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Hot Topics at NoBlood

by David Ampleford, NoBlood Editorial Team

There have been a number of very interesting topics discussed in recent weeks. For instance, two closely-related subjects generated some lively debate and got us all thinking about the issues surrounding the incapacitated or incompetent patient. Let's take a brief look at some of the dialogue.

"The unconscious J.W patent having emergency surgery with no medical directive" (57 replies with 5,524 views)

• User haywoodm posed the question: "What would you do if there was an unconsious J.W. patient who had no medical directive on them and the family could not find it, but the relatives said the patient is a J.W?"
• MThomasRN said to go by the next of kin's instructions.
• Jan B Wade agreed and recommended calling Risk Management as well.
• Ybunch said that where there is no advance directive and the patient is unconscious it becomes implied consent. This led to a discussion about the finer points in law about medical professionals' right or duty to provide treatment when it can be established to a reasonable degree that the patient, if conscious, would refuse such treatment.
• TMac urged calling the hospital's legal adviser, and while this was disputed by some, most particpants agreed that the Hospital Liaison Committee (HLC) for Jehovah's Witnesses should be involved in all such cases.
• Evelyn_M pointed out that for anyone other than the patient's next of kin to contact the HLC would breach patient confidentiality. Evelyn_M also felt that by refusing blood transfusion Jehovah's Witnesses are in effect committing suicide. This conclusion was vigorously opposed by several other users.

The ethical and moral dilemma that such cases pose for health care professionals was debated at length by Julie_M, Jan B Wade and myself, and the thread eventually went quiet, as everyone apparently realized that all that could be said on the subject had been said... for the time being.

"The Jehovah's Witness and dementia: who or what defines 'best interests'?" (29 replies with 703 views)

• This discussion was sparked by a case of an 85-year-old patient with a fractured femur and dementia, whose daughter stated that her mother was a Jehovah's Witness and would refuse blood if she were able to make known her wishes. Doctors felt that surgery was not an option and opted to place her in traction.
• She subsequently died. Julie_M felt that the daughter brought about her mother's premature demise.
• There followed a lively interchange between Jan B Wade and Julie_M, as well as others, until everyone again retired to their corners exhausted from a debate that ultimately can have no absolutes.

However, as several of the participants in both these threads pointed out, the discussions have underscored the importance of completing and carrying an advance medical directive that clearly states the bearer's wishes about medical treatment. Also, in those countries where a durable power of attorney can be executed, it is imperative that this power be given to someone who will be supportive of the patient's stated wishes.

Attention Jehovah's Witnesses

BHI, the publisher of NoBlood, is not affiliated with any political or religious organization. It is recognized that Jehovah's Witnesses likely make up the largest group using this site. Issues relating to advance healthcare directives, questions about various blood fractions and medical treatments are regularly discussed in NoBlood forums. However, please be reminded that the primary source of bloodless healthcare support for you is your local elders and Hospital Liaison Committee (HLC). We hope that NoBlood continues to be an excellent resource to compliment your healthcare research needs. Please limit your comments to healthcare topics.

New NoBlood Guide: Medicines Containing Blood Components and Fractions

by Ms. Jan Grossberg, RN, BSN - Noblood Editorial Team

We are producing a guide entitled "Medications Containing Blood Components or Blood Fractions" or the NoBlood MedGuide for short. Why? Well, did you know that many common medications contain small amounts of blood or blood fractions? These include:

• certain vaccinations, such as immune globulin (IG) preparations,  varicella zoster immune globulin (VZIG)
• erythropoietin utilized in the U.S. (Epogen, Procrit)
• snake antivenin (may be produced using horse blood)
• TB and others vaccinations cultured in blood or plasma medium

Most people, including many physicians and other health care personnel, are likely unaware that this is the case! We at NoBlood would like to help change that. Our goal is to compile and offer as a resource here on NoBlood a comprehensive guide to all medications that contain any kind of blood component.

Since NoBlood is a community-oriented site, we encourage everyone to provide input into the MedGuide contents and format. We especially need help from those with medical, pharmaceutical, biochemistry, or research backgrounds, but feedback from all is invited and appreciated. We think this is essential information that will benefit members of the public and health care personnel alike. You can help us get the NoBlood Med Guide rolling!

If you are interested participating in the development of this feature, please contact me by clicking here. Or you may post comments and/or observations in this thread.

Read more... /

Coming Soon: Polyheme, Its Impact On You and Healthcare

by Ms. Jan Graziani, LPN/LVN - Swedish Covenant Hospital, Noblood Editorial Team

Northfield Labs has finished its clinical trials on PolyHeme™ here in the United States. PolyHeme™ according to Northfield Labs is "The Company's human hemoglobin-based oxygen-carrying red blood cell substitute" The results are to be released soon. PolyHeme™ has raised eyebrows and questions. Due to these clinical trials "The U.S. is to Re-Examine Studies of Emergency Treatments." (Reuters Health Information 2006 © 2006 Reuters Ltd.) Your input on this vital issue is important to the research and compilation of this article.

If you are interested participating in the development of this feature, please contact me by clicking here. Or you may post comments and/or observations in this thread.

Read more... /

Jehovah's Witness Barred From Making Decisions For Comatose Wife

by Ms. Michelle Thomas, RNC - Noblood Editorial Team

A recent news article from Iowa City highlights the issue of patient's rights and the need for documentation to support a patient's wishes.

