JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE - THE PHYSICIAN'S CHALLENGE

Understandably, caring for Jehovah's Witnesses might seems to pose a dilemma for the physician dedicated to preserving life and health by employing all the techniques at his disposal. Editorially prefacing a series of articles about major surgery on Witnesses, Harvey admitted, "I do find annoying those beliefs that may interfere with my work."  But, he added: "Perhaps we too easily forget that surgery is a craft dependent upon the personal technique of individuals. Technique can be improved."

Professor Bolooki took note of a disturbing report that one of the busiest trauma hospital in Dade County, Florida, had a "blanket policy of refusing to treat Witnesses. He pointed out that "most surgical  procedures in this group of patients are associated  with less risk than usual."  He added:  "Although the surgeons may feel that they are deprived of an instrument of modern medicine . . . I am convinced that by operating on these patients they will learn a great deal."

Rather than consider the Witness patient a problem, more and more physicians  accept the situation as a medical challenge. In meeting the challenge they have developed a standard of practice for this group of patients that is accepted at numerous medical centers around the country. These physicians  are at the same time providing care that is best for the patient's total good.  As Gardner et al observe:  "Who would benefit if the patient's corporal malady is cured but the spiritual life with God, as he sees it, is compromised, which leads to a life that is meaningless and perhaps worse than death itself."

Witnesses recognize that, medically, their firmly held conviction appears to add a degree of risk and may complicate their care.  Accordingly, they generally manifest unusual appreciation for the care they receive.  In addition to having the vital elements of deep faith and an intense will to live, they gladly cooperate with physicians and medicals staff.  Thus, both patients and physician are united in facing this unique challenge. 

REFERENCES

1. Jehovah's Witnesses and the Question of Blood. Brooklyn, NY, Watchtower Bible and Tract Society, 1977, pp 1-64.

2. The Watchtower 1978; 99 (June 15) 29-31.

3. Hypotensive anesthesia facilities hip surgery, Medical News. JAMA 1978; 239:181. 

4. Hetastarch (Hespan) -a new plasma expander. Med Lett Drugs 1981; 23:16.

For more references, go on jw.org publications, under this subject; put in search engine.

Next time:  BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?

From the jw.org publications

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

Witnesses readily sign  the American Medical Association form relieving physicians and hospitals of liability, and most Witnesses carry a dated, witnessed Medical Alert card  prepared in consultation with medical and legal authorities.  These documents are binding on the patient (or his estate) and offer protection to physicians, for Justice Warren Burger held that a malpractice proceeding "would  appear unsupported"  where a waiver had been signed. Also, commenting on this in an analysis of "compulsory medical treatment and religious freedom"  Paris wrote:  "One commentator who surveyed the literature reported,  'I have not been able to force a transfusion on an unwilling patient.'  The risk seems more  the product of a fertile legal mind than a realistic possibility." 

Care of minors presents the greatest concern, often resulting in legal action against parents under child neglect statutes.  But such actions are questions by many physicians and attorneys familiar with Witness cases, who believe that Witness parents seek good medical care for their children. Not desirous of shirking their parental responsibility or of shifting it to a judge or other third party, Witnesses urge that consideration be given to the family's religious tenets.  Dr. A.D. Kelly, former Secretary of the Canadian Medical Association, wrote that "parents of minors and the next of kin of unconscious patients possess the right to interpret the will of the patient. . . I do not admire the proceedings of a moot court assembled at 2:00 AM to remove a child from his parent's custody." 

It is axiomatic that parents have a voice in the care of their children, such as when the risk-benefit potentials of surgery, radiation, or chemotherapy are faced. For moral reasons that go beyond the issue of the risk of the transfusion, Witness parents ask that therapies  be used that are not religiously prohibited.  This accords with the medical of tenet of treating "the whole person," not overlooking the possible lasting psychosocial damage of an invasive procedure that violates a family's fundamental  beliefs.  Often, large centers around the country having experience with the Witnesses, now accept patient transfers from institutions unwilling to treat Witnesses, even pediatric cases. 

Next time: JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE - THE PHYSICIAN'S CHALLENGE

From the jw.org publications

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 seem 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 employed successfully.  Current and future applications of hetastarch, large doses intravenous 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, it used will not conflict with Witness beliefs.

In 1977, Ott and Cooley reported on 42 cardiovascular operations performed on Witnesses without transfusing blood and concluded that this product 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 Witness group has not been substantially higher than for others."  Similarly, Michael E. DeBakery, MD. communicated "that in the great majority of situations [involving Witnesses] the risk of operation without the use of blood transfusions is no greater than in those patients on whom we use blood transfusions"  (personal communications, March 1981). The literature also records successful major urologic and orthopaedic surgery.  G.Dean MacEwen MD,  and J. Richard Bowen MD, write  that posterior spinal fusion "has been successfully accomplished for 20 (Witness) minors" (unpublished data, August 1981).  They add:  "The surgeon needs to establish the philosophy of respect for a patient's right to refuse blood transfusion but still perform surgical procedure 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 jw.org publications 

JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE - WITNESS POSITION ON THERAPY

Jehovah's Witnesses accept medical and surgical treatment.  In fact, scores  of them are physicians, even surgeons.  But Witnesses are deeply religious people who believe the blood transfusion is forbidden for them by Biblical passages such as: "Only flesh with its soul-its blood-you must not eat." ( Genesis 9:3,4) "[You must] pour its blood out and cover it with dust" [Leviticus 17:13, 14]; and  "Abstain from fornication and from what is strangled and from blood. - Acts 19:10-22. 

While these verses are not stated in medical terms, Witnesses view them as  ruling out transfusion of whole blood, packed RBC's and plasma, as well as WBC and platelet administration.  However, Witnesses' religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these.

Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood.  Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them.  However, many Witnesses permit the use of dialysis and heart-lung equipment (non-blood prime) as well as introperative salvage where the extracorporal circulation is uninterrupted; the physician should consult with the individual patient as to what his conscience The Witnesses do not feel that the Bible comments directly on organ transplants; hence, decisions regarding cornea, kidney, or other transplants must be made by the individual Witness.

