Requesting opinions of the appropriateness of hospitals obtaining court orders for blood transfusions for Jehovah's Witnesses or their children.

Hospitals in the United States and Canada rarely seek court orders to transfuse blood into adult patients. The exception being when adult patients are incapable of expressing their wishes due to injury, mental incompetence or lack of a properly executed advance directive. Hospitals often seek court orders to transfusion children for what they feel is life saving treatment of various kinds. This happens with all sorts of children not only children of Jehovah's Witnesses. For the past two decades hospitals see the wisdom of working with the parents when approaching the court. This helps to find the most reasonable approach to treating the child.

Facts to consider:
How long blood transfusion has been in use, and/or considered safe
Generally blood transfusions entered mainstream medicine following WWII. Transfusion of blood always carried risk. When the practice began to spread in the 1950's some well known physician's spoke out against the "magic bullet" saying it allowed sloppy surgery. Some felt it would lead to lowering surgical standards. I know surgeons who feel it has.

Why blood transfusion would be considered as a medical treatment
Because it is a medical treatment.

Influencing factors, and risks of blood transfusion
Red Cells carry oxygen, although transfused RBC delivers a small amount compared to the patients own red blood cells. Oxygen is necessary to sustain life.
Platelets promote hemostasis or in other words stop bleeding.
White cells fight infection and disease.
Other minor components found in blood do various positive things.

Since the 1970's studies have documented a growing number of factors that increase the risk of accepting blood transfusion. Shock, disease, suppression, lung injury, cell aggregation blocking proper O2 delivery etc.

How long Gods law has considered blood sacred in the Bible, from Genesis 9:4 to Acts 15:20.

Why would loving parents take this supposed risk?
This seems to prove the veracity of their position.

The ethics of trampling on these religious convictions.
Parents have their position and providers have theirs. Currently the two parties must work out the pathway to the most favorable result for all parties taking into account the needs, feelings and convictions of all.

Do you know why Jehovah's Witnesses take this stand, and will you as a medical professional, respect it?

As a past blood management program manager, I understand that though parents have the right to provide religious training and moral direction to their children they do not have the right under the US constitution of withhold life saving medical treatment regardless of the reason. However, that does not mean that man's laws and policies supersede God's . It has been proven to me that the Bible does in fact state (a divine law) that no human should "eat blood". I have come to believe that transfusing blood breaks this law. Unfortunately, this is not the only area where "man" and God are in diametric opposition. I respect Jehovah's Witnesses right "not to consent" to giving blood to their children. I also respect their desire to find alternatives to blood transfusion. In the early years this desire and quest was the driving force behind the movement toward advanced blood management.

These are strong convictions. Do you have any convictions like the stand of Jehovahs Witnesses against blood transfusion? Would you like your convictions respected? for example, cremation vs. burial?
This question is not germane to my decision as a health care professional. With that said, I suppose it would be hypocritcal of me to demand my own right to choose while ignoring someone else's.

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

Very well said, Mr. Wade and thank you for your informative posting.
The questions were hypothetical, but a situation we could all have to face at any time.
Thank you for mentioning the medical advances that have been made in a search for alternatives to transfusion.
I believe that in a trauma where there is major blood loss, the first consideration would be hypovolemic shock, as red blood cells are stored in e.g. bone marrow?
For example, what use is transfusing forty units of blood to a patient who has a ruptured aortic aneurism? Volume expanders would have the same effect, to keep the circulatory system from collapsing. That is an extreme example though.
I understand that now doctors are approaching transfusions as they would an organ transplant, it is that big of a deal, that serious.
Pam