Continue with BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?

While physicians may voice concerns about ethics or liability, courts have stressed the supremacy of patient choice.  The New York Court of Appeals stated that "the patient's right to determine the course of his own treatment [is] paramount . . . [A] doctor cannot be held to have violated his legal or professional responsibilities when he honors the right of a competent adult patients to decline medical  treatment.  That court also observed that "the ethical integrity of the medical profession, while important, cannot outweigh the fundamental individual rights here asserted. It is the needs and desires of the individual, not the requirements of the institution, that are paramount."

When a Witness refuses blood, physicians may feel pangs of conscience  at the prospect of doing what seems to be less than the maximum.  What the Witness is asking conscientious doctors to do, though, is to provide the best alternative care possible under the circumstances.  We often muse alter our therapy to accommodate circumstances, such as hypertension, severe allergy to antibiotics, or the unavailability of certain costly equipment.  With the Witness patient, physicians are being asked to manage the medical or surgical problem in harmony with the patient's choice and conscience, his moral/religious decision to abstain from blood.

Numerous reports of major surgery on Witness patients show that many physicians can, in good consciences and with success, accommodate the request not to employ blood.  For example, in 1981, Cooley reviewed 1, 026 cardiovascular operations, 22% on minors. He determined "that the risk of surgery in patients of the Jehovah's Witness group has not been substantially higher than for others. Kambouris reported on major operations on Witnesses, some of whom had been "denied urgently needed surgical treatment because of their refusal to accept blood."  He said:  "All patients received pre-treatment assurances that their religious beliefs would be respected, regardless of the circumstances in the operating room.  There were no untoward effects of this policy."

When a patients is a Jehovah's Witness, beyond the matter of choice, conscience comes into the picture.  One cannot think only of the physicians conscience.  What of the patient's?  Jehovah's Witnesses view life as God's gift represented by blood. They believe the Bible's command that Christians must "abstain from blood."  ( Acts 15:28, 29). Hence, if a physician paternalistically violated such patients' deep and long-held religious convictions, the result could be tragic.  Pope John Paul II has observed that forcing someone to violate his conscience "is the most painful blow inflicted to a human dignity.  In a certain sense, it is worse than inflicting physical death, or killing."

Next time: Continue with BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?

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