Next time: JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE - MAJOR SURGERY POSSIBLE

From the jw.org publications

JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE

Physicians face a special challenge in treating Jehovah's Witnesses.  Members of this faith have deep religious convictions against accepting homologous or autologous whole blood, packed RBC's [red blood cells], WBC's  [white blood cells], or platelets. Many will allow the use of (non-blood prime) heart-lung dialysis, or similar equipment if the extracorporeal circulation is uninterrupted.  Medical personnel need not be concerned about liability, for Witnesses will take adequate legal steps to relieve liability as to their informed refusal of blood.  They accept non-blood replacement fluids.  Using these and other meticulous techniques, physicians are performing major surgery of all types on adult and minor Witness patients.  A standard practice for such patients  has thus developed that accords with the tenet of treating the "whole person." (JAMA 1981; 246:2471;2472)

PHYSICIANS face a  growing challenge that is a major issue.  There are over half a million Jehovah's Witnesses in the United States who do not accept blood transfusions.  The number of Witnesses and those associated with them is increasing. Although formerly, many physicians and hospital officials viewed refusal of a transfusion as a legal problem and sought court authorization to proceed as they believed was medically advisable, recent medical literature reveals that a notable change in attitude in occurring.  This may be a result of more surgical experience with patients having very low hemoglobin levels and may also reflect increased awareness of the legal principle of informed consent. 

Now, large numbers of elective surgical and trauma cases involving both adult and minor Witnesses met with surgical and administrative personnel at some of the largest medical centers in the country.  These meetings improved understanding and helped resolve questions about blood salvage,  transplants, and the avoidance of medical/legal confrontations.  

Next time: JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE - WITNESS POSITION ON  THERAPY

From the jw.org publications 

The Blood That Really Saves Lives - ENJOY LIFE SAVED BY BLOOD

When we understand what God says about blood, we come to have the greatest respect for its lifesaving value.  The Scriptures describe Christ as the one who 'loves us and who loosed us from our sins by means of his own blood.'  (Revelation 1:5;  John 3:16)  Yes, by means of Jesus' blood,we can gain full and lasting forgiveness of our sins.  The apostle Paul wrote: "Since we have been declared righteous now by his blood, shall we be saved through him from wrath."   That is how lasting life cam be saved by blood. - Romans 5:9; Hebrews 9:4.

Jehovah God long ago gave assurance that by means of Christ 'all the families of the earth can bless themselves.'  (Genesis 22:18) That blessing includes restoring the earth to a paradise.  Then believing mankind will no longer be afflicted with sickness, aging, or even death; they will enjoy blessings that far exceed the temporary aid medical personnel can now offer us. We have this marvelous promise:  "He will wipe out ever tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore.  The former things have passed away." - Revelation 21:4. 

How wise, then, for us to take to heart all of God's requirements!  That includes obeying his commandments about blood, not misusing it even in medical situations.  We thus will not live just for the moment. Rather, we will manifest our high regard for life, including our future prospect of everlasting life in human perfection.  

Next time: JEHOVAH'S WITNESSES THE SURGICAL/ETHICAL CHALLENGE

From the jw.org publications

The Blood That Really Saves Lives -Conclusion of THE ONLY BLOOD THAT IS LIFESAVING

The Bible compares the Messiah's role to what was done on Atonement Day:  "When Christ came as q high priest of the good things that came to pass, through the greater and more perfect  [temple] not made with hands, . . . he entered, no, not with the blood of goats and of young bulls, but with his own blood, once for all time into the holy place [heaven] and obtained an everlasting deliverance for us. Yes, nearly all things are cleansed with blood according to the Law, and unless blood is poured out no forgiveness takes place." - Hebrews 9:11, 12, 22. 

It thus became plain why we need to have God's view of blood.  In accord with his right as Creator, he has determined its exclusive usefulness. Israelites of old may have heaped health benefits by not taking in animal or human blood, but that was not the most important point.  (Isaiah 48:17) They had to avoid sustaining their lives with blood,  not primarily because doing otherwise was unhealthy, but because it was unholy to God. They were to abstain from blood, not because it was polluted, but because it was precious in obtaining forgiveness.

The apostle Paul explained about the ransom:  "By means of him [Christ] we have the release by ransom through the blood of that one, yes, the forgiveness of our trespasses, according to the riches of his undeserved kindness."  (Ephesians 1:7)  The original Greek word found there is properly translated  "blood,"  but a number of Bible versions err in substituting the word "death."  Hence, readers might miss the emphasis on our Creator's view of blood and the sacrificial value that he has linked to it.

The Bible's theme revolves around the fact that Christ died as a perfect ransom sacrifice but did not remain dead.  Following the pattern that God sent on Atonement Day, Jesus was raised to heaven to "appear before the person of God for us."  He presented there the value of his sacrificial blood. (Hebrews 9:24)  The emphasizes that we must avoid any course that would amount to 'trampling on the son of God and esteeming his blood as of ordinary value.' Only  this may we keep a good relationship and peace with God. - Hebrews 10:29; Colossians 1:20. 

Next time: The Blood That Really Saves Lives - ENJOY LIFE SAVED BY BLOOD

From the jw.org publications 

Blood That Really Saves Lives - THE ONLY BLOOD THAT IS LIFESAVING

As noted earlier, God told all mankind they must not eat blood. Why? Because blood represents life. (Genesis 9:3-6) He explained this further in the Law code given to Israel. At the time the Law code was ratified, the blood of sanctified animals  was used on an altar.  (Exodus 24:3-8) Laws in that code addressed the fact that all humans are imperfect; they are sinful, as the Bible puts it. God told the Israelites that by means of animal sacrifices offered to him, they could acknowledge the need to have their sins covered. (Leviticus 44:7, 13-18, 22:30)  Granted, that was what God asked of them back then, not what he asks of true worshipers today. Yet it has vital import for us now.

God himself explained the principle underlying those sacrifices:  "The soul [or, life]  of the flesh is in the blood, and I myself put it upon the altar for you to make atonement for your souls, because it is the blood that makes atonement by the soul in it.  That is why I have said to the sons of Israel:  'No soul of you must eat blood.'" - Leviticus 17:11, 12.

On the ancient festival called Atonement Day, Israel's high priest took blood of sacrificed animals into the most sacred part of the temple, the center of God's worship. Doing that was a symbolic way  of asking to cover the people's sins.  (Leviticus 6:3-6, 11-16)  Those sacrifices did not actually do away with all sin, so they had to be repeated each year. Still, this use of blood set a meaningful pattern. 

A major teaching in the Bible would eventually provide one perfect sacrifice that could fully atone for the sins of all believers.  This is called the ransom, and it focuses on the sacrifice of the foretold Messiah, or Christ. 

