Saturday, August 11, 2007

Religious beliefs in the NICU - Jehovah's Witnesses

My first experience as a NICU nurse with a Jehovah's Witness family was in the 1970's. The baby had severe hydrops fetalis because his mother was Rh negative and had developed antibodies to the baby's Rh positive blood. This sensitization very likely occurred prior to the introduction of Rhogam.

The baby was so critically ill and so unlikely to survive that our neonatologist opted not to request a court order to permit him to transfuse the baby. He felt that it would cause unnecessary pain for the family without any benefit to the baby.

Since then, I've had the opportunity to discuss blood transfusion with several families who are Jehovah's Witnesses. Their responses vary.

The very young moms who have been raised in the faith tend to say, "I can't give consent, but you can get a court order, can't you?" Not always the case, but they often have to balance their concern for the baby with their relationship with relatives.

The physician's answer is always the same. "We'll try to avoid transfusing your baby, but we can get a court order if needed." Care for those babies isn't significantly different than for our other preemies. We try to avoid transfusions in all of them if we can. The one difference is that the babies for whom we need a court order get an appointed guardian who has to approve any transfusions. It's not simply left up to the physician once the court order is in place. The guardian, who is generally a hospital administrator, has to be convinced of the need. I've only seen one transfusion refused, but the guardians take their responsibility very seriously.

Older Jehovah's Witness families don't always have the hard-line belief that all transfusions are prohibited for all members of the faith. Some believe very strongly that transfusion is always wrong. Others believe that it would be wrong for them to have a transfusion, but that their baby is not yet in a position to make that choice. They, like our appointed guardians, want to be convinced that each transfusion is actually needed, but they will sign the consent form themselves. Retaining control is probably an important part of choosing that path.

While doing some background reading for this post, I discovered a web site titled Associated Jehovah's Witnesses for Reform on Blood. The site says that they have members who are or have been elders or members of Hospital Liaison Committees. They disagree with stated positions of the Watchtower on the use of blood and blood products and say that they hope to educate Jehovah's Witnesses on what they call inconsistencies in doctrine.

I don't share the Jehovah's Witness belief that it is a sin to use blood or blood products, but I do appreciate the technological advances that have resulted from medical and surgical attempts to minimize or avoid transfusions. Transfusions save lives, but they're not free of risk.


tom sheepandgoats said...

Tell me what you think of this idea regarding transfusion in general, not necessarily for infants. You sound like you have the right qualifications.

Medical people are coming to the viewpoint that, if it is at all possible to avoid a transfusion, one should do it. A far cry from the not-too-remote past when you would routinely “top off the tank.” [my wife, as a little girl, had a blood transfusion as part of treatment for a nosebleed] Thanks to JW tenaciousness (stubbornness?) techniques of bloodless medicine are entering the mainstream. Might the time come, or is it even here already, when the lives saved in using bloodless techniques will outnumber those lost by a tiny group that has held fast to it’s beliefs?

Judy said...

I'm a NICU nurse so my clinical expertise really is limited to that patient population. I have done quite a bit of reading on the subject related to medical problems in my family.

Basically, transfusions can be lifesaving. Where multiple units of blood products are needed, there is very little doubt that they are. Situations like serious trauma, postpartum hemorrhage, people with certain chronic anemias and leukemias, very pre-term infants who simply cannot make enough red blood cells to keep up with their need. Those are pretty clear cut.

Serious nose bleeds can be life threatening - but that's rare.

We've come to realize the advantages of avoiding transfusions in certain situations. Iron Dextran and erythropoietin can both help decrease the need in more chronic situations, but they're useless in acute blood loss and really won't help with some types of anemias. I believe we'd have figured that out regardless of the JW's beliefs, but they did help speed things along - at least at the start. They were a catalyst for research into bloodless, or nearly, surgeries. The evidence that it could be done and might prove advantageous to the patients kept it going.

Physicians are most convinced by scientific evidence. The more studies we have which show when transfusions are needed and when other methods are the better choice, the better off we'll all be.

Judy said...

An anonymous poster left a comment which I am not going to publish - not because the comment is offensive, but because it offends by being incomplete.

The following web site which is pretty blatantly anti-Jehovah's Witness, contains what is described as case summaries of court cases about blood transfusions, custody issues, etc regarding the children of Jehovah's Witnesses.

I invite anyone with knowledge of either a more balanced web site, or one which favors Jehovah's Witnesses to let me know about such a site.

tom sheepandgoats said...

Just checking back on prior comments and I see your open question.

You might try here:

Lots of materials cited. Yes, they are produced by Jehovah's Witnesses, but the medical personell they interview...soem quite distinquished...are not.

In the video catergory, I recommend Transfusion...Alternative Strategies.

A google search under "bloodless medicine" would turn up things, too, I suspect. Likely you've already thought of that. There's well over 100 facilities now that offer some form of bloodless medicine, and many that do it exclusively.