Refuse Blood Transfusion Research Articles

Intervention principles in pediatric health care: the difference between physicians and the state.

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or bythe harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians' ethical obligations, neither adequately reflects the state's ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah's Witnesses.

Surgical Indication and Blood Transfusion Policy for Patients Who Refuse Blood Transfusions for Religious Reasons during 3 Years in a Single Tertiary Center

Surgical Indication and Blood Transfusion Policy for Patients Who Refuse Blood Transfusions for Religious Reasons during 3 Years in a Single Tertiary Center

Tu1460 – Is Major Pancreatic Surgery Feasible and Safe in Patients Who Refuse Blood Transfusion? Single-Institution Experience with 32 Consecutive Jehovah's Witnesses Patients

Tu1460 – Is Major Pancreatic Surgery Feasible and Safe in Patients Who Refuse Blood Transfusion? Single-Institution Experience with 32 Consecutive Jehovah's Witnesses Patients

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

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.

Abstract 204: Comparison of Hemodynamic Parameters and Clinical Outcomes in Jehovah’s Witness Patients versus Non-Jehovah’s Witness Patients Undergoing Transcatheter Aortic Valve Replacement

Background: Surgical aortic valve replacement may be complicated by significant perioperative bleeding. TAVR is a less invasive procedure, however bleeding may still occur related to periprocedural complications and anti-thrombotic therapy. We sought to compare baseline characteristics, hemodynamic parameters and clinical outcomes following TAVR between Jehovah’s witness (JW) patients who decline the use of blood products, and non-JW patients. Methods: Demographic, echocardiographic, and hemodynamic data of 245 consecutive patients with symptomatic severe aortic stenosis who underwent TAVR at our institution between January 2013 and December 2015 were analyzed at baseline and at 30 day follow-up. Results: 10 patients were identified as JW refusing blood transfusion. None of the JW patients received blood products. JW and non-JW patients did not differ in respect to hemodynamic or echocardiographic parameters at baseline or 30 days post TAVR, including: blood pressure, heart rate, valve area, gradient, valvuloarterial impedance, cardiac output, stroke volume and ejection fraction. Baseline hemoglobin was higher in the JW versus non-JW groups, respectively (12.76 vs. 11.62 mg/dL p=0.045) and this was sustained at follow-up. Clinical outcomes were similar at 30 days between JW and non-JW patients, notably major bleed (10% vs 8.97%, respectively; p=0.91, defined as a clinical bleeding event with hemoglobin decrease > 2g/dL or transfusion of > 2 units of whole blood/red cells ) and 30 day mortality (0% vs 6.41%, respectively; p=0.19). Conclusion: JW patients were found to have similar hemodynamic and clinical outcomes up to 30 days. TAVR may be considered a reasonable treatment option for patients with symptomatic severe aortic stenosis who refuse transfusion of blood products.

The Jehovah's Witness obstetric patient - a literature review.

The patient's right to refuse blood transfusion must be honoured in case of its clear expression. Some special pharmacologic and/or surgical procedures can be useful in a Jehovah Witness (JW) parturient. In case of excess blood loss the maintenance of peripheral tissue oxygenation is crucial. Only a few hospitals have equipment for blood salvage, and alternative oxygen carriers have potentially lethal side effects. Findings suggest that obstetric facilities should develop special algo-rithms of management in the case of the JW obstetric patient, with written declaration of which elements of blood are not acceptable for the patient, early diagnosis and intensive treatment of anaemia in pregnancy, administration of antifibrinolytic agents before surgery, use of electric surgical tools to restore haemostasis, early detection and aggressive treatment of excessive blood loss and, last but not least, close cooperation between obstetricians and anaesthesiologists, including sharing the information about the patient's refusal of blood transfusion.