Next time: Blood That Really Saves Lives - Conclusion of THE ONLY BLOOD THAT IS LIFESAVING

From the jw.org publications

The Blood That Really Saves Lives

This same surgeon added:  "The passage of time and treating many patients has a tendency to change one's perspective, and today I find the trust between a patient and his physician, and the duty to respect a patient's wishes far more important than the new medical technology which surrounds us. . . It is interesting that the frustration has now given way to a sense of awe and reverence for that particular patient's steadfast  faith."  The physician concluded:  'It reminds me that I should always respect a patient's personal and religious wishes regardless of my feelings or the consequences.'

You may already realized something that many physicians  come to appreciate with "the passage of time and treating many patients."  Even if the best of medical care in the finest hospitals, at some point people die.  With or without blood transfusion, the die.  All of us are aging, and life's end is approaching. That is not fatalistic.  Dying is a fact of life. 

The evidence shows that people who disregard God's law on blood often experience immediate or delayed harm; some even die from the blood.  Those who survive have not gained endless life.  So blood transfusions do not save lives permanently. 

Most people who, for religious and/or medical reasons, refuse blood but accept alternative therapy do very  well.  They may thus extend their life for years.  But not endlessly.

Note: We all must die at some point in time, when Jehovah deems it to be. A lot of people say they know this, but in all honesty, the people that have said that, don't really believe it. I can see it in their eyes and face.  We have to face reality. We don't have an endless life.  We may have providing we have the true God in our life and worship the true God, follow all his laws, commandments, statutes, follow all Bible principles, keep the faith etc., because people,  we have to realistic and see the truth when we are given it and live by it. We are all better off when we do.  Our life is better off when we do. Believe it or not, Jehovah God does know and see all that is in our heart, our minds, and what we all are doing in this world. That is the truth.  

That all humans are imperfect and are gradually dying leads us to the central truth of what the Bible says about blood.  If we understand and appreciate this truth, we will see how blood can actually save life-our life-lastingly. 

Next time: The Blood That Really Saves Lives - THE ONLY BLOOD THAT IS LIFESAVING

From the jw.org publications 

The Blood That Really Saves Lives

Certain points are clear from the foregoing information.  Though many people view them as lifesaving, blood transfusions are fraught with risks.  Each year thousands die as a result of transfusions, multitudes more get very sick and face long-term consequences.  So, even from a standpoint, there is wisdom right now in heeding the Biblical command to 'abstain from blood.' -Acts 15:28, 29.

Patients are protected from many hazards if they request non-blood medical management. Skilled physicians who have accepted the challenge of applying this on Jehovah's Witnesses have developed a standard of practice that safe and effective, as is proved in numerous medical reports.  Physicians who provide quality care without blood are not compromising valued medical principles.  Rather, they show respect for a patient's right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life.

We are not being naive in this matter, for we realized that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook.  Hence, others, including some doctors, may find it hard to accept a patient's decision to abstain from blood. One New York surgeon wrote:  "I will never forget 15 years ago, as  a young intern when I stood at the bedside of a Jehovah's Witness who bled to death from a duodenal ulcer.  The patient's wishes were respected and no transfusions were given, but I can still remember the tremendous frustration as a physician I felt." 

He no doubt believed that blood would have been lifesaving. The year after he wrote that, however, The British Journal of Surgery (October 1986) reported that prior to the advent of transfusions, gastrointestinal  hemorrhage had "a mortality rate of only 2.5 percent."  Since transfusions became customary, 'most large studies report a 10-percent mortality.'   Why a death rate four time as high?  The researchers suggested:  "Early blood transfusions appears to reverse the hypercoagulable response to haemorrhage thereby encouraging rebleeding."  When the Witness with the bleeding ulcer refused blood, his choice may actually have maximize his prospects for survival. 

Next time: The Blood That Really Saves Lives

From the jw.org publications 

We Have the Right to Choose - Conclusion of LOVING CARE FOR CHILDREN

"Medical knowledge is not sufficiently advanced to enable a physician to predict with reasonable certainty that his patient will live or die. . . . If there is a choice of procedures - if, for example, the doctor recommends a procedure which has an 80 percent chance of success but which the parents disapprove, and the parents have no objection to a procedure which has only a 40 percents chance of success-the doctor must take the medically riskier but parentally unobjectionable course." 

In view of the many lethal hazards in medical use of  blood that have surfaced and because of there are effective ways of management, might not avoiding blood even carry the lower risk? 

Naturally, Christians weigh many factors if their children need surgery.  Every operation, with or without the use of blood, has risks.  What surgeon give guarantees? The parents may know that skilled physicians have had fine successes with bloodless surgery on Witness children.  So even if a physician or a hospital official has another preference, rather than cause a stressful and time-consuming legal battle, is it not reasonable for them to work with the loving parents?  Or parents may transfer their child to another hospital where the staff is experienced in handling such cases and willing to do so.  In fact, non-blood management will more likely to be quality care, for it can help the family "to achieve legitimate medical and non-medical goals," as we noted earlier.

Next time:  The Blood That Really Saves Lives

From the jw.org publications

We Have the Right to Choose - Continue with LOVING CARE FOR CHILDREN

In 1979 the U.S. Supreme Court stated clearly:  "The law's concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life's difficult decisions. . . . Simply because the decision of a parent [on a medical matter] involves risks not automatically transfer the power to make that decision from parents to some agency or officer of the state." -Parham v. J.R.

That same  year the New York Court of Appeals ruled:  "The most significant factor in determining whether a child is being deprived  of adequate medical care . . . is whether the parents have provided an acceptable course of medical treatment for their child in light of all the surround circumstances.  This injury cannot  be posed in terms of whether the parent has made a 'right or wrong' decision. for the present state of the practice of medicine, despite its vast advances, very seldom permits such definitive conclusions. Nor can a court assume the role of a surrogate parent." -In re Hofbauer.

Recall the example of parents choosing between surgery and antibiotics. Each therapy would have its  own risks. Loving parents are responsible  to weigh risks, benefits, and other factors and then to make a choice.  In this connection, Dr. Jon Samuels (Anesthesiology News, October  1989) suggested  a review of  Guides to the Judge in Medical Orders Affecting Children, which took this position. 

Next time: We Have the Right to Choose - Conclusion of  LOVING CARE FOR CHILDREN

From the jw.org publications

We Have the Right to Choose - LOVING CARE FOR THE CHILDREN

Court cases regarding blood mainly involve children.  On occasion, when loving  parents have respectively asked that non-blood management be used, some medical personnel  have sought court backing to give blood.  Of course, Christians agree with laws or court actions to prevent child abuse or neglect.  Perhaps you have read cases in which some parent brutalized a child or denied it all medical care.   How tragic!  Clearly, the State can and should step in to protect a neglected child.  Still, it is easy to see how very different it is when a caring parent requests high-quality non-blood medical therapy.

