Medicine, religion and faith: issues in Jehovah’s Witnesses and major surgery

Abstract

Background: Major surgical treatment in Jehovah’s Witnesses (JW) presents complex ethical and legal issues to the physician. The Jehovah’s Witness is willing to accept all medical treatment except blood transfusion; and so, the physician is often confronted with a difficult task especially in emergency settings and among minors. This paper looks at the ethical and legal aspects of this peculiar religious sect in relation to surgical treatment. It also provides guidelines for contemporary management of JW using transfusion avoidance strategies. Methodology: Medical literature on the subject was reviewed using manual library search, articles in journals and internet search. The search words were: Jehovah’s Witness + blood transfusion +legal and ethical issues. The search was done using Pubmed, Medline, Hinari and Medscape, as search engines. The search covered a period between 1940 and 2013. Results: Jehovah's witnesses do not argue that blood transfusions have not kept alive patients who otherwise might have died, "but to them, such life is vacuous”. Jehovah's Witnesses, therefore, are exercising a fundamental right of any sane adult with capacity to refuse medical treatment. There is, however, no conclusive evidence that Jehovah's Witnesses have a higher mortality rate after traumatic injury or surgery despite their refusal to accept blood transfusion. As a result of these findings, an increasing number of patients are refusing blood transfusion even for non-religious reasons. Transfusion avoidance strategies are, therefore, desirable. These strategies are likely to gain popularity, and become standard practice for all patients. Dearth of legal statutes in our environment is a major limitation. The legal issues sometimes are conflicting in the setting of emergency and minors. Conclusion: Respect for a patient’s wish and autonomy is sacrosanct. Where a sane adult has expressly rejected a particular treatment option, applying the same option in whatever guise is unethical, and legally, damaging. When in doubt, especially in the minors, the doctor should obtain a court order before administering the life-saving treatment. Every hospital must have institutional protocols for managing these patients.