Jehovah’s Witnesses and surgery

Anna Sayburn explores the consent issues that surgeons face when operating on patients who refuse blood transfusions

Opinions of pediatric nurses about Jehovah’s Witnesses refusal of blood transfusion for their child

Abstract Introduction. Jehovah’s Witnesses absolutely refuse having blood transfusion performed. The situation is even more difficult when the refusal of blood transfusion concerns a child. Despite existing legal solutions, medical staff experiences value conflicts. Aim. To analyze the opinions of pediatric nurses about problems that may arise in case of Jehovah’s Witnesses refusal of blood transfusion for their child. Material and methods. Quantitative research was based on a diagnostic survey method. The variables were measured with the use of a survey questionnaire co-developed by the authors. A group of 104 pediatric nurses from the South-East Poland participated in the study. Results. To the question “Have you ever encountered the situation throughout all your working career when parents refused their child to undergo a blood treatment due to their beliefs?”, 67.31% (n = 70) of the respondents replied the situation rarely happened. Half of the nurses surveyed (n = 52, 50.02%) admitted they did not accept the position of Jehovah’s Witnesses concerning blood treatment. Most of the nurses surveyed – 87.38% (n = 89) think the existence of procedures on how to proceed in this difficult situation is crucial, and 83% (n = 86) of the respondents admitted that there was no better solution than the already existing legal procedure. Conclusions. The most difficult experience of pediatric nurses in the situation of Jehovah’s Witnesses refusal of blood transfusion for their child is in the opinion of surveyed nurses, endangering the child’s health or even life. Thus, most of the respondents agree that the best solution in that case is to implement a legal procedure that allows blood transfusion despite parents’ refusal.

The Efficacy of Recombinant Human Erythropoietin in Pregnant Patients with Iron Deficiency Anemia

AbstractBackground: Gestational anemia increases the incidence of maternal and fetal complications. Adjuvant recombinant human erythropoietin (rHuEPO) has been used in patients who refuse blood transfusions, have a low response to treatment with iron iron sucrose, have limited time before birth, or have other illnesses that complicate the anemia. We demonstrated that the use of adjuvant rHuEPO with iron sucrose reduces the anemia time period and is innocuous to the fetus.Aim of the Study: To evaluate the efficacy of Recombinant Human Erythropoietin in the pregnant Patients with Iron Deficiency Anemia.Patients and Methods: This is a prospective study includ-ing 70 pregnant women with iron deficiency anemia attending to the out-patient clinic of the department of Obstetric and Gynecology of Tanta University Hospital from June 2016 till June 2017. Divided into two groups, Group (A) Include (35) patients; received 200mg (10ml) iron sucrose intravenously twice weekly. Group (B) Include (35) patients; received 200 mg iron sucrose intravenously twice weekly and reco mbinant human erythropoietin (rhEPo) subcutaneous twice weekly.Results: We found that group B shows higher level of serum iron than group A in second sample but differences still insignificant p-value 0.077. But group B shows lower level of serum ferritin than group A in the same sample and the difference is significant p-value 0.042 but it had higher level Hb level & Hematocrite & MCH and Reticulocytic count. The mean Hb level was 11g/dl ranging from (10.5 to 11.5) and 11.7g/dl ranging from (10.8 to 12.6) in group A&B respectively.Hemoglobin levels are raisied by up to 2.7g/dL and 3.2g/dL in group A&B respectively.Conclusion: The use of adjuvant recombinant human erythropoietin can safely enhance the efficacy of iron sucrose in the treatment of gestational iron-deficiency anemia that did not respond to oral supplementation.

자율성 존중 원칙과 선행 원칙의 충돌 상황에서의 인간 이해 : 종교적 이유로 인한 수혈 거부를 중심으로

자율성 존중 원칙과 선행 원칙의 충돌 상황에서의 인간 이해 : 종교적 이유로 인한 수혈 거부를 중심으로

Blood transfusion and Jehovah’s Witnesses

Brazilian physicians and judges frequently have to decide whether to save the life of a Jehovah Witness patient that refuses blood transfusion or let the patient die when treatment refusal reflects their religious belief. The Penal Code condemns the physician who fails to use all the available means to save the patient. The Civil Code, contrarily, requires the professional to respect the patient’s autonomy regarding their decision over an intervention with potential risk of death. The Brazilian Constitution guarantees religious freedom and the inviolability of the right to life. This article reviews the Brazilian jurisprudence on the matter through recovery of all available decisions in the Federal and State Courts’ online database up to 2013. The results show that these superior courts consider that people are not allowed to let go of their own lives for religious reasons when in a state of “imminent death”. However, when the patient’s clinical state is qualified as “at risk of dying”, physicians are requested to respect their dissent.

