For very understandable reasons, health care providers sometimes resist patient’s directives refusing life- sustaining treatment. This resistance is due, in part, to a general uncomfortability of letting people die in hospitals, where the means to prolong their lives are at our disposal. It is very uncomfortable to let people die. Such situations create conflict with individual decision making and autonomy. Autonomous decision making is grounded on the ethical value of personal determination and dignity, and in the legal right to make intimate, personal decisions, especially those involving bodily integrity. Ethical values and legal rights take center stage in conflicts involving the decision to refuse life- sustaining treatment.
Transfusing of blood or blood components is a nursing procedure which requires direct order form physicians. The nurse is responsible for the assessment of the patient’s situations before and during this procedure. This is their one big serious task and responsibility.
Nonetheless, nurses should not just zero in on the “hows” of blood transfusion. It is logical and practical to understand the moral and the legal implications that go with it.
A. Blood Transfusion/ Replacement
Blood replacement/ transfusion is the intravenous administration of whole blood or components such as plasma, packed RBC’s or platelets. Blood transfusion is resorted to:
1. Increase circulating blood volume after surgery, trauma or hemorrhage;
2. Increase the number of red blood cells and maintain hemoglobin levels in clients with severe anemia; and
3. Provide selected cellular components as replacement therapy (for example, plasma- clotting factors to help control bleeding in the case of hemophilia) (Higgins, 1995).
B. History of Blood Doctrine
Physicians know little of the history of the blood policy and its enforcement, which raises questions in light of medical ethics. Lack of this knowledge in the medical community contributes to the generally supportive attitude, even though many physicians do not agree with the practice.
The Watch Tower Bible and Tract Society or the WTS has a long history of changing doctrines regarding medical issues. Few remember that the WTS once denounced vaccinations and organ transplants in severe terms and with flaming rhetoric. They based their prohibition on the same scriptural interpretation as the current blood prohibition; that those practices were “against Jehovah’s everlasting covenant with mankind” (Genesis 9:4). They called vaccinations “a crime, an outrage, and a delusion” and “the most barbarous practice”, and prohibited organ transplants as cannibalism, only quietly to reverse these positions as those practices became standard medical care. Most Jehovah’s Witness accepted this reversal without questioning whatever tragedies that had been caused by the misguided doctrines. Once denounced as strongly as blood transfusion, vaccinations and organ transplants are now considered “matters of conscience” by the WTS. Most JWs receive these treatments routinely and recent WTS publications describe positively the benefits of blood transfusion (Higgins, 1995).
While most people dislike constantly changing religious doctrines, JWs are taught to welcome such changes, based on Proverbs 4:18 “ The path of the righteous is like the first gleam of dawn, shining ever brighter till the full light of the day.” They are taught that changing doctrines should be welcomed as” new light” or “new understanding from God” and are proof that they are on “ the path of the righteous.” (Hughes, 1978).
C. Biblical basis of blood doctrine
Prohibition of blood transfusion was first promulgated in the Watchtower on July 1, 1945. The doctrine is based in three Biblical passages.
The first passage is Genesis 9: 4 where God (Jehovah) established a covenant with Noah: “But you must not eat meat that has it lifeblood still in it. The WTS says that the prohibition against eating blood is a part of the eternal covenant with mankind.
The second passage is from Leviticus 17: 10- 16 where God gave a law to Moses, saying: “None of you may ear blood, nor may any alien living among you eat blood” (Leviticus 17:12). Since Christians are no longer under the Mosaic Law, JWS argue that only one dietary law is binding: Leviticus 3:17, which says “This is a lasting ordinance for the generations to come, wherever you live: You must not eat any fat or any blood.
The third passage is from Acts 15 where James proposes to write a letter to Gentile Christians, urging them to follow Jewish customs as follows”
“It seemed good to the Holy Spirit and to us not to burden you with anything beyond the following requirements: You are to abstain from food sacrificed to idols from blood, from the meat strangled animals and from sexual immorality. You will do well to avoid these things. Farewell.” (Acts 15: 28, 29)
One problem with WTS application of this verse to blood transfusion is the lack of evidence that this verse was meant as an everlasting command for all Christians in an absolute sense. Most scholars view the context of Acts 15 this way: The so- called Jerusalem Council was held because a dispute arose about whether the Gentile Christians should be circumcised in accordance with the Mosaic Law. The council decided that Christians were not under the Mosaic law but in order to maintain a peaceful relationship between Jewish and Gentile Christians the council decided to ask Gentiles to follow the touchiest Jewish traditions, including avoiding eating blood. Paul, who taught that eating food sacrificed to idols is a matter of conscience event though Acts 15 mentions it in the same terms as eating blood, supports this interpretation ( 1 Corinthians 8: 4-8).