These court cases usually focus  on a child in a hospital.  How did the youngster get there, and why?  Almost always the concerned parents brought their child to get quality care.  Even as Jesus was interested in children, Christian parents care for their children. The Bible speaks  of 'a nursing mother cherishing her own children.' Jehovah's Witnesses have such deep love for their children. - 1 Thessalonians 2:7; Matthew 7:11; 19:13-15.

Naturally, all parents make decisions effecting their children's safety and life: Will the family use gas or oil to heat the home?  Will  they take a child on a long-distance drive?  May he go swimming?  Such matters involve risks, even the life-and-death ones.  But society recognizes parental discretion, so parents are granted the major voice in nearly all decisions affecting their children. 

Next time: We Have the Right to Choose - LOVING CARE FOR THE CHILDREN

From the jw.org publications 

We Have the RIght to Choose - RATHER THAN THE COURTS

Many people agree that a court is no place for personal medicine issues.  H0w would you feel if you chose antibiotic therapy but someone went to court to force a tonsillectomy on your?  A doctor may want to provide what he thinks is the best care, but he has no duty to seek legal justification to trample on your basic rights.  And since the Bible  puts abstaining  from blood on the same moral level as avoiding fornication, to force blood on a Christian would be equivalent of forcible sex-rape. -Acts 15:28,29. 

Yet, Informed Consent for Blood Transfusion (1989) reports that some courts are so distressed when a patient is willing to accept a certain risk because of his religious rights "That they make up some legal exceptions-legal fictions, if you will-to allow a transfusion to occur."  They might try to excuse it by saying that a pregnancy is involved or there are children to be supported.  "Those are legal fictions," the book says.  "Competent adults are entitled to refuse treatment."

Some who insist on transfusion blood ignore the fact that Witnesses do not decline all therapies.  They reject just one therapy, which even experts say is fraught with danger. Usually a medical problem can be managed in a variety of ways.  One has this risk, another that risk. Can a court or a doctor paternalistically know which risk is "in your best interest"?  You are the one to judge that.  Jehovah's Witnesses  are firm that they do not want someone else to decide fro them; it it their personal responsibility before God.

If a court forced an abhorrent treatment on you, how might this affect your conscience and the vital element of your will to live?  Dr. Konrad Drebinger wrote: "It would certainly be a misguided form of medical ambition that would lead to force a patient to accept a given therapy, overruling his conscience,  so as to treat him physically but dealing his psyche a mortal blow." - Der Praktische Arzt, July 1978. 

Next time: We Have the Right to Choose - LOVING CARE FOR CHILDREN

From the jw.org publications 

We Have the Right to Choose -OUR RIGHT IS RECONGNIZED

In many places today, the patients has an inviolable right to decide what treatment he will accept. "The law of informed consent has been based on two premises: first, that a patient has a right to receive sufficient  information to make an informed choice about the treatment recommended; and second, that the patient may choose to accept or decline the physician's recommendation. . . .  Unless patients are viewed has having the right to say no, as well as yes, and even yes with conditions, much of the rationale for informed consent evaporates." -Informed Consent-Legal Theory and Clinical Practice, 1987.

United States: "Underlying the necessity for patient consent is the ethical concept of individual autonomy, that decisions about one's own fate should be made by the person involved.  The legal ground for requiring consent is that a medical act performed without the patient's consent constitutes battery." - Informed Consent for Blood Transfusion, 1989. 

Germany: "The patient's right of self-determination overrides the principle of preservation of life.  As a result: no blood transfusion against the will of the patient." - Herz Kreislauf, August 1987. 

Japan:  "There is no 'absolute' in the medical world.  Doctors believe that the course of modern medicine is the best and follow its course, but they should not force every detail of it as an 'absolute' on patients. Patients too must have freedom of choice." -Minami Nihon Shimbun, June 28, 1985. 

Some patients have encountered resistance when they have tried to exercise their right. It might have been from a friend having strong feelings about a tonsillectomy or about antibiotics.  Or a physician might have been convinced of the rightness of his advice.  A hospital official might even have disagreed based on legal or financial interests. 

"Many orthopaedists elect not to operate on [Witness] patients," says Dr. Carl L. Nelson.  "It is our belief that the patient has the right to refuse any type of medical therapy.  If it is technically  possible to provide surgery safely while excluding a particular treatment, such as transfusion, then it should exist as an option." -The Journal of Bone and Joint Surgery, March 1986.

A considerate patient will not pressure a physician to use a therapy at which the doctor is unskilled .  As Dr. Nelson noted, though, many dedicated physicians can accommodate the patient's beliefs.  A German official advised:  "The doctor cannot refuse to render aid . . . reasoning that with a Jehovah's Witness not all medical alternatives are at his disposal.  He still has a duty to render assistance even when the avenues open to him are reduced."  (Der Frauenarzt, May-June 1083)  Similarly, hospitals exist not merely to make money but to serve all people without discrimination.  Catholic theologian Richard J. Devine states:  "Although the hospital must make every other medical effort to preserve the patient's life and health, it must ensure that medical care does not violate  [his] conscience.  Moreover, it must avoid all forms of coercion, from cajoling the patient to obtaining a court order to force blood transfusion." - Health Progress, June 1989. 

Next time: We Have the Right to Choose - RATHER THAN THE COURTS

From the jw.org publications

We Have the Right to Choose - RELIEVING THE LEGAL CONCERNS

This would also be so if it was your child that had the chronic tonsillitis.  The risks, and the benefits, and therapies  would be outlined for  you, the loving parents who are most directly affected and who will be responsible to cope with the results.  After considering all the aspects, you can make an informed choice on this matter involving your child's health and even his or her life.  Perhaps you consent to the surgery, with its risks.  Other patients might choose the antibiotics, with their risks.  As physicians differ in their advice, so patients or parents differ as to what they feel is best.  Such is an understood feature of making informed (risk/benefit) choices. 

What about use of blood?  No one who objectively examines the facts can deny that blood transfusions involve great risk.  Dr. Charles Huggins, who is the director of transfusion service at the large Massachusetts General Hospital, made this very clear:  "Blood has never been safer.  But it must be considered unavoidably non-safe. It is the most dangerous substance we use in medicine." -The Boston Globe Magazine, February 4, 1990. 

With good reason, medical personnel have been advised:  "It is necessary to reevaluate as well the risk of the benefit/risk relationship for blood transfusion and to seek alternatives ."  (Italics ours.) - Perioperative Red Cell Transfusion, National Institutes of Health conference, June 278-29, 1988. 