Blood Transfusion in Children: The Refusal of Jehovah's Witness Parents'.

In Italy, both parents have parental responsibility; as a general principle they have the power to give or withhold consent to medical procedures on their children, including consent for blood transfusion; however these rights are not absolute and exist only to promote the welfare of children.MethodsThe Authors discuss ethical and legal framework for Jehovah’s Witness parents’ refusal of blood transfusion in Italy. They searched national judgments concerning Jehovah’s Witness parents’ refusal of blood transfusion – and related comments – in national legal databases and national legal journals, and literature on medical literature databases.ResultsIn the case of Jehovah’s Witness parents’ refusal of blood transfusion for their child, Italian Courts adopt measures that prevents the parents from exercise their parental responsibility not in the child’s best interest.DiscussionIn the event that refusal by the parents, outside of emergency situations, exposes the child’s health to serious risk, health workers must proceed by notifying the competent authority, according also to the Italian Code of Medical Ethics.ConclusionWhen the patient is a minor, the child’s best interest always come first.

文化摩擦としての輸血拒否 : 日本におけるエホバの証人の輸血拒否をめぐる医療環境の変化について( 先端技術と/の人類学)

文化摩擦としての輸血拒否 : 日本におけるエホバの証人の輸血拒否をめぐる医療環境の変化について( 先端技術と/の人類学)

A prospective randomized study of bovine carotid artery biologic graft and expanded polytetrafluoroethylene for permanent hemodialysis access

ObjectiveArteriovenous grafts (AVGs) remain reliable substitutes for permanent hemodialysis access in scenarios that preclude the placement of native arteriovenous fistulas (AVFs). The majority of AVGs are constructed of expanded polytetrafluoroethylene (ePTFE), which is relatively inexpensive and readily available, but synthetic AVGs have poor patency rates. On the other hand, biologic grafts confer an advantage by virtue of their inherent similarity to the native human vasculature. However, evidence to support the current preference of synthetic conduits over biologic grafts in clinical practice is scarce. The aim of this protocol is to propose a contemporary re-evaluation and comparison between ePTFE and bovine carotid artery (BCA) grafts. MethodsThis prospective randomized controlled trial is being conducted at an academic hospital center. A total of 100 patients at least 18 years of age and undergoing AVG placement will be recruited and prospectively randomized into two parallel groups with a 1:1 allocation ratio. Patients eligible to receive AVF and those with a known allergic reaction or history of intolerance to any ePTFE or BCA component will not be included in the study. Moreover, patients with a recent active infection at the site of previous AVG placement and patients with a bleeding disorder, an active malignant disease, or a life expectancy <1 year or who refuse blood transfusion and pregnant women will be excluded. Patients will receive either BCA (experimental) or standard ePTFE grafts (control) in compliance with the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines for AVG creation. Primary end points include primary, primary assisted, secondary, and functional patency at 1 year and 2 years after graft placement. Secondary outcomes include complications (pseudoaneurysms, infections, and steal syndrome) and reintervention rates during the first and second postoperative years. Outcomes will be assessed and documented every 6 months. ResultsOnce the study is completed, analysis of the data will be performed using univariate methods, and Kaplan-Meier and multivariate Cox proportional regression analyses will be employed to evaluate and to compare outcomes between BCA and ePTFE over time. ConclusionsThe creation of a functional and durable dialysis vascular access is crucial in the treatment of patients with end-stage renal disease and is a challenging quest for vascular surgeons. The proposed study compares the outcomes of synthetic and biologic AVG options in patients who are poor candidates for a native AVF. This will help derive contemporary evidence and improve the care of vascular access patients.