Ironically, the founder of WTS, Charles Taze Russell interpreted Act 15 in line with many Bible scholars, and considered abstaining from eating blood as “a basis of common fellowship between” Jews and Gentiles and “necessary to the peace of the church,” not as an everlasting law for all Christians. If his interpretation were adopted by the WTS today, blood prohibition would not exist. Most Jehovah’s Witness do not know this (Higgins, 1995).
D. Blood transfusion—the same as eating blood
The WTS argues that since the Bible forbids eating blood, Jehovah’s Witness should not take it into the body by any route including transfusion. In support of this, they quote 17th century anatomist Thomas Bartholin and French physician Jean Baptiste Denys to show that blood transfusion was equated with nourishing the body by mouth (Drane, 1994). The WTS fails to mention that modern medicine had abandoned this concept many decades ago. Current blood transfusion merely replace functions lost due to blood loss, such as oxygen transport—-a concept entirely different from that held by certain 17th- century physician.
The WTS has used the following analogy:
“A patient in the hospital maybe fed through the mouth, through the nose, or through the veins. When sugar solutions are given intravenously it is called intravenous feeding. So the hospitals’ own terminology recognizes feeding the process of putting nutrition into one’s system via the veins. Hence the attendant administering the transfusion is feeding the patient through the veins, and the patient receiving it is eating through his veins.”(Drane, 1994).
A more recent version of the scenario is:
“In a hospital, when a patient cannot eat through his mouth, he is fed intravenously. Now, would a person who never put blood into his mouth but who accepted blood by transfusion really be obeying the command to “keep abstaining from blood” (Acts 15:29)? To use a comparison, consider a man who is told by the doctor that he must abstain from alcohol. Would he be obedient if he quit drinking alcohol but had it put directly into his veins?”
As any medical professional knows, this argument is false. Orally ingested alcohol is absorbed as alcohol circulates into the blood, whereas orally eaten blood is digested and does not enter the circulation as blood. Blood introduced directly into the veins circulates and functions as blood, not as nutrition. Hence, blood transfusion is a form of cellular organ transplantation. And organ transplants are now permitted by the WTS. These inconsistencies are apparent to physicians and other rational people, but not to Jehovah’s Witness because of the strict policy against viewing critical judgments, they continue to view the WTS’s illogical analogy as “the truth”.
For Jehovah’s Witness saying “yes” to blood transfusion is “against God’s word”. The current JW position includes unconditional refusal of whole blood, packed red blood cells and white blood cells, platelets and plasma. However, they may accept albumin, immunoglobulin and hemophiliac preparations. Those components are considered a “conscience of matter.” (Hughes, 1978).
Perhaps the most peculiar and inconsistent aspect of the JW policy is that they may accept all of the individual components of blood plasma, as long as they are not taken at the same time. In addition, JWs do not even accept autologous transfusion of their predeposited blood, though intraoperative salvage is accepted as long as extra corporeal circulation is uninterrupted via a tube. They may also accept treatment by heart- lung hemodialysis machines. More recently induced haemodilution has been permitted (Drane, 1994).
One subtle irony that most JWs are not aware of is that albumin, constitutes 2.2% of blood volume, whereas white blood cells and platelets constitute 1%, and 0.17% respectively. JW patients and their doctor must somehow rationalize why certain “small fractions” can be permitted when the WTS teaches adamantly that “abstaining from blood means not taking it into our bodies at all.” the WTS also fails to explain why it is permissible to accept vast quantities. Yet it teaches JWs that blood must not be used in any purposeful way, prohibiting blood donation with the same punishment as receiving blood (Hughes, 1978).
Many JWs emphasize the danger of blood transfusion and the advantages of alternatives to blood transfusion. Needless to say, there are significant risks in blood transfusion and patients should be informed about them. However, some critics have presented distorted picture because it fails to report any benefits of blood- based treatments. Just as with its campaign against organ transplants and vaccinations, it uses exaggeration and emotionalism to create paranoia against blood transfusion in Jehovah’s Witness’ minds, while it fails to present objective analysis of risk versus benefit.
Many JWs cannot see that if blood transfusion did not have proven effectiveness in saving lives, blood would not have been used to such an extend by the physicians whose main concern is to save lives and heal disease.
Acts 15. Holy Bible New King James Version. Thomas Nelson Publishers
Blood Transfusion. New Standard Encyclopedia. Page 298. Volume 3.
1 Corinthians 8: 4-8. Holy Bible New King James Version. Thomas Nelson Publishers
Drane, James F. Clinical Bioethics. Kansas City: Sheed & Ward, 1994.
Higgins, Gregory C. Where do you stand? New Jersey: Paulist Press, 1995.
Hughes, Gerald J. Authority in Morals. London: Heythrop Monographs, 1978.
Genesis 9:4.Holy Bible New King James Version. Thomas Nelson Publishers.
Proverbs 4:18. Holy Bible Contemporary English Version, Global Edition.
Leviticus 3:17 & 17: 10-16. Holy Bible Contemporary English Version, Global Edition.