Tom Anthony A.

Tonguia MSMT-1 April 27,2020

No Blood – Medicine Meets the Challenge

The title of the documentary is “No Blood-Medicine meets the challenge”. This was
released on 2001 by Watchtower. Notable characters include Professor Charles H. Baron
which is from the Jehovah’s witness. The documentary begins with cases in which patients
needs a life-threatening operation and because of religion, the person subject to the
operation rejects a blood transfusion that could make the operation smooth because
surgery sometimes cause blood loss that the patient really need to be transfused with
blood in order to compensate the loss of blood during the operation. In this documentary,
we will learn some of the medical procedures or alternative strategies that has been used
to compensate or avoid blood transfusion to treat the patient successfully.
These new strategies may soon benefit all patients including persons whose
religion is Jehovah’s witness. The documentary talks about how diverse people are which
includes how people accept different languages, customs, cultures and how they accept
different religious beliefs. Adapting to these may have an effect in the human society and
a singular challenge in the medical community. Professor Oliver Guillod thinks that the
duty of the physicians is not simply to preserve life but the first and foremost duty of
physicians is to respect the patients. It was a challenge for the medical community
especially one religious’ group, Jehovah’s witnesses because of their avoidance with blood
resulting misconceptions in the public.
Eugene Rosam, a spokesperson of the Jehovah’s witness stated a verse in the
bible in Acts 15:20 stating to abstain from blood. They also talked about the right to choose
treatment of the patient especially blood transfusions. According to David Day, all patients
as a general rule have the right to receive treatment or to refuse to receive that treatment
after they’ve had full, open and candid discussion with the treating physician. Physicians
had stamped the standard of being blood as a standard treatment for blood loss with the
idea that blood is the gift of life and that blood is good for you according to Dr. Peter
Carmel. Dr. Avroy Fanaroff said that the refusal of blood transfusion concerns the
physicians because it may jeopardize the life of the patient. They discussed also how blood
functions in the body.
According to Dr. Nicholas Namais, if there’s no blood to bring the oxygen to the
cells, the cells dies and the body dies. There were two urgent priorities if a patient is
suffering a severe blood loss: First, you need to stop the bleeding, according to Dr. Edwin
A. Deitch, it is the most critical immediate need of the patient. Second, is to restore the
volume within the system. If none of these is done, then the patient will most likely die
because there’s no delivery of blood in to the brain and other organs. Increasing number
of patients are opting out blood transfusion for personal reasons. According to Professor
Roland Hetzer, at least 80 percent of the patients would strongly favor not to have blood
transfusions. In the 80s until the present time, concerns about transfusion transmitted
infections or TTIs raised, such as concerns of contracting such as HIV/AIDS, Hepatitis B,
Hepatitis C and etc.
Tranfusion reactions and clerical errors was also believed to be a factor on why
patients are opting out of blood transfusions. Because of these concerns, physicians have
spurred a wide range of alternative strategies that have been acceptable to Jehovah’s
witnesses and to those choosing to opt out blood transfusions. Alternative strategies have
been grouped into four organizing principles: First is to minimize blood loss. Minimizing or
avoiding blood loss is said to be the important technique to control bleeding. Various
instruments have been available to minimize bleeding in surgeries.
According to Dr. Nicholan Namais, there are strategies for interoperatively using
electrocautery instead of scalpels. There is also a recommendation of stopping the
bleeding, usage Argon-Beam coagulator delivers radiofrequency electrical energy to
tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal
hemostasis. Another one is the use of fibrin glue. The fibrin glue is made from blood
fractions that stimulates coagulation upon contact. Second, is to conserve red blood cells.
There are new technologies that has been used in conserving blood, there is this
hemodilution ad reinfusion. Hemodilution induces macro and microcirculatory responses,
allowing the adaptation of the organism to the dilution-associated reduction in the oxygen
content of the blood. Another strategy used is recovering the lost blood. Dr. Richard K.
Spence stated that we can use cell saver. Cell saver is a technology that uses a cell
salvage technique. In a cell saver machine, it can suction up any blood that’s lost, then it
will be washed up, cleaned, processed, filtered and it goes back to the system of the
human body.
Lastly is we stimulate blood production. One suggests the use of erythropoietin.
Erythropoietin is a natural substance which is formed in the kidneys and other organs as
well but mainly in the kidneys to help our bone marrow to form RBCs (red blood cells) that
is carrying our oxygen. It is considered to be a key element of the body’s ability to replenish
its own blood supply. There are case histories presented in the documentary, one of them
is Leslie which is diagnosed with scoliosis.
It was a difficult surgery because she can’t receive blood transfusion. They look for
alternatives such as hemodilution and the use of cell saver and with careful surgery
minimizing the risk of blood loss, they were able to do the surgery successfully. Another
case was a 75-year-old Dorothy McPhee whose suffering for an abdominal aortic
aneurysm which is a life-threatening condition, that traditionally requires extensive
