Skip to main content

Advertisement

Log in

Reflections on Cultural Preferences and Internal Medicine: The Case of Jehovah’s Witnesses and the Changing Thresholds for Blood Transfusions

  • Original Paper
  • Published:
Journal of Religion and Health Aims and scope Submit manuscript

An Erratum to this article was published on 24 January 2017

Abstract

Jehovah’s witnesses oppose receiving blood transfusions based on religious grounds. This refusal raises complex medical, legal and ethical issues for the treating medical staff. In the past physicians attempted to force patients and children to accept transfusions when deemed medically necessary through the use of court orders. However, in recent years the threshold for blood transfusion has been gradually raised by medical experts as expressed in consensus guidelines, which means that Jehovah’s witnesses’ aversion to transfusion would have been partially justified medically. This article will further discuss these current trends.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ballen, K. K., Becker, P. S., Yeap, B. Y., Matthews, B., Henry, D. H., & Ford, P. A. (2004). Autologous stem-cell transplantation can be performed safely without the use of blood-product support. Journal of Clinical Oncology, 22(20), 4087–4094.

    Article  PubMed  Google Scholar 

  • Bodnaruk, Z. M., Wong, C. J., & Thomas, M. J. (2004). Meeting the clinical challenge of care for Jehovah’s witnesses. Transfusion Medicine Reviews, 18(2), 105–116.

    Article  PubMed  Google Scholar 

  • Brunetta, D. M., et al. (2015) Severe acute anemia after liver transplantation in an elderly Jehovah’s witness treated with high-dose erythropoietin and ferric carboxymaltose: A case report. In: Transplantation Proceedings, Elsevier, Amsterdam.

  • Brunskill, S. J., Wilkinson, K. L., Doree, C., Trivella, M., & Stanworth, S. (2015) Transfusion of fresher versus older red blood cells for all conditions. The Cochrane Library.

  • Carson, J. L., Carless, P. A., & Hebert, P. C (2012). Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. The Cochrane Library.

  • Carson, J. L., Duff, A., Poses, R. M., Berlin, J. A., Spence, R. K., Trout, R., et al. (1996). Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. The Lancet, 348(9034), 1055–1060.

    Article  CAS  Google Scholar 

  • Carson, J. L., Grossman, B. J., Kleinman, S., Tinmouth, A. T., Marques, M. B., Fung, M. K., et al. (2012b). Red blood cell transfusion: A clinical practice guideline from the AABB. Annals of Internal Medicine, 157(1), 49–58.

    Article  PubMed  Google Scholar 

  • Carson, J. L., Noveck, H., Berlin, J. A., & Gould, S. A. (2002). Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion, 42(7), 812–818.

    Article  PubMed  Google Scholar 

  • Carson, J. L., Terrin, M. L., Noveck, H., Sanders, D. W., Chaitman, B. R., Rhoads, G. G., et al. (2011). Liberal or restrictive transfusion in high-risk patients after hip surgery. New England Journal of Medicine, 365(26), 2453–2462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chigbu, B., Onwere, S., Kamanu, C., Aluka, C., Okoro, O., Feyi-Waboso, P., et al. (2009). Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s witness women presenting in the extremis with ruptured uterus. Archives of Gynecology and Obstetrics, 279(4), 469–472.

    Article  CAS  PubMed  Google Scholar 

  • Dabak, V., Kuriakose, P., & Raman, S. (2007). Successful management of a Jehovah’s witness with thrombotic thrombocytopenic purpura unwilling to be treated with therapeutic plasma exchange. Journal of Clinical Apheresis, 22(6), 330–332.

    Article  PubMed  Google Scholar 

  • Dalal, S., Boddapati, M., Lowery, M. N., Veillon, D. M., Glass, J., & Munker, R. (2006). Treatment of acute myeloid leukemia in a Jehovah’s witness. Annals of Hematology, 85(6), 407–408.

    Article  PubMed  Google Scholar 

  • Digieri, L. A., Pistelli, I. P., & De Carvalho, C. E. (2006). The care of a child with multiple trauma and severe anemia who was a Jehovah’s witness. Hematology, 11(3), 187–191.

