Artificial Cells, Blood Substitutes, and Biotechnology

ISSN: 1073-1199 (Print) 1532-4184 (Online) Journal homepage: https://www.tandfonline.com/loi/ianb19

The View of Jehovah's Witnesses on Blood

Substitutes

Richard Bailey & Tomonori Ariga

To cite this article: Richard Bailey & Tomonori Ariga (1998) The View of Jehovah's Witnesses
on Blood Substitutes, Artificial Cells, Blood Substitutes, and Biotechnology, 26:5-6, 571-576, DOI:
10.3109/10731199809117476

To link to this article: https://doi.org/10.3109/10731199809117476

Published online: 04 Aug 2009.

Submit your article to this journal

Article views: 2643

View related articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=ianb20
ART. CELLS, BLOOD SUBS., AND IMMOB. BIOTECH., 26(5&6), 571-576 (1998)

THE VIEW OF JEHOVAH’S WITNESSES ON BLOOD SUBSTITUTES

Richard Bailey, Tomonori Ariga

Hospital Information Services,
Watch Tower Bible and Tract Society,
Kanagawa, Japan

PREFACE

With the exception of blood transfusions, Jehovah’s Witnesses accept the

full range of medical treatments. We are very much interested therefore in the
development of blood substitutes. We greatly appreciate the efforts being made
throughout the world by researchers and doctors in this regard and hope through
this conference to learn more about these studies. We are also pleased to have
this opportunity to present the view of Jehovah’s Witnesses on blood substitutes.

At present, the number of Jehovah’s Witnesses and their associates in

Japan is about 380,000. There are more than 2,000,000 in the United States, and
about 13,000,000 in the world, increasing at the rate of about 4.4 percent per year.

Under the direction of the Watchtower Bible and Tract Society whose
headquarters are in New York City, a department called “Hospital Information
Services” is set up in each of 104 branches around the world. This department
gives oversight to the Hospital Liaison Committees of Jehovah’s Witnesses in the
principal cities of more than 230 countries. The Hospital Liaison Committees
engage in various activities designed to promote cooperation between Witness
patients and medical professionals. They explain to medical and legal
professionals for example, the views of Jehovah’s Witnesses on medicine and
medical treatment and seek to clarify misconceptions. They also provide useful
medical and legal information helpful in dealing with Witness’ cases. On this
occasion, we would like to explain the view of Jehovah’s Witnesses on blood and
blood substitutes, as well as show how informed consent is related to treatment
by blood substitutes.

57 1

Copyright i(> 1998 by Marcel Dekker, Inc www,dekker.com

572 BAILEY AND ARIGA

BENEFITS OF BLOOD SUBSTITUTES

What is behind the growing interest in blood substitutes today? For one
thing, there is the growing awareness of the numerous risks associated with blood
transfusions. This is not only on the part of the medical professionals but also by
the public in general. For example, according to a Gallop poll conducted in
February 1996, 89 percent of Canadians requiring surgery, if given a choice,
would prefer an alternative to donor blood. When we consider the lethal risks
inherent in the use of blood or blood products, such as AIDS and hepatitis, as
well as the difficulties in completely eliminating those risks, even using the latest
screening techniques, we can see why the development of safe and effective
blood substitutes is very much desired.

When could blood substitutes be employed? When there has been

bleeding due to accident or surgery. If a blood substitute were available with a
long shelf life that could be immediately used regardless of blood type, it would
be a very effective tool in saving a patient’s life. Professor Eishun Tsuchida at
the Waseda University pointed out the various benefits of blood substitutes. He
stated that the development of blood substitutes is ‘a matter of widespread and
extremely important social significance, not only in normal medical treatment,
but as an emergency measure in large scale disasters such as earthquakes, coping
where there is no medical system in place, in addition to transfusing in districts
where specific blood diseases and AIDS are widespread, and treatment of blood
disorders.’ (1)

As is well known, based on their deeply held religious convictions and for
sound medical reasons, Jehovah’s Witnesses refuse blood transfusions.
Therefore, if blood substitutes acceptable to Jehovah’s Witnesses were
developed, these would be valuable options in treating them while respecting
their ethical views.

