It is written in the Book of Leviticus:
"As for any man who eats any sort of blood, I shall
certainly set my face against the soul that is eating
the blood, and I shall indeed cut him off from among
his people."
An injunction against cannibalism,
perhaps? To most practising Christians, this is probably
one of the lines in the Bible that is best skimmed over
without too much analysis. But to Jehovah's Witnesses,
it has become a central tenet of their faith —
one that many are quite literally prepared to die for.
Or perhaps to let others die for.
Coping with the unwillingness of Jehovah's Witnesses
to accept blood transfusion has become an accepted feature
of the doctor's job. In all western countries, the patient's
right to refuse transfusion has been upheld again and
again in the courts. But there remains the thorny problem
of treating the children of Jehovah's Witnesses, especially
premature neonates, who are very likely to need transfusion.
This quandary has landed on the
doorstep of British Columbia's government in a big way,
with the arrival of Canada's first known sextuplets,
born prematurely to a family of Jehovah's Witnesses.
Before the birth, the parents had
refused selective reduction, which would have terminated
some fetuses to improve the chances of the others. All
four boys and two girls were born weighing less than
two pounds. Within a week two had died. Doctors at BC
Children's and Women's hospitals insisted that the surviving
infants needed transfusion, but the parents refused.
The hospital then appealed to the provincial government
to take the babies into protective custody, which it
did. Two received transfusions. Almost nothing is known
about their progress since, except that all four are
still alive.
They are all now again in the legal
custody of their parents, but the legal wrangle continues,
with the anonymous parents accusing the government of
not letting them present evidence to a court before
going ahead with the transfusions. "We have been stripped
of our parental rights and been labelled unfit," they
say in their filing with the BC Supreme Court. Under
a provision of the BC Child, Family and Community Service
Act, the government may act before a scheduled hearing
takes place, if it has reasonable grounds to believe
a child's health is in danger.
Needless to say, the case generated
a fine media storm, and put the church organization
of Jehovah's Witnesses in Canada on the defensive. "It
is important for the media and others to avoid making
stereotypical assumptions regarding Jehovah's Witnesses,"
they said in a statement.
IT'S
IN THE BLOOD
Jehovah's Witnesses are often painted as medical Luddites,
but in fact they have no issues with most modern medical
treatment — their objections are very tightly focused
on blood products.
The Watch Tower Bible and Tract
Society of Pennsylvania, based in Brooklyn, is the Jehovah's
Witnesses' equivalent of the Vatican. It actually monitors
medical developments rather closely, always on the lookout
for ways to improve treatment of its members without
breaching this fundamental ordinance.
The society has kept abreast of
technologies like intraoperative blood salvage and isovolaemic
haemodilution with autotransfusion, which recycle the
patient's blood during surgery. As long as it remains
in contact with their circulation, it's deemed acceptable.
They've also moved to accept new minor blood fractions
and substitutes as they've appeared. They also permit
members to use vaccines, even though these are often
made with albumin.
There's even a modern hospital
which specializes in "blood avoidance" medicine for
the children of Jehovah's Witnesses: Schneider Children's
Hospital in New York. In fact Schneider provided the
escape route last time British Columbia ran into a sticky
ethics case. A 14-year-old Jehovah's Witness girl was
required to undergo transfusion with her cancer therapy,
and her refusal was overruled by the BC Supreme Court
because she was a minor (see "BC
teen ordered to get treatment despite religious objections"
May 30, 2005 , Vol 2, No 10). (A similar case, involving
a 15-year-old Winnipeg girl with Crohn's disease, has
just concluded with the girl being forced to undergo
transfusions.) The BC teen fled to Ontario, and was
eventually treated at Schneider after that province
negotiated a deal with her family.
Crossing the continent was evidently
not feasible for four fragile neonates in incubators,
however. What's more, the substitute therapies favoured
by the church, such as recombinant human erythropoietin,
are usually poorly suited to neonatal treatment. They
often take time to work, and are usually treatments
instituted when a patient has time to prepare for elective
surgery.
This time, the doctors were insistent:
transfusion was the only option. Under BC law, they
had a duty to inform child protection workers if parents
refused therapy they deemed essential to a child's health.
The basic assumptions of medical
ethics as practised in Canada undoubtedly support the
hospital's decision. University of Victoria bioethicist
Eike-Henner Kluge summed up the position succinctly
to the Globe and Mail: "While the parents are
at liberty to make martyrs of themselves, their children
are not."
But what about the parents? Jehovah's
Witnesses are clearly willing to assume risk. Indeed,
this is a church with 6.5 million "witnessing" members
and perhaps another 10 million who attend services,
yet whose doctrine preaches that only 144,000 elect
will ascend to Heaven.
It's possible that the problem
will go away on its own. The church is open to blood
replacements, so a technical fix may be over the horizon.
And the Watchtower Society may be softening its position.
In 2000 it abandoned its long-held policy of "disfellowshipping"
any member found to have accepted a blood transfusion.
This essentially meant excommunication, and followed
a formal investigation. There were even disturbing anecdotal
reports of other Jehovah's Witnesses visiting hospital
patients to check they were not transgressing.
Today, a Jehovah's Witness who
accepts blood is held to have "disassociated" himself
from the congregation. There is no investigative process,
so if medical confidentiality is upheld, the patient
can sneak a blood transfusion without being punished.
The 2000 directive also made it clear that a member
must take the blood "wilfully and without regret" to
have broken a core tenet of the faith.
That would seem to leave the BC
kids in the clear. It would also potentially open the
door to transfusing unconscious adults. A 2003 survey
of European doctors in the Postgraduate Medical Journal
found that two-thirds would transfuse an unconscious
Jehovah's Witness who was losing blood, and 41% said
they would not tell the patient on awakening. God may
see all our sins, but the Watchtower Society evidently
does not.
The opinions expressed are those
of the author and are not necessarily the views of the
National Review of Medicine.
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