VOL: 98, ISSUE: 17, PAGE NO: 36
June Simpson, RGN, SCM, ONC, is a nurse at Queen Margaret Hospital, Fife Acute Hospitals NHS Trust, Dunfermline
From a medical point of view, one of the distinguishing features of Jehovah’s Witnesses is their refusal to accept blood transfusions. But is this actually true? Some nurses may have come across Jehovah’s Witnesses who refuse red blood cells, but others may have encountered those who will accept blood proteins such as Factor VIII. And there are still pregnant Jehovah’s Witnesses who are rhesus negative but will not accept immunoglobulins.
Nurses need to keep up to date with Jehovah’s Witnesses’ position on blood and blood products and understand that they do have some autonomy when choosing blood fractions.
American Charles Taze Russell founded the religion in the 1870s and there are about 125,000 Jehovah’s Witnesses in the UK. Acknowledging Jehovah as the only God, believers are baptised by immersion and carry their message from door to door, warning of a future vengeful battle of Armageddon. They are a law-abiding sector of the community who believe that their conduct reflects their worship of Jehovah. They also believe that Satan was once an angel and is now an evil and powerful opponent of Jehovah.
Jehovah’s Witnesses see the elective termination of pregnancy as the wilful taking of human life. In the rare event of a choice having to be made between the life of the mother and that of the child, the individuals concerned have freedom of choice.
Birth control and reproductive technology
Birth control methods that effectively terminate a pregnancy are avoided. In vitro fertilisation involving eggs and sperm from unmarried people is unacceptable as it is considered adultery, as is gestational surrogacy.
Organ transplants and organ donation are a matter of personal choice.
Jehovah’s Witnesses refuse all blood transfusions, including stored autologous blood. They also refuse red cells, white cells, plasma and platelets. They may elect to receive fractions of these components, such as albumin, clotting factors, immunoglobulins, interferon and haemoglobin-based oxygen carriers.
A group of Jehovah’s Witnesses, the Associated Jehovah’s Witnesses for Reform on Blood, is currently seeking to reform the organisation’s position on blood and blood products. For further information see the AJWRB website at: www.ajwrb.org
The use of this technique as a haemostatic agent is a matter of personal choice.
Blood salvage (autotransfusion)
Many Jehovah’s Witnesses will accept such procedures as intraoperative blood salvage and postoperative blood salvage from drains (cell saver), as well as haemodilution techniques. To make such procedures acceptable, tubing should be visible to show that the diverted blood is still in contact with the patient (tubing is seen as an extension of the circulatory system).
Members of the organisation make personal decisions on treatment with blood fractions so Jehovah’s Witnesses may differ in their choice of treatment. Any changes in blood product policy are conveyed to Jehovah’s Witnesses through the Watchtower magazine.
Jehovah’s Witnesses and their relatives are taught by their faith that it is important for them to ‘keep Jehovah’s organisation clean’. One of the ways in which they are encouraged to do so is to inform those in positions of authority about the indiscretions of others.
Because family members may also speak to those in authority in the organisation, it is important that each patient is asked in private what information may be passed on to relatives. If a patient elects to receive a ‘forbidden’ blood product there could be grave social implications if that decision becomes known.
In such circumstances it may be necessary to make special provisions to ensure that unexpected visitors do not become aware of any treatment. Indiscreet talk between all members of hospital staff should be avoided to guarantee patient confidentiality. However, if the treatment is discovered by visitors, social services should be contacted in case the patient needs help after discharge.
Most hospitals have policies in place to provide Jehovah’s Witnesses with the treatment they require. Ideally these policies should:
- Acknowledge the right of patients to be treated with dignity and respect in regard to their religious beliefs;
- Offer appropriate care, advice and education;
- Involve individual patients so far as is practical in making informed choices and decisions on their care and treatment;
- Provide a prepared list of haematologists who can be consulted;
- Encourage patients identified as Jehovah’s Witnesses to carry a signed and witnessed advance directive card refusing blood and stating which blood products they are not willing to receive;
- Provide Jehovah’s Witnesses with additional identification. Some hospitals offer a coloured wristband to alert staff to their needs;
- Make every effort to ensure that the patient understands the consequences of giving consent or refusing specific treatments;
- Ensure that all appropriate forms are signed when dealing with minors. There is usually another policy to deal with ‘consent to procedure’;
- Be reviewed at regular intervals to identify changes in acceptable blood products.
Most Jehovah’s Witnesses are unwilling to accept the word of a nurse about the suitability of blood products for their condition. It would benefit this group of patients if hospitals investigated the possibility of holding a list of treatments endorsed by Watchtower. This could be used to help Jehovah’s Witnesses make informed choices about their treatment.
Baptised Jehovah’s Witnesses often carry an advance medical directive/release document instructing health care professionals not to give a blood transfusion under any circumstances and releasing hospitals of the responsibility for damage caused by the refusal of blood. These documents usually state that they can be rescinded only in writing, but there may be problems if the patient is well enough to rescind it verbally but not in writing.
Some patients also fill in a more detailed health care advance directive form which outlines their personal treatment choices regarding blood fractions and autologous blood procedures.
Jehovah’s Witness hospital liaison committees
In response to possible misunderstandings about their specific needs in hospital, Jehovah’s Witnesses have formed special committees to mediate between hospital staff and patients. It is important to gain patients’ full consent to such committees’ involvement as they could be counterproductive if the patient felt under pressure.
Given the importance of patient confidentiality, it is vital that committee members receive no confidential information from hospital staff unless the patient has given permission for them to do so.
By exhibiting an empathic understanding of Jehovah’s Witnesses’ anxieties and beliefs about blood and blood products, nurses are in a better position to implement an appropriate care plan. As part of a multidisciplinary team they can, as patient advocates, communicate Jehovah’s Witnesses’ special needs and help to provide holistic patient care.
Ellis, A. (2000)Consent and the Teenage Jehovah’s Witness. Paediatric Nursing; 12: 3, 29-31.
Franz, R. (1983)Crisis of Conscience. Atlanta: Commentary Press.
Muramoto, O. (2001)Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah’s Witnesses. British Medical Journal; 322: 7277, 37-39.
- Hospital Information Services for Jehovah’s Witnesses, IBSA House, The Ridgeway, London NW7 1RN. Tel: 020 8906 2211.
- Free Minds website: www.freeminds.org
- Watchtower news website: www.watchtowernews.org
This series has been endorsed by the Transcultural Nursing and Healthcare Association.