JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE

MAJOR SURGERY POSSIBLE

Although surgeons have often declined to treat Witnesses because their stand on the use of blood products seemed to "tie the doctor's hands," many physicians have now chosen to view the situation as only one more complication challenging their skill.  Since Witnesses do not object to colloid or crystalloid replacement fluids, nor to electrocautery, hypotensive anesthesia, or hypothermia, these have been employed successfully.  Current and future applications of hetastarch, large-dose interavenous iron dextran injections, and the "sonic scalpel" are promising and not religiously objectionable. Also, if a recently developed fluorinated blood substitute (Flusol-DA) proves to be safe and effective, its use will not conflict with Witness beliefs. 

In 1977, Ott and Cooley reported on 542 cardiovascular operations performed on Witnesses without transfusing blood and concluded  that this procedure can be done "with an acceptably low risk."  In response to our request, Cooley recently did  a statistical review of 1,026 operations. 22% on minors, and determined "that the risk of surgery in patients of the Jehovah's Witnesses group has not been substantially higher than for others."  Similarly, Michael E. De Bakey, MD, communicated "that in the great majority of situations [involving Witnesses] the risk of operation without the use of blood transfusions is no greater that in those patients on whom we use blood transfusions" [personal communication, March 1981]. The literature also records successful major urologic and orthopedic surgery. G. Dean MacEwen, MD, and J. Richard Bowen, MD, write that posterior spinal fusion "has been successfully accomplished for 20 [Witnesses] minors" (unpublished data, August 1981). They add:  "The surgeon needs to establish the philosophy of respect for a patient's right to refuse a blood transfusion but still perform surgical procedures in a manner that allows safety to the patient."

Herbsman reports success in cases, including some involving youths,"with massive traumatic blood loss."  He admits that "Witnesses are somewhat at a disadvantage when it comes to blood requirements. Nevertheless it's also quite clear that we do have alternatives to blood replacement." Observing that many surgeons have felt restrained from accepting Witnesses as patients out of "fear of legal consequences," he shows that this is not a valid concern. 

Next time: JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE -LEGAL CONCERNS AND MINORS 

From the Watchtower magazine