Physicians may disagree as to the benefits or risks in using blood.  One may give transfusions and be convinced that they are worth the risk.  Another may feel the risks  are unjustified, for he has had good results with non-blood management.  Ultimately, however, you, the patient or the parent must decide.  Why you?  Because your (or your child's) body, life, ethics, and profoundly important relationship with God are involved.

Next time: We Have the Right to Choose - OUR RIGHT IS RECOGNIZED

From the jw.org publications

You Have the Right to Choose - Continue with RELIEVING THE LEGAL CONCERNS

Witnesses will also sign hospital consent forms.  One used at a hospital in Freiburg, Germany, has space where the physician can describe the information he gave the patient about the treatment. Then, above the signatures of the physician and the patient, this form adds:  "As a member of the religious body of Jehovah's Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery.  I am aware that the planned and needed procedure thus has a greater risk due to bleeding complications.  After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components." - Herz Kreislauf, August 1987. 

Actually, non-blood management may have a lower risk.  But the point here is that Witness patients happily relieve any needless concerns so that the medical personnel can move forward in doing what they are committed to do, helping people get well.  This cooperation benefits all, as Dr. Angelos A. Kambouris showed in "Major Abdominal Operations on Jehovah's Witnesses": 

"Preoperative agreement should be views as binding by the surgeon and should be adhered to regardless of events development during and after operation.  [This] orients the patients positively toward their surgical treatment and diverts the surgeon's attention from the legal and philosophical considerations to the surgical and technical ones, thus, allowing him to  perform optimally and serve his patient's best interests." -The American Surgeon, June 1987. 

Each competent physician likely considered risks and benefits, but now you have to weigh the risks and possible benefits, as well as other factors that you best know. (You are in the best position to consider such aspects as your emotional and spiritual strength, family finances, effect on the family, and your own ethics.)  Then you make a choice.  Possibly you give informed consent for one therapy but decline the other. 

Next time: You Have the Right to Choose -Conclusion of RELIEVING THE LEGAL CONCERNS

From the jw.org publications 

You Have the RIght to Choose - RELIEVING LEGAL CONCERNS

You may wonder, 'Why are some doctors and hospitals quick to get a court order to give blood?'  In some places a common reason is fear of liability.

There is no basis for such concern when Jehovah's Witnesses choose non-blood management.  A doctor at Albert Einstein College of Medicine (U.S.A.) writes:  "Most [Witnesses] readily sign the American Medical Association form relieving the physicians and hospitals of liability, and many carry a Medical Alert [card].  A properly signed and dated 'Refusal to Accept Blood Produces' from a contractual agreement and is legally binding." -Anesthesiology News, October 1989. 

Yes, Jehovah's Witnesses cooperatively offer legal assurance that a physician or hospital will not incur liability in providing requested non-blood therapy.  As recommended by medical experts, each Witness carries a Medical Document card.  This is renewed annually and is signed by the person and by witnesses, often his  next of kin.

In March 1990, the Supreme Court of Ontario, Canada, upheld a decision that commented approvingly on such a document:  "The card is a written declaration  of a valid position which the card carrier may legitimately take in imposing a written restriction on [the] contract with the doctor."  In Medicinsk Etik (2985), Professor Daniel Andersen wrote:  "If there is an unambiguous written statement from the patient saying that he is one of Jehovah's Witnesses and does not want blood under any circumstances, respect for the patient's autonomy requires that this wish be respected, just as if it had been expressed orally."

Next time: You Have the Right to Choose -Continue with RELIEVING LEGAL CONCERNS

From the jw.org publications

You Have the Right to Choose

A current medical approach  (called risk/benefit analysis) is making it easier for doctors and patients to cooperate in avoiding blood therapy.  Doctors weight factors  such as the risks of certain drug or surgery and the probable benefits. Patients too share in such analysis.

Let us use one example that people in many places can  relate to-chronic tonsillitis.  If you had this problem, likely you would go to a doctor.  In fact, you might consult two, since health experts often recommend getting a  second opinion.  One might recommend surgery.  He outlines what that means: length of stay in the hospital,  amount of pain, and cost.  As to risks, he says that severe bleeding is not common and death from an operation is very rare.  But the doctor giving the second opinion urges you to try antibiotic therapy.  He explains the type of drug, likelihood of success, and expense. As to risk, he says that very few patients have life-threatening reactions to the drug. 

Next time: You Have the Right to Choose -RELIEVING LEGAL CONCERNS

From the jw.org publications

Quality Alternatives to Transfusions -SURGERY, YES-BUT WITHOUT TRANSFUSIONS

Many people today will not accept blood.  For health reasons, they are requesting what Witnesses seek primarily on religious grounds; quality medical care employing alternative non-blood management.  As we have noted, major surgery  is still possible.  If you have any lingering doubts, some other evidence from medical literature may dispel them.

Little children too?  "Forty-eight pediatric open heart surgical  procedures were performed with bloodless techniques regardless of surgical complexity."  The children were as small as 10.3 pounds (4.7 kg)  "Because of consistent success in Jehovah's Witnesses and the fact that blood transfusion carries a risk of serious complications, we are currently performing most of our pediatric cardiac operations without transfusion." -Circulation, September 1984.

The article "Quadruple Major Joint Replacement in Member of Jehovah's Witnesses"  (Orthopaedic Review, August 19 86) Told of an anemic patient with "advanced destruction in both knees and hips.  "Iron dextran was employed before and after the staged surgery, which was successful.  The British Journal of Anaesthesia (1983) reported on a52-year old Witness with a hemoglobin level under 10.  With the use of hypotensive anesthesia to minimize blood loss, she had a total hip and shoulder replacement.  A surgical team at the University of Arkansas (U.S.A.)   also used this method in a hundred hip replacements on Witnesses, and all the patients recovered.  The professor heading the department comments:  "What we have learned from (Witness) patients, we now apply to all our patients that we do total hips on."

Professor Dr. V. Schlosser, of the surgical hospital at the University of Freiburg (German), noted: "Among this group of patients, the incidence of bleeding during the preoperative period was not higher; the complications were, if anything, fewer.  The special view of illness, typical of Jehovah's Witnesses, had a positive influence in the preoperative process." - Herz Kreislauf, August 1987. 

Witnesses do not accept transfusions of whole blood, red cells, white cells, platelets, or blood plasma.  As to minor fractions, such as immune globulin, see the Watchtower of [June 15, 2000, pages 29-31]. 