JEHOVAH’S WITNESS VIEW ON BLOOD

When considering what kind of blood substitutes would be acceptable to

Jehovah’s Witnesses, it is necessary to first consider their view of blood. The
Bible shows that blood represents life and therefore they understand that it should
be treated as sacred. Repeatedly the command is found ‘do not eat blood’
(Genesis 9:4) or “keep abstaining from . . . blood.” (Acts 15:28, 29) Jehovah’s
Witnesses believe that these commandments apply not only to animal blood, but
also includes human blood, and so refuse blood transfusions. Of course, blood
transfusions were not performed when the Bible was written, but they believe that
God’s commandment to abstain from blood includes not only taking in blood
JEVOHAH’S WITNESSES AND BLOOD SUBSTITUTES 573

through the mouth, but also through the veins in the form of a blood transfusion.
(2)
Based on this religious understanding, Jehovah’s Witnesses do not accept
whole blood, or major components of blood, namely, red blood cells, white blood
cells, platelets and plasma. Also, they do not accept hemoglobin which is a major
part of red blood cells. However, the decision whether to accept minor
derivatives of blood, namely blood plasma fractions, such as albumin, immune
globulins or clotting factors is up to each individual. In other words, the
conscience of some Jehovah’s Witnesses would allow them to accept these minor
blood fractions, but others would not. (3)

JEHOVAH’S WITNESS VIEW ON BLOOD SUBSTITUTES

What kind of blood substitutes do Jehovah’s Witnesses accept? They

make a decision in this regard based on the above mentioned principles. They
would not accept a blood substitute which contained a major component of blood
such as red blood cells, white blood cells, platelets, plasma or hemoglobin.
However, as to a blood substitute which contained a minor blood derivative such
as albumin, immune globulins, or clotting factors, each individual Jehovah’s
Witness would decide whether to accept it or not. Of course, a blood substitute
containing no blood, would normally be acceptable to Jehovah’s Witnesses.

According to these principles then, Jehovah’s Witnesses do not accept a

blood substitute which uses hemoglobin taken from a human or animal source.
They regard hemoglobin as a major part of blood. What about recombinant
hemoglobin? If it is made from non-blood bacteria such as E. coli (Escherichia
coli), and as long as no major component of blood is used in its process of
production or as an additive, it would generally be acceptable.

Some blood substitutes being developed today, include blood plasma

fractions such as albumin. As previously mentioned, each individual Witness,
would decide whether to accept it or not. In this connection, we can use
recombinant erythropoietin as an example, although this is not a blood substitute
in the strict sense, but a stimulant to red cell production. Some recombinant
erythropoietin products contain albumin as a buffer. Therefore use of this product
would be left up to the religious conscience of each individual Witness. Our
experience is that most Witnesses will accept erythropoietin.

Jehovah’s Witnesses accept totally synthetic blood substitutes. Therefore,

if safe and effective liposome embedded heme, perfluorochemicals or other
chemical blood substitutes were developed, these would be acceptable like other
514 BAILEY AND ARIGA

non-blood solutions. Consequently, Jehovah’s Witnesses very much anticipate

the development of safe and effective totally synthetic blood substitutes. Of
course, before using such products, the opportunity should be given to the
individual Jehovah’s Witness to decide whether to accept it or not after
considering its medical safety and effectiveness. This brings us to the very
important matter of informed consent.

BLOOD SUBSTITUTESAND INFORMED CONSENT

The matter of informed consent in connection with blood substitutes is a

very important one. In clinical trials involving the development of blood
substitutes, and also in dispensing the substitute blood product itself, it is
essential that the patient receive clear and complete information enabling him to
make an intelligent decision in harmony with his beliefs. Jehovah’s Witnesses
are concerned not only about the risks and benefits from using the product, but
especially about whether it contains blood, either as a base material or additive.
As we have mentioned, there are some products that would definitely be
objectionable, but others are in an area left to each individual Jehovah’s Witness
to decide. Therefore the doctors should make adequate explanation and gain the
patient’s consent before proceeding with its use.

