JEHOVAH’S WITNESSES:

ETHICAL ISSUES

Ma. Cristina S. Sombilon, M.D., F.P.S.P.

Department of Medical Humanities
UERMMMC College of Medicine
GENERAL OBJECTIVES
1. Determine the special ethical issues
inherent to JEHOVAH'S WITNESS
patients and understand the background
of their religious belief system.

2. Be able to make sound ethical

decisions
in various medical situations involving
JEHOVAH’S WITNESS patients.
Ma. Cristina S. Sombilon, MD, FPSP
Department of Medical Humanities UERMMMC
PRINCIPLES IN
BIOETHICS
 A – Autonomy
 B – Beneficence
 C – Confidentiality
 D – Do no harm (Non-maleficence)
 E – Equality (Justice)

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
ETHICAL ISSUE IN JEHOVAH’S
WITNESSES
and PRINCIPLES BEHIND
IT REFUSAL OF BLOOD TRANSFUSIONS
EVEN IN LIFE THREATENING CONDITIONS

AUTONOMY – Respect for Persons

JUSTICE – Patients be treated fairly and their
religious beliefs be respected
versus
NON-MALEFICENCE
BENEFICENCE
STEWARDSHIP

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
RELIGIOUS
BACKGROUND
 Sect founded by Charles Russel in

Pittsburgh, PA in 1872
 Steadily grown in number through years

 LITERAL TRANSLATION of BIBLE

Genesis 9:4 “only you shall not eat flesh with its life,
that is, its blood”
Leviticus 17:10 “I will set my face against that person
who eats blood, and I will cut him off from among his
people” (RSV)

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
RELIGIOUS ORGs of JW
WATCH TOWER BIBLE and TRACT SOCIETY (WTS)
- controlling religious organization
- releases official statements / positions
“death due to lack of blood transfusion is nothing
compared to eternal life to be obtained from refusing blood.”

ASSOCIATED JEHOVAH’S WITNESSES

for REFORM ON BLOOD (AJWRB)
- believe otherwise, that teaching on
blood is irrational and misinterpreted

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
AJWRB claims congregants who elect for blood
transfusion will be “disfellowshipped”;
unrepentant members will be “shunned”

“shunning” – a powerful and persuasive tool for

members to refuse blood transfusion; separates
members from family and community

“ a clear impediment to a Jehovah’s

Witness patient’s true AUTONOMY”

Autonomous decisions require intent, understanding,

and an absence of controlling influences

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
AUTOLOGOUS Transfusion – also NOT allowed

CELL SAVERS – as in dialysis / heart-lung machines are ALLOWED

WTS – in 15 June 2000 issue of the The Watchtower published a

change in policy which allows “fractions of all primary components”

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
NON-BLOOD EXPANDERS -- are ALLOWED
- Ringer’s lactate, dextran, hydroxyethyl starch, aprotinin,
antifibrinolytics

BLOODLESS MEDICINE and SURGERY ALLOWED:

- FLUIDS to prevent hypovolemic shock
- DRUGS: genetically engineered proteins like eythropoietin,
interleukin-11 (platelets), WBC growth stimulating proteins,
desmopressin to help reduce acute blood loss
- BIOLOGICAL HEMOSTATS: to stop bleeding on application
Like collagen and cellulose woven pads; fibrin glues and sealants
to plug puncture wounds.
- BLOOD SALVAGE: lost blood in surgery salvages, cleansed
And returned to patient in a closed circuit.
- MINIMALLY INVASIVE SURGICAL PROCEDURES

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
ETHICAL DILEMMAS in JW
patients:
Dr. Osamu Muramoto:
1. Are JWs truly INFORMED?
2. Do JWs truly have AUTONOMY?
3. Does consultation with church (WTS) officials promote
patient autonomy?
4. Can rational deliberation change a patient’s view?
5. Can irrevocable loss of life be justified, based on the
inconstant doctrinal system of JWs?

“Physicians may inadvertently promote irrationality and

unethical practices by giving UNQUESTIONING SUPPORT
to JW patients’ decisions of refusal of blood transfusion.”

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
Dr. Thomas R. McCormick: (Univ. of Washington School of Medicine)
“Health care professionals often seek to HONOR THE AUTONOMY OF
JW regarding blood transfusion, yet their fellow members do not
respect the autonomy of individuals who, in conscience, elect to
receive blood.”

Dr. Osamu Muramoto: (Kaiser Permanente NE Division, Oregon)

“If there is no reasonable alternative to blood-based treatment or if this
form of treatment is significantly high risk and costly, use a RATIONAL
NON-INTERVENTIONAL PATERNALISTIC APPROACH”
- do not automatically accept the instructions in the BLOOD CARD
they carry (check validity dates)

- IN EMERGENCIES, STABILIZE THE PATIENT FIRST AND

REMOVE THE PATIENT FROM IMMEDIATE DANGER OR
DISABILITY until a court ruling or assessment of the card is made.

- MAIN PROBLEM: Legal

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
.

• In STABLE CASES and those requiring ELECTIVE

TRANSFUSION:

1. validate the patient’s status as a COMPETENT JW

2. have a confidential meeting with the patient about
informed refusal of blood product, in an atmosphere FREE
FROM INFLUENCE OF CHURCH MEMBERS, PEERS, FAMILY
3. consultation with CHURCH be made only if the patient
REQUESTS FOR IT

• REMEMBER: Avoid coercion and deception that can deny

patient's autonomy and can result in charges of battery.

Ma. Cristina S. Sombilon, MD, FPSP

Department of Medical Humanities UERMMMC
In the case of MINORS, courts have sometimes
ordered transfusions despite parental objections,
arguing that the principle of "parens patriae"
requires the state to take an overriding interest in
the health and welfare of its citizens.

Using similar reasoning, courts have sometimes

ordered a transfusion in PREGNANT WOMEN to
save the life of the fetus.

Ma. Cristina S. Sombilon, MD, FPSP || Depatment

of Medical Humanities UERMMMC