The Watchtower of [October 15, 2000], pages 30-1, considers Bible principles that bear on methods of blood salvage on blood-circulating (extracorporeal) equipment. 

Next time: You Have the Right to Choose

From the jw.org publications

Quality Alternatives for Transfusion- Conclusion of HOW CAN DOCTORS HELP?

Patients on a heart-lung machine primed with non-blood fluid may benefit from the resulting hemodilution, few red cells being lost.

And there are other ways to help. Cooling a patient to lesson oxygen needs during surgery. Hypotensive anesthesia. Therapy to improve coagulation.  Desmopressin (DDAVP) to shorten bleeding time.  Laser "scalpels." You will see the list grow as physicians and concerned patients seek to avoid blood transfusions. We hope that you never lose a great amount of blood. But if you did, it is very likely that skilled doctors could manage your care without using blood transfusions, which have so  many risks. 

Next time: Quality Alternatives to Transfusion - SURGERY, YES-BUT WITHOUT TRANSFUSIONS

From the jw.org publications

Quality Alternatives to Transfusion - Continue with HOW CAN DOCTORS HELP?

The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded:  "The overall results suggest that real transplantation can be safely and efficaciously applied to  most Jehovah's Witnesses."  (Transplantation, June 1988) Likewise, refusal of blood has not stood in the way even of successful heart transplants.

What about bloodless surgery of other types?  You may wonder.  Medical Hotline (April/May 1983) Told of surgery on "Jehovah's Witnesses who underwent major gynecological and obstetric operations [at Wayne State University, U.S.A.] without blood transfusions."  The newsletter reported: "There were no more deaths and complications than in women who had undergone similar operations with blood transfusions."  The newsletter then commented:  "The results of this study may warrant a fresh look at the use of blood for all women undergoing obstetric and gynecological operations." 

At the hospital of Gottingen University (Germany), 30 patients who declined blood underwent general surgery."  No complications arose that could not also have arisen with  patients who accept blood transfusions. . . . That recourse to a transfusion is not possible should  not be overrated, and thus should not lead to refraining from an operation that is necessary and surgically justifiable." -Risiko in der Chirurgie, 1987.

Even brain surgery without using blood has been done on numerous adults and children, for instance, at New York Medical Center.  In 1989 Dr. Joseph Ransohoff, head of neurosurgery, wrote:  "It is very clear that in most instances avoidance of blood products can be achieved with minimal risks in patients who have religious  tenets against the use of these products, particularly if surgery can be carried  out expeditiously and with a relatively short operative period.  Of considerable interest is the fact that I often forget that the patient is a Witness until at the time of discharge when they thank me for having respected their religious beliefs."

Next time: Quality Alternatives to Transfusion - Conclusion of HOW CAN DOCTORS HELP?

From the jw.org publications

Quality Alternatives to Transfusion - HOW CAN DOCTORS HELP?

Skilled Physicians can help one who has lost blood and so has fewer red cells.  Once volume is restored, doctors can administer oxygen at high concentration.  this makes more of it available for the body and has often had remarkable results.  British doctors used this with a woman who had lost so much blood that  "her haemoglobin fell to 1.8 g/ditre.  She was successfully treated . . . [with] high inspired oxygen concentrations and transfusions of gelatin solution [haemaccel]."  (Anaesthesia, January 1987)  The report also says that others with acute blood loss have been successfully treated in hyperbaric oxygen chambers.  

Physicians can also help their patients to form more red cells. How?  By giving them iron-containing preparations (into muscles or veins), which can aid the body in making red cells three to four times faster than normal.  Recently another help has become available.  Your kidneys produce a  harmone called erythropoietin (EPO), which stimulates bone marrow to form red cells.  Now synthetic  (recombinant) EPO is available.  Doctors may give this to some anemic patients, thus helping them to form replacement red cells very quickly. 

Even during surgery, skilled can conscientious  surgeons and anesthesiologists can help by employing  advanced blood-conservation methods.  Meticulous operative technique, such as an electrocautery to minimize bleeding, cannot be overstressed.  Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation. 

Next time: Quality Alternatives to Transfusion - HOW CAN DOCTORS HELP?

From the jw.org publications 

Conclusion of Quality Alternatives to Transfusion

While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says:  "With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three  months . . . The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration  with no apparent clinical difficulties." -Pediatric Clinics of North America, February 1986. 

Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery.  If the loss is rapid and great, a person's blood pressure drops, and he may go into shock.  What is primarily needed is that the bleeding be stopped and the volume in his system be restored.  That will serve to prevent shock and keep the remaining red cells and other components in circulation. 

Volume replacement can be accomplished without using whole blood or plasma.  Various non-blood fluids are effective volume expanders.  The simplest is saline (salt) solution, such as dextran, Haemaccel, and lactated  Ringer's solution. Hetastarch (HES) is a newer volume expander, and "It can be safely recommended for those [burn] patients who object to blood products."  (Journal of Burn Care and Rehabilitation, January/February 1989)  Such fluids have definite advantages.  "Crystalloid solutions [such as normal saline and lactated Ringer's solution ] Detran and HES are relatively nontoxic and inexpensive, readily available, and can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease." -Blood Transfusion Therapy-A Physician's Handbook, 1989. 

You may ask, though,'Why do non-blood replacement fluids work well, since I need red cells to get oxygen throughout my body?'  As  mentioned, you have oxygen-carrying reserves.  If you lose blood, marvelous compensatory mechanisms start up.   Your heart pumps more blood with each beat.  Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels.  As a result of chemical changes, more oxygen is released to the tissues.  These adaptations are so effective that if only have of your red cells remain, oxygen deliver may be about 75 percent of normal.  A patient at rest uses only 25 percent of the oxygen available in his blood.  And most general anesthetics reduce the body's need for oxygen.  

Next time: Quality Alternatives to Transfusion - HOW CAN DOCTORS HELP?

From the jw.org publications

Continue with Quality Alternatives to Transfusion

Note, there are alternatives! This becomes understandable when we review why blood is transfused.

The hemoglobin in the red cells carries oxygen needed for good health and life.  So if a person has lost a lot of blood, it might seem logical just to replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood.  (Another measure of the concentration is hematocrit, which is commonly about 45 percent.) The accepted "rule" was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30 percent hematocrit.)  The Swill Journal Vox Sanguinis (March 1987) reported that "65% of (anesthesiologists) required  patients to have a preoperative hemoglobin of 10 gm/dl for elective surgery." 