The importance of informed consent has been recognized internationally.

The American Journal of Surgery carried an article in its June 1990 issue by Dr.
Lawrence T. Goodnough that recommends doctors explain to the patient “not
only relative risks and benefits of blood transfusion, but the alternatives.” (4)
Also in France, article 36 of the Medical Code of Ethics obliges the physician to
obtain his patient’s informed consent before any treatment. It states that where
the patient is capable of expressing his wishes, refuses the diagnostic procedures
or treatment proposed, the physician shall respect this refusal after having
informed the patient of the consequences thereof. ( 5 ) In addition, many legal
precedents in the United States, Canada and European countries have affirmed the
importance of respecting the patient’s informed consent and right to self-
determination.

The importance of informed consent is gradually being recognized in

Japan. The Report of the commission for the study of informed consent to the
Ministry of Health and Welfare (June 1995) stated: “Now, Japanese medicine is
corning to a big turning point, heading for a new state of medicine where we can
say ‘The times have ended where doctors made one-sided decisions’ and ‘the
times have ended when we did not know what drugs were being given to us.’” (6)
In addition, the Final Report of the Commission on Safety Assurance of Drugs to
JEVOHAH’S WlTNESSES AND BLOOD SUBSTITUTES 575

the Ministry of Health and Welfare (November 1996) stated, “It is a basic of
informed consent in pharmacotherapy that medical professionals fully explain to
patients the effects of a drug, how to take it, possible side-effects, and obtain their
understanding. Medical professionals have to fully appreciate that it is the efforts
of giving appropriate information to patients and of obtaining their understanding
that builds up a trustful relationship with patients and realization of better medical
treatment.” (7) As to what is required in informed consent, Dr. Michitaro
Nakamura stated the following in the Japan Medical Journal (1993): “It is the
idea that the doctor explains to the patient in easily understood words the illness
and prognosis, the method of treatment and side effects, and respects the patient’s
right of self-determination on the prognosis and method of treatment.” (8) We
eagerly hope that informed consent will be performed as a part of holistic
medicine in which the entire patient, including his rights and values are respected,
rather than merely being a means to avoid medical risks, and later litigation or
liabilities.

CONCLUSION

We have explained the benefits of blood substitutes, the view of

Jehovah’s Witnesses on blood and its substitutes and the concept of real informed
consent in connection with blood substitutes. The development of safe and
effective blood substitutes, especially totally synthetic substitutes can be a very
valuable option in treating Witness patients while respecting their ethical views
and values. At the same time, the development of such blood substitutes will lead
to overcoming the problems and limits of blood transfusion therapy, and will
bring inestimable benefits, not only to Jehovah’s Witnesses but also all patients in
the world. When such development is advanced along with true informed
consent, which respects the patient’s human rights, we believe that it will greatly
contribute to the advancement of medicine throughout the world. We deeply
appreciate and respect the efforts having been made in this regard by researchers
and doctors, and hope for further success in their studies and future
developments.

REFERENCES

1. Eishun Tsuchida. Blood Substitutes - Perspective on oxygen transport

systems -. Biomedical Perspectives. 3: 67 ( 1994).
2. How Can Blood Save Your Life? Watch Tower Bible and Tract Society of
Pennsylvania. 6-7 (1990).
576 BAILEY AND ARIGA

3. The Watchtower. Watch Tower Bible and Tract Society of Pennsylvania. June
1: 30-31 (1990).
4. Lawrence T. Goodnough, et al. Risks, Options, and Informed Consent for
Blood Transfusion in Elective Surgery. The American Journal of Surgery. 159:
607 (1990).
5. E c r e t no 95-1000 du 6 semtembre 1995 portant code de dkontologic
medicale. J.O. 8 September, 13305 (1995).
6. The Public Welfare Ministry. The Informed Consent Commission Report. 1
(1995).
7. The Public Welfare Ministry. The Final Report of Commission on Safety
Assurance of Drugs, 5 (1996).
8. Michitaro Nakamura. Relationship Between Patient’s Right of Self-
Determination and Doctor’s Right of Free Discretion. Japan Medical Journal,
95; 3632 (1993).