that of a conscienceless opportunist who only seeks their own temporary and selfish advantage even to the detriment of others. It is not up me to be the conscience of another; only to point out those relevant facts which underpin my own moral standards and actions based thereon.
In this case I am not saying that the doctors or the state did anything illegal, or against their own conscience, but what they did was wrong because they deemed their own rights to be more equal than that of other people even to the point of alienating the rights of others simply because they had the power to do so. No, I don't know the medical details, and if I did I still would not be qualified to make a decision based on those facts. I do know that under similar circumstances other doctors have respected the rights of their patients, all their rights; not just the right to life. To focus on only one right to the exclusion of all other rights, or to contend that another person has no rights if this are based on beliefs which conflict with your own would be a form myopia . I resent the implication that only people with certain qualifications can talk about this topic. I, for one, am not a doctor, but that doesn't necessarily mean that I am also stupid. When I was in the sixth grade the others students called me "science" because that was my first area of interest and reading test I took that year indicated I was reading at the level of a college sophomore at three time the average adult speed and in the top percentile of comprehension. According, though, to the rights I quoted above even if I were illiterate I would still have the right to make my own decisions based on my own conscience; rather than be dictated by someone else's conscience, such as that of a doctor who might feel superior to me.
I would like to refer one more time to the earlier experience concerning my Father. I never knew the name of the doctor who saved his life, who viewed the conscience of a patient as more important than his own, but I can tell you that his act was completely selfless. My family was very poor, and had no insurance. He must have even lost money since this act took him away from his own practice and patients who needed him. Since that time I have met some doctors who are really very nice people. That is my last point. Doctors are people, and are thus subject to prejudice, to pride, and every other human shortcoming. Doctors are not deities, but it seems that some, if not most, people view them as such.

Tiger, you said "I disagree with your statement when such a protagonist is the party of the first part , i.e. if I for example were in the situation when this applied to me then there would be no one more qualified to make this decision than I, even the best educated doctor with the utmost experience and credentials would not be more qualified than I to decide for my body "When vs. When" as you say. "

Well there we have it then. I speak of being medically qualified to decide when to use or not use blood and you say you disagree because you think you should be allowed to make decisions regarding your own body...I think we are discussing two separate things.

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

Jan,
I'm sure we are, that in itself is the point.

Actually in this circumstance, legal requirements were apparently not followed. The children were seized without the hearing required by law. In that hearing the parents could have had expert medical representation either in person or via teleconference to present the alternatives. It could have been discussed and the judge issue an informed decision, having heard both sides. Unfortunately the process was evidently bypassed.

That is correct, the law generally requires this, even in a bloodless program. However in those programs the expertise and recurrent proficiency with blood conservation tools and techniques make such situations very uncommon.

Also the "trigger" criteria for state intervention is NOT necessarily when blood products provide the best or most familiar standard of care. The exact laws vary between nations and provinces. However Dr. Nicolas Jabbour describes the criteria as "when there are NO nonblood alternative treatments available" (emphasis mine, Transfusion-Free Medicine and Surgery, p. 14).

This is obviously not a black-and-white area. Treatments vary in efficacy, as does the expertise level, tools/techniques and proficiency at different medical centers.

E.g, Nicolas Jabbour at USC has done many bloodless live donor liver transplants. That doesn't mean such expertise is available everywhere. Duke University Medical Center is expert at hyperbaric medicine, and uses it in their bloodless program. Such expertise isn't available everywhere. Just because we read of such successes doesn't mean that's the general standard of care available everywhere. But -- it is available.

Thus we see a complication: what if expert (albeit non-mainstream) alternative treatment is available at a different location, and the doctors have successfully treated similar cases and are willing to take the patient? Suddenly it's not so black and white. Rather than state intervention to avoid certain death, the state is intervening based on the lack of expertise in the current facility or unwillingness to transfer the patient.

I have no idea if that happened with the Canadian sextuplets, but the fact is most situations can be successfully treated -- somewhere -- without blood, given sufficient tools and expertise.

That raises the issue of patient transport and related complications and decision factors. It's not always advisable to transfer the patient, although it's often possible. There are many variables -- distance, time, surface vs aerial transport, patient condition, etc.

The confusion in these cases often stems from a black-and-white view of what is a grey area, sometimes exacerbated by premature overly aggressive legal action. It's one thing if a minor child comes in the ER from a car wreck, bleeding profusely with a hemoglobin of 2 g/dl. It's another thing if the patient has a hemoglobin of 8-9 g/dl which is gradually declining.

While the law generally requires rendering lifesaving treatment to minor children regardless of the parent's wishes, the exact definition of what constitutes "lifesaving" treatment and threshold for legal intervention is fuzzy. In a slowly deteriorating, non-time-critical situation, transferring the patient to an expert specialized facility may avoid legal problems. Identifying and acting on these cases early avoids the patient degrading to a condition where transport is more risky.

Potential patients and parents should also understand there's a difference between a cooperative doctor vs a structured, formal bloodless program. In an elective situation best results are often obtained at a facility with a formal bloodless program. Even in some trauma situations the option may exist early on to transfer to such a facility. Once the situation medically deteriorates, transport is more difficult, although not necessarily impossible. In his book "No Man's Blood", Dr. Ron Lapin related an example of aerial transport and successful operation on a female adult patient with a hemoglobin level of 2.0 g/dl.

Where transport is impossible, expert medical consultation about nonblood treatment options can be made available via teleconference or video conference.

Pretty much. While there was no law stating that the parents had to have a hearing, a 1995 Supreme Court ruling stated that there ought to be one (so the parents can argue their case).

I'm sure though, that the SC left an opening for the judge issuing the order to bypass the hearing... perhaps when the lawsuit goes forth we'll get to hear the reasoning behind why the judge did what he did. I haven't heard any details so far on that.