But at a 1988 conference on blood  transfusion, Professor Howard L. Zauder asked, "How Did We Get a 'Magic Number'?" He stated clearly: "The etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in obscurity, and unsubstantiated by clinical or experimental evidence."  Imagine the many thousands of patients whose transfusions were triggered by an 'obscure, unsubstantiated' requirement! 

Some might wonder, 'Why is a hemoglobin level of 14 normal if you can by on much less?  Well, you thus have considerate reserve oxygen capacity so that you are ready for exercise or heavy work.  Studies of anemic patients even reveal that "it is difficult to detect a deficit in work capacity with hemoglobin concentration as low as 7 g/dl. Others have found evidence of only moderately impaired function." -Contemporary Transfusion Practice, 1987.

Next time: Conclusion of Quality Alternatives to Transfusion 

From the jw.org publications 

Quality Alternatives to Transfusion

You might feel, 'Transfusions are hazardous, but are there high-quality alternatives?'  A good question, and note the word "quality." 

Everyone, including Jehovah's Witnesses wants effective medical care of high quality.  Dr. Grant E. Steffen noted two key elements:  "Quality medical care is the capacity of the elements that care to achieve legitimate medical and non-medical goals.' " (The Journal of the American Medical Association, July 1, 1988) "Non-medical goals" would include not violating the ethics or Bible-based conscience of the  patient. - Acts 15:28, 29.

Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the the answer is yes. 

Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their case of blood dropped rapidly.  An editorial in Mayo Clinic proceedings  (September 1988) said that "one of the few benefits of the epidemic" was that it "resulted in various strategies on the part of the patients and physicians to avoid blood transfusion."  A blood-bank official explains:  "What has changed is the intensity of the message, the receptivity of clinicians to the message  (because of the increased perception of risks),  and the demand for consideration of alternatives." - Transfusion Medicine Reviews, October  1989.

Next time: Continue with Quality Alternatives to Transfusion

From the jw.org publications

Blood-Vital for Life! - THE NEXT SHOE? OR SHOES?

Many apartment dwellers have heard the thump of one shoe hitting the floor above them; the may then get tense awaiting for the second.  In the blood dilemma, no one knows how many deadly shoes may still hit.

The AIDS virus was designated HIV, but some experts now call it HIV-1.  Why?  
Because they found another virus of the AIDS (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by AIDS tests now in use here," reports the New York Times.  (June 7, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe."

Or what of distant relatives to the AIDS virus?  A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease."  This virus is already in the blood donor populations and can be spread in blood. People have a right to wonder, 'How effective is the blood-bank screening for such other viruses?' 

Really, only time will tell how many blood-borne viruses are lurking in the blood supply. "The unknown may be more cause for concern than the known," writes Dr. Harold T. Meryman.  "Transmissible viruses with incubation times measured in many years will be difficult to associate with  transfusions and even more difficult to detect.  The HTLV group is surely the first of these to surface."  (Transfusion Medicine Reviews, July 1989) "As if the AIDS epidemic were not misery enough, . . . a number of newly proposed or described risks of transfusion  have drawn attention during the 1980's. It does not require great imagination to predict the other serious viral diseases exist and are transmitted by homologous transfusions" -Living Homologous Exposure Alternative Strategies, 1989. 

So many "shoes" have already dropped that the Centers for Disease Control recommends  "universal precautions."  That is, 'health-care workers should assume that all patients are infectious for HIV and other blood-borne pathogens.'  With good reason, health-care workers and members of the public are reassessing their view of blood. 

We cannot assume that all blood is yet being tested.  For example, it is reported that by the start of 1989, about 80 percent of Brazil's blood banks were not under government control, nor were they testing for AIDS. 

Next time: Quality Alternatives to Transfusion

From the jw.org publications 

Blood-Vital for Your LIfe! -THE AIDS PANDEMIC

AIDS has changed forever the way doctors and patients think about blood. And that's no a bad idea, said the doctors gathered at the National Institutes of Health for a conference on blood transfusion." -Washington Post, July 5, 1988.

The AIDS  (acquired immunodeficiency syndrome) pandemic has, with a vengeance, awakened people to the danger of acquiring infectious diseases from blood.  Millions are now infected. It is spreading out of control. And its death rate is virtually 100 percent. 

AIDS is caused by the human immunodeficiency virus (HIV), which can spread by blood.  The modern plague of AIDS came to light in 1981.  The very next year, health experts learned that virus could probably be passed on in blood products. It is now admitted that the blood industry was slow to respond, even after tests were available to identify blood containing HIV antibodies.  Testing of donor blood finally began in 1985, but even then it was not applied to blood products that were already on the shelf. 

Thereafter, the public was assured, 'The blood supply is safe.' Later, however, it was revealed that there is a dangerous "window period" for AIDS.  After a person is infected, it could be months before he produces detectable antibodies. Unaware that he harbors the virus, he might donate blood that would test negative.  This has happened. People have developed AIDS after being transfused with such blood!

The picture got even grimmer. The New England Journal of Medicine (June 1, 1989) reported on "Silent HIV Infections."  It was established that people can carry the AIDS virus for years without its being detectable by current indirect tests.  Some would like to minimize these as rare cases, but they prove "that the risk of AIDS transmission via blood and its components cannot be totally eliminated." (Patient Care, November 30, 1989)  The disturbing conclusion: A negative test cannot be read as a clean bill of health. How many will yet get AIDS from blood? 

Next time: Blood-Vital for Life! - THE NEXT SHOE? OR SHOES?

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Blood-Vital for Life! - Conclusion of DISEASE FREE OR FRAUGHT WITH DANGER?

Even the test for hepatitis B is fallible;  many still contract it from blood.  Moreover, will people be satisfied with the announced test for hepatitis C?  The Journal of the American Medical Association (January 5 1990) showed that a year can pass before antibodies of the disease are detectable by the test.  Meanwhile, people transfused with the blood  may face ruined livers - and death.

Actually, the list of such diseases is growing.  You many have read headlines  such as "Lyme Disease From a Transfusion?  It's unlikely, but Experts Are Wary."  How safe is blood from someone testing positive for Lyme Disease?  A panel of health officials were asked if they would accept such blood."  "All of them answered no, although no one recommended discarding blood from such donors."  How should the public feel about banked blood that experts themselves would not accept? -The New York Times, July 18, 1989. 

A second reason for concern is that blood collected in one land where a certain disease abounds may be used far away, where neither the public nor the physicians are alert to the danger. With today's increase in travel, including refugees and immigrants, the risk is growing that a strange disease may be in the blood product.