This story involves the case of a young wife and mother, Tawnya Nissen, who had a severe reaction to diet pills and was hospitalized with neuroleptic malignant syndrome. As of August 18, 2006, the date that this news article was published, she has been in a coma for two weeks. During those two weeks Mrs. Nissen's healthcare has been directed by her husband. This arrangement came to an end recently when a Johnson County judge ordered that her father, Mr. Reid, take temporary guardianship.

Why would Mr. Nissen's rights as next-of-kin and decision-maker be given to his father-in-law? Mr. Reid sought guardianship when Mr. Nissen, who is one of Jehovah's Witnesses, would not consent to a blood transfusion. It was asserted by her husband that she too would decline a blood transfusion and it was furthered cited that she had signed a document stating this fact several years ago when she had a cesarean section to deliver their son. No documentation of Tawnya's wishes could be located at the time of the hearing. The judge ruled that it was impossible to definitively conclude whether Tawnya would accept or decline a transfusion. The court ruled "on the side of life" and gave guardianship to her father who stated he will consent to any treatment to save her life including a blood transfusion.

It is interesting to note that doctors at University Hospitals in Iowa City where Mrs. Nissen is being treated still are unsure as to whether a transfusion will be necessary. It was stated by a representative of the family that the issue was taken before the judge "in the slim chance" that she might need a blood transfusion.

This case draws attention once again to patient's rights. Who should make decisions for the patient? It is hoped that a loved one would make decisions that are in harmony with the patient's beliefs and convictions, but in stressful situations family members may not be able to support the patient's choices. The only way to make certain that the patient's wishes are carried out is to document them in an advance directive. This case is a good example of how conflicting points of view about what a patient would or would not want, have muddied the legal waters.

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Medical Ethics/Bioethics in the Case of an Unconscious Patient

by Ms. Jessica Varisco, BMPC - Christus St. John Hospital/St. Joseph Hospital, Noblood Editorial Team

Medical ethics can be defined as the discipline of evaluating the merits, risks and social concerns of activities in the field of medicine. Many in the healthcare field have suggested various methods to help evaluate the ethics of a medical situation. These methods provide basic principles that doctors should consider when making decisions about care given to patients in regards to death and dying, reproductive medicine, medical research and alternative medicine.

These principles include:

• Beneficence- what is in the patient's best interest
• Non-malfeasance - "first, do no harm"
• Autonomy - patients have the right to refuse or choose their treatment
• Justice - scarce resources then who gets what treatment
• Dignity - the patient and practitioner have the right to be treated with dignity
• Truthfulness - patients deserve to know the whole truth about his/her illness and treatment options

Read more... /

New NoBlood Forums

We have been contemplating some improvements in the organization of our forums. To begin with we have added a 'top-level' forum called "Community Center". Some of the forums you will find there are:

• NoBlood News & Announcements (News and announcements from the Site Administrators.)
• Meeting Hall (This is the place where public discussions about NoBlood and website related issues are discussed.)
  • Introductions & Greetings (Stop in, say hello and introduce yourself.)
  • Testimonials (Please feel free to post feedback, testimonials regarding your experience on NoBlood. We'd love to hear what you have to say. Thank you!)
  • Spotlight (Please share how you have been served by bloodless healthcare medical centers and professionals. Thank you!)
  • Public Site Feedback (Please use this forum for public feedback.)
  • Private Site Feedback (Posts in this forum can only be seen by the original author and the Administrators. Please use this forum for feedback, forum related requests, and other administrative requests.)
• Help & Suggestions Center (This is where you can ask for help, make suggestions or even share some goodwill by helping others.)
  • Library & Records (This is the place to find User Guides, FAQs, How-to's and much more.)
  • Visitors Center (This forum will explain some interesting topics about NoBlood and give you some benefits and reasons to register!)
• NoBlood Newsletter Archives (Current and previous issues of our NoBlood Bulletin.)

Join the NoBlood Team

by Ms. Sharon Grant - Noblood Editorial Team

In the NoBlood survey that was taken in February we raised the question: "Do you have a passion for this topic and would you be available an hour or more a week to write, research, edit or assist in website development for NoBlood.org?" More than 8% said yes and almost 26% said maybe. That is awesome! Just think how much good we can accomplish with so many helping hands. The following illustrates the skills that many expressed interest:

If so, please check the skills you are proficient at and would be willing to use to help NoBlood.org: (check all that apply)

Since the survey was completely anonymous, there was no provision for who expressed interest to respond. The invitation is now open. We sincerely invite you to volunteer your skills and talents with the people at NoBlood and discover the many benefits of sharing yourself with others. We enjoy our work and we'll be the first to admit it! We think it is because we are doing something that has meaning, great purpose and fun. The pace is stimulating, filled with a wealth of challenging experiences that are rewarding. If you can commit to devoting a small amount of your time per week, please email us and provide contact information along with a brief summary of your background and skills to ersonnel@noblood.org">personnel@noblood.org.

We Appreciate and Continue to Rely Upon Your Support!

by Larry Eitel, Executive Director

Our success is directly attributable to the hard work of staff members and the generosity of supporters. Today, NoBlood receives over 15,000 visits each month from people who seek to educate themselves and to network with healthcare professionals advancing bloodless medicine and surgery.

We gratefully thank those who have helped us become the number one resource on the web devoted to bloodless healthcare.

Please consider supporting NoBlood by making a financial contribution. Donations are accepted through PayPal (which accepts credit card payments). Click here to see how. We also accept donations by check or money order. You can mail your donation to:

Because Bloodless Healthcare International, Inc., the publisher of NoBlood, is a registered 501(c)3 charitable organization, your donation is tax-deductible.

If you would like to discuss how you can financially support the mission of NoBlood, please contact me by clicking here.