surgery. Dorothy is a Jehovah’s Witness, in which she can’t have a blood transfusion. They
used a surgical technique that is called endovascular aortic surgery which can minimize
blood loss during surgery, then she also recovered from the successful surgery.
With this development, we can truly say that this issue is not limited to the
Jehovah’s witnesses but with these advances I think I should say that it raised the bar high
for physicians to do bloodless surgery. Major Spry, a Jehovah’s witness spokesman
quoted “I guess it could be likened to a patient who is allergic to penicillin. You wouldn’t
expect the physician to say, ‘Well I’m sorry I can’t treat you because I can’t administer
penicillin. ‘No, he simply says, “We’ll give you a medical alternative. We’ll give you another
antibiotic.’ Then he gets on with treating the patient.” Dr. Richard K. Spence believed that
transfusion alternatives clearly are good medical practice.
If I were to evaluate the movie, I think it presented some good points and things
that I could agree on. I would agree that we humans are diverse, we have different cultures
and religious beliefs. One religion stood out from the movie and that Jehovah’s Witnesses.
Without the concern of opting out blood transfusion, we won’t be able to really look upon
alternatives in compensating blood loss. Truly this is an advancement in medicine. I think
the documentary is pointing out that rejecting blood transfusion is not only sole for
Jehovah’s witnesses, it proves that we have a right to decide whether we want this blood
transfusion or not. I would agree to Professor Oliver Guillod that the duty of physicians is
not simply to preserve life but the first and foremost duty of physicians is to respect the
patient.
Which is why I say that we have the right to choose treatment. I have a question
regarding the Jehovah’s witnesses, why do they reject blood transfusion? According to the
documentary, Eugene Rosam, a Jehovah’s witness spokesman quoted a scripture in the
bible saying to “Abstain from blood” (Acts 15:20). Based on the book “Jehovah’s Witness
and Question of Blood by Watchtower (1977), Jehovah’s witnesses cherish and deeply
respect life. They also believe in the bible verse found in Genesis 9:3,4 stating “A human
is not to sustain his life with the blood of another creature”. Another verse from Leviticus
17:13,14 stating “When an animal life is taken the blood representing that life is to be
poured out, given back to the life giver”.
Do science really consider the facts of this? no it does not but merely if we are for
example a physician treating a Jehovah’s witness patient, we want to have respect for the
beliefs of the patient. Blood is a gift of life, but I believe that blood is not the only treatment
that can be done in treating severe blood loss. What matters is that we value the life of the
patient, we do the best that we can do and we respect them as they respect us. One factor
also on why do people refuse to have transfusions including Jehovah’s witnesses is the
fear of having infected blood. In the 80s, AIDS come out. In the movie “And the Band
Played On”, there was a concern of the blood banks having contaminated blood.
 No testing was done in that time, only the blood product is filtered and separated.
Study shows in the movie that most of the donors are HIV positive that caused to passed
on to immunocompromised patients in particular hemophiliacs. HIV/AIDS is not the only
transfusion transmitted infections occurring, one of them also is your Hepatitis B, Hepatitis
C, Syphilis, HTLV, malaria, Trypanosoma cruzi infections and etc. Concerns about this
includes also your transfusion reactions and clerical errors in the blood facility or in the
hospital based on testing example of that is mixing of the blood, wrong blood given and
false positives results in crossmatching. In this present time, we have developed different
kinds of alternatives and approaches in dealing with this situation. In minimizing blood loss
alternatives such as electrocautery instead of scalpels, the use of the Argon-Beam
Coagulator and the use of fibrin glue. Another alternative used is using hemodilution
technique and using cell saver that salvages the cell and bought back to the body. The
use of erythropoietin can be also used, it is an enzyme that promotes blood production to
compensate the lost blood.
To conclude, I believe that medicine is very diverse and deep. We as medical
healthcare professionals can also contribute to discoveries of various advancements in
medicine. I believe that advancement in medicines is still a lot that we are to discover in
the future. I totally agree with the documentary because it tells us that treatment is has its
own choice. I was really amazed of what turn out this issue into developing advancement
in the field of medicine. Dr. Stephen M. Crohn quoted that “the belief that you don’t want
a blood transfusion should not in the way, that it should be a tiny part of the whole medical
care environment, that should be acknowledged, put over to the side”. Transfusion
alternatives is really a good practice not only in treatment but also ideas that can be utilized
by physicians all over the world.

References:
Watchtower (1977). Jehovah’s Witnesses and Question of blood. Watchtower Bible and
Tract Society of New York, Inc.

Harmening, D. (2005). Modern Blood Banking and Transfusion Practices (5th ed.).
Philadelphia, Pennsylvania: F.A Davis Company.

https://www.sciencedirect.com/topics/medicine-and-dentistry/hemodilution
https://www.ncbi.nlm.nih.gov/pubmed/1920562
https://www.ncbi.nlm.nih.gov/pubmed/20879634
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307508/
https://my.clevelandclinic.org/health/drugs/14573-erythropoietin-stimulating-agents
https://wol.jw.org/en/wol/d/r1/lp-e/202004447
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096856/
https://www.youtube.com/watch?v=QJkI4jdBxgA
https://www.fandango.com/and-the-band-played-on-104514/plot-summary