Moreover, a specialist in disease warned:  "The blood supply may have to be screened to prevent transmission of several disorders that were not previously considered infectious, including leukemia, lymphoma, and dementia [or Alzheimer's disease]." - Transfusion Medicine Reviews, January 1989. 

Chilling as these risks are, others have created much wider fear.

Next time: Blood-Vital for Life! - THE AIDS PANDEMIC

From the jw.org publications 

Blood-Vital for Life! -Continue with DISEASE FREE OF FRAUGHT WITH DANGER?

Before long it was clear that thousands who were given screened blood still developed hepatitis.  Many, after debilitating illness, learned that their lives were ruined.  But if the blood had been tested, why was this happening? The blood contained another form, called non-A,  non-B hepatitis (NANB).  For a decade it plagued transfusions-between 8 ad 17 percent of those transfused in Israel, Italy, Japan, Spain, Sweden, and the United States contracted it. 

Then came headlines such as "Mysterious Hepatitis Non-A, Non-B Virus Isolated at last"; "Breaking a Fever in the Blood." Again, the message was, 'The elusive agent is found!' In April 1989, the public was told that a test was available for NANB, now being called hepatitis C.  

You might wonder if this relief is premature. In fact, Italian researchers have reported another hepatitis virus, a mutant, which might be responsible for a third of the cases.  "Some authorities, the Harvard Medical School Health Letter (November 1989) observed, "worry that A, B, C, and D are not the whole alphabet of hepatitis; yet others may emerge."  The New York Times (February 13, 1990) stated:  "Experts strongly suspect that other viruses can cause hepatitis, if discovered, they will be designated hepatitis E and so on." 

Are blood banks faced with more long searches for tests to make blood safe?  Citing the problem  of cost, a director of the American Red Cross made this disturbing comment: "We can't just keep adding test after test for each infectious agent that might be spread." -Medical World News, May 8, 1989.

Next time: Blood-Vital for Life! - Conclusion of DISEASE FREE OR FRAUGHT WITH DANGER?

From the jw.org publications

Blood-Vital for Life! DISEASE FREE OR FRAUGHT WITH DANGER?

Blood-borne disease worries conscientious physicians and many patients.  Which disease?  Frankly, if you cannot limit it just one, there are indeed many.

After discussing the more well-known diseases, Techniques of Blood Transfusion (1p82) addresses "other transfusion-associated diseases," such as syphilis, cytomegalovirus infection, and malaria.  It then says:  "Several other diseases gave also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis [African sleeping sickness and Chagas' disease],leishmaniasis, brucellosis [undulant fever], typhus, filariasis, measles, salmonellosis, and Colorado tick fever."

Yes,vast numbers have got very sick and have died from such hepatitis, which has no specific treatment.  According  to U.S. News &World Report (May 1, 1989), about 5%  of those given blood in the United States get hepatitis-175,000 people a year.  About half become chronic carriers, and at least 1 in 5 develop cirrhosis or cancer of the liver.  It is estimated that 4,000 die.  Imagine the headlines you would read if a jumbo jet crashed, killing all aboard.  But 4,000 deaths amount to a full jumbo jet crashing every month!

Physicians had long known that a milder hepatitis (type A) was spread through unclean food or water. Then they saw that a more serious form was spreading through blood, and they had no way to screen blood for it. Eventually, brilliant scientists learned how to detect "footprints" of this virus (type B). By the early 1970's, blood was being screened in some lands.  The blood supply appeared safe and the future for blood bright! Or was it?

Next time: Blood-Vital for Life! - Continue with  DISEASE FREE OR FRAUGHT WITH DANGER?

From the jw.org publications 

Blood-Vital for Life! -Conclusion of BLOOD AND YOUR IMMUNITY

A prime task of your immune system is detecting and destroying malignant (cancer) cells.  Could suppressed immunity lead to cancer and death? Note two reports. 

The Journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands:  "In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen.  In this group there was a cumulative 5-year overall survival of 48% for the  transfused and 74% for the non transfused patients.  "Physicians  at the University of Southern California followed up on a hundred patents  who underwent cancer surgery.  "The recurrence rate for all cancers of the larynx was 14%  for those who did not receive blood and 65% for those who did.  For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions." -Annals of Otology, Rhinology & Laryngology, March 1989.  What do such studies suggest regarding transfusions?  In his article "Blood Transfusions and Surgery for Cancer," Dr. John S. Spratt concluded:  "The cancer surgeon may need to become a bloodless surgeon." -The American Journal of Surgery, September 1986. 

Another primary task of your immune system is to defend against infection. So it is understandable that some studies show that patients receiving blood are more prone to infection.  Dr. P.I Tartter did a study of colorectal surgery. Of patients given transfusions. He reports:  "Blood transfusions were associated with infectious complications when given pre-, intra-,  or postoperatively . . .the risk of postoperative infection increased progressively with the number of units of blood given."  (The British Journal of Surgery, August 1988) Those attending  1989 meeting of the American Association of Blood Banks learned this:  Whereas 23 percent of those who received donor blood during hip-replacements surgery developed infections, those given no blood had no infection at all.

Dr. John A. Collins wrote concerning this effect of blood transfusion:  "It would be ironic indeed if a 'treatment' which has very little evidence of accomplishing anything worthwhile should subsequently be found to intensify one of the main problems faced by such patients."  -World Journal of Surgery, February 1987. 

Next time: Blood-Vital for Life! - DISEASE FREE OR FRAUGHT WITH DANGER?

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Blood-Vital for Life! - Continue with BLOOD AND YOUR IMMUNITY

When doctors transplant a heart, a liver, or another organ, the recipient's immune system may sense the foreign tissue and reject it.  Yet, a transfusion is  a tissue transplant.  Even blood that has been "properly cross matched can suppress the immune system. At a conference of pathologists. The point was made  that hundreds if medical papers "have linked blood transfusions to immunologic responses." -"Case Builds Against Transfusions," Medical World News, December 11, 1989.

A prime task of your immune system is detecting and destroying malignant (cancer) cells. Could suppressed immunity  lead to cancer and death! Note two reports. 

The journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands:  "In the patients with colon cancer, a significant adverse effect of transfusion on a long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the non-transfused patients."  Physicians at the University of Southern California followed up on a hundred patients who underwent cancer surgery.  "The recurrence rate for all cancers of the larynx was 14% for those who did not receive blood and 65% for those who did.  For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 32% without transfusions and 71% with transfusions." -Annals of Otology, Rhinology, & Laryngology, March 1989. 

Next time: Blood-Vital for Life! - Conclusion of  BLOOD AND YOUR IMMUNITY

From the jw.org publications