    Article  PubMed  Google Scholar 

  • Dyer, C. (2014). Doctors need not give blood transfusion to mentally ill Jehovah’s witness, judge rules. BMJ, 27(348), g2950.

    Article  Google Scholar 

  • Ferraris, V. A., Ferraris, S. P., Saha, S. P., Hessel, E. A., Haan, C. K., Royston, B. D., et al. (2007). Perioperative blood transfusion and blood conservation in cardiac surgery: The society of thoracic surgeons and the society of cardiovascular anesthesiologists clinical practice guideline. The Annals of Thoracic Surgery, 83(5), S27–S86.

    Article  PubMed  Google Scholar 

  • Hamm, C. W., Bassand, J. P., Agewall, S., Bax, J., Boersma, E., Bueno, H., et al. (2011). ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 32(23), 2999–3054.

    Article  PubMed  Google Scholar 

  • Hébert, P. C., Wells, G., Blajchman, M. A., Marshall, J., Martin, C., Pagliarello, G., et al. (1999). A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. New England Journal of Medicine, 340(6), 409–417.

    Article  PubMed  Google Scholar 

  • Hegde, R., Bell, D., & Cole, P. (2006). The Jehovah’s witness and dementia: Who or what defines ‘best interests’? Anaesthesia, 61(8), 802–806.

    Article  CAS  PubMed  Google Scholar 

  • Hoffman, A. (2014) Jehovah’s witness parents’ refusal of blood transfusions: Ethical considerations for psychologists. Journal of Health Psychology.

  • Holst, L. B., Petersen, M. W., Haase, N., Perner, A., & Wetterslev, J. (2015). Restrictive versus liberal transfusion strategy for red blood cell transfusion: Systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ, 24(350), h1354.

    Article  Google Scholar 

  • Jassar, A. S., Ford, P. A., Haber, H. L., Isidro, A., Swain, J. D., Bavaria, J. E., et al. (2012). Cardiac surgery in Jehovah’s witness patients: Ten-year experience. The Annals of Thoracic Surgery, 93(1), 19–25.

    Article  PubMed  Google Scholar 

  • Jehovah’s witness official web site. http://www.jw.org/en/. Accessed 3 Nov 2015.

  • Keane, C., Mollee, P., Marlton, P., & Gill, D. (2011). Treatment of acute promyelocytic leukaemia in the Jehovah’s witness population. Annals of Hematology, 90(3), 359–360.

    Article  PubMed  Google Scholar 

  • Madueño, F. C., Tomás, E. A., & Velázquez, Á. S. (2013). Lung transplant in Jehovah’s witness patient. The Journal of Thoracic and Cardiovascular Surgery, 145(6), e65–e67.

    Article  Google Scholar 

  • Muramoto, O. (1998a). Bioethics of the refusal of blood by Jehovah’s witnesses: Part 2. A novel approach based on rational non-interventional paternalism. Journal of Medical Ethics, 24(5), 295–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Muramoto, O. (1998b). Bioethics of the refusal of blood by Jehovah’s witnesses: Part 1. Should bioethical deliberation consider dissidents’ views? Journal of Medical Ethics, 24(4), 223–230.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Muramoto, O. (2001). Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah’s witnesses. BMJ, 322(7277), 37–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Napolitano, L. M., Kurek, S., Luchette, F. A., Corwin, H. L., Barie, P. S., Tisherman, S. A., et al. (2009). Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. Critical Care Medicine, 37(12), 3124–3157.

    Article  PubMed  Google Scholar 

  • Watch Tower Bible and Tract Society. New Watchtower Blood Transfusion Policy. http://www.watchman.org/articles/jehovahs-witnesses/new-watchtower-blood-transfusion-policy/. Accessed 3 Nov 2015.

  • Rogers, D. M., & Crookston, K. P. (2006). The approach to the patient who refuses blood transfusion. Transfusion, 46(9), 1471–1477.

    Article  PubMed  Google Scholar 

  • Salpeter, S. R., Buckley, J. S., & Chatterjee, S. (2014). Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. The American Journal of Medicine, 127(2), 124–131.