BLOODLESS TRANSCATHETER MITRAL VALVE REPLACEMENT: A VALVE TEAM APPROACH TO A JEHOVAH'S WITNESS

There are an estimated 8 million practicing Jehovah's Witness'(JW) worldwide, many of whom refuse blood transfusions based on religious beliefs. Given the medical, ethical and legal implications surrounding these preferences hospitals have sought to offer alternatives, both in emergency and peri-

Relational autonomy, care, and Jehovah's Witnesses in Germany.

Drawing from an ethics of care, relational approaches to autonomy have recently emerged in bioethics. Unlike individual autonomy with its emphasis on patients' rights, choice, and self-determination which has been the hallmark of bioethics consistent with the ideology of individualism in neoliberal democracies in Western countries, relational autonomy highlights the relatedness, interdependency, and social embeddedness of patients. By examining the mediating role that male Hospital Liaison Committee members in Germany play in facilitating care that supports Jehovah's Witnesses' refusal of blood transfusions, this article moves beyond 'dyadic relations' and contexts of caregiving. It also contributes to a deeper understanding of care and relational conceptualizations of Witness patients' autonomy globally.

Refusal of blood transfusion by a hemodialysis patient with renal anemia for religious reasons

Refusal of blood transfusion by a hemodialysis patient with renal anemia for religious reasons

Het weigeren van bloedtransfusies en vaccinaties op grond van godsdienstige motieven

Members of religious communities sometimes refuse medical treatments, not only for themselves, but also for their children. Certain orthodox Protestants refuse vaccinations against infectious childhood diseases and Jehovah's Witnesses refuse blood transfusions. The central question in this contribution is how that refusal should be judged from a fundamental rights' perspective.

Opinions of nurses regarding conscientious objection.

Background:In the last decades, there have been important developments in the scientific and technological areas of healthcare. On certain occasions this provokes conflict between the patients' rights and the values of healthcare professionals which brings about, within this clinical relationship, the problem of conscientious objection.Aims:To learn the opinions that the Nurses of the Madrid Autonomous Community have regarding conscientious objection.Research design:Cross-cutting descriptive study.Participants and research context:The nurses of 9 hospitals and 12 Health Centers in the Madrid Autonomous Community. The study was done by means of an auto completed anonymous questionnaire. The variables studied were social-demographical and their opinions about conscientious objections.Ethical considerations:The study was approved by the Ethical Community of Clinical Research of the University Hospital Príncipe de Asturias. Participants were assured of maximum confidentiality and anonymity.Findings:A total of 421 nurses answered the questionnaire. In total, 55.6% of the nurses confirmed they were religious believers, and 64.3% declared having poor knowledge regarding conscientious objection. The matters that caused the greatest objections were voluntary abortions, genetic embryo selection, refusal of blood transfusions, and therapy refusal.Discussion:Different authors state that the most significant cases of conscientious objections for health professionals are those regarding carrying out or assisting in abortions, euthanasia, the practice of assisted reproduction and, finally, the prescription and dispensing of the morning-after pill. In our study, the most significant cases in which the nurses would declare conscientious objections would be the refusal to accept treatment, the selection of embryos after genetic diagnosis preimplantation, the patient’s refusal to receive blood transfusions due to religious reasons and pregnant women’s request for voluntary abortions within the first 14 weeks.Conclusion:Nurses’ religious beliefs influence their opinions regarding conscientious objection. The nurses who declare themselves as religious believers object in a higher percentage than those without religious beliefs.

Jehovah’s Witnesses and Blood Transfusions: An Analysis of the Legal Protections Afforded to Adults and Children in European/English Human Rights Contexts

Abstract This article considers the degree to which the religious beliefs of Jehovah’s Witnesses are given consideration in European and English courts. Adults’ refusal of blood transfusions is examined within the context of European human rights jurisprudence. A focus is also placed on the position of Jehovah’s Witness children who refuse blood transfusions in the specific context of English medical law due to the prevalence of related case law in this jurisdiction. It is argued that the European Court of Human Rights has given appropriate protection to the will-rights of competent adult Jehovah’s Witnesses who refuse blood transfusions. The position of children is somewhat different, and it is suggested that the courts should give greater consideration to the rights of competent children to manifest their religious beliefs.