    Article  CAS  PubMed  Google Scholar 

  • Savulescu, J. (1995). Rational non-interventional paternalism: Why doctors ought to make judgments of what is best for their patients. Journal of Medical Ethics, 21(6), 327–331.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shander, A., Javidroozi, M., Naqvi, S., Aregbeyen, O., Çaylan, M., Demir, S., et al. (2014). An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME). Transfusion, 54(10pt2), 2688–2695.

    Article  PubMed  Google Scholar 

  • Spasovski, G., Stankov, O., & Masin-Spasovska, J. (2014). Living-related donor kidney transplantation in Jehovah’s witness patient: The importance of EPO preconditioning. International Urology and Nephrology, 46(3), 669–670.

    Article  PubMed  Google Scholar 

  • Tanaka, A., Ota, T., Uriel, N., Asfaw, Z., Onsager, D., Lonchyna, V. A., et al. (2015). Cardiovascular surgery in Jehovah’s witness patients: The role of preoperative optimization. The Journal of Thoracic and Cardiovascular Surgery, 150(4), 976–983.

    Article  PubMed  Google Scholar 

  • Vaislic, C. D., Dalibon, N., Ponzio, O., Ba, M., Jugan, E., Lagneau, F., et al. (2012). Outcomes in cardiac surgery in 500 consecutive Jehovah’s witness patients: 21 year experience. Journal of Cardiothoracic Surgery, 7(95), 8090–8097.

    Google Scholar 

  • Villanueva, C., Colomo, A., Bosch, A., Concepción, M., Hernandez-Gea, V., Aracil, C., et al. (2013). Transfusion strategies for acute upper gastrointestinal bleeding. New England Journal of Medicine, 368(1), 11–21.

    Article  CAS  PubMed  Google Scholar 

  • Virchis, A., Hughes, C., & Berney, S. (2004). Severe gastrointestinal haemorrhage responding to recombinant factor VIIa in a Jehovah’s witness with refractory immune thrombocytopenia. The Hematology Journal, 5(3), 281–282.

    Article  PubMed  Google Scholar 

  • Wang, J., & Klein, H. (2010). Red blood cell transfusion in the treatment and management of anaemia: The search for the elusive transfusion trigger. Vox Sanguinis, 98(1), 2–11.

    Article  CAS  PubMed  Google Scholar 

  • Questions From Readers. The Watchtower. 121:29–31. http://wol.jw.org/en/wol/d/r1/lp-e/2004448. Accessed 3 Nov 2015.

  • Weinstein, A., Chandra, P., Schiavello, H., & Fleischer, A. (2005). Conservative management of placenta previa percreta in a Jehovah’s witness. Obstetrics and Gynecology, 105(5, Part 2), 1247–1250.

    Article  PubMed  Google Scholar 

  • White, S., & Baldwin, T. (2006). The Mental Capacity Act 2005—implications for anaesthesia and critical care. Anaesthesia, 61(4), 381–389.

    Article  CAS  PubMed  Google Scholar 

  • Wilson, P. (2005). Jehovah’s witness children: When religion and the law collide. Paediatric Nursing, 17(3), 34–37.

    Article  PubMed  Google Scholar 

  • Woolley, S. (2005a). Jehovah’s witnesses in the emergency department: What are their rights? Emergency Medicine Journal, 22(12), 869–871.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Woolley, S. (2005b). Children of Jehovah’s witnesses and adolescent Jehovah’s witnesses: What are their rights? Archives of Disease in Childhood, 90(7), 715–719.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Iftach Sagy.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Human Rights

This article does not contain any studies with human participants performed by any of the authors.

Additional information

The original version of this article was revised: The co-author name should be Leonid Barski instead of Leonid Barksi. This has been corrected in this version.

An erratum to this article is available at http://dx.doi.org/10.1007/s10943-017-0364-6.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sagy, I., Jotkowitz, A. & Barski, L. Reflections on Cultural Preferences and Internal Medicine: The Case of Jehovah’s Witnesses and the Changing Thresholds for Blood Transfusions. J Relig Health 56, 732–738 (2017). https://doi.org/10.1007/s10943-016-0353-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10943-016-0353-1

Keywords

Navigation