Religious Convictions and Medical Treatment

The most interesting observation I made during this seminar meeting was the physical distance which grew between the spokesperson for the Jehovah' s Witnesses and the Chief of Trauma at the Emergency Department of Vanderbilt University Medical Center (VUMC).

On a personal level, I find it rather ridiculous that a Jehovah's Witness can accept an organ transplant (which clearly has elements of blood products) and concurrently maintain a fundamental position that prevents them from accepting a blood transfusion in a life-threatening medical emergency. This makes no sense to me since I feel it is somewhat fanatic to interpret the Bible with such literal translation.

On the other hand, I also think that if an adult over the age of 18 has made a decision not to accept blood in a medical emergency, we must honor that decision the same way we honor other living wills and contracts. I would be extremely disturbed to hear that such living wills and directives were being forced upon minors under the age of 18 since I do not feel that we can accept their decision as one made independent of parental influence and church authority.

Perhaps it because of my belief in the separation of church and state that we must protect innocent children from making life or death decisions they do not fully understand. Furthermore, I would support legislation requiring ER physicians to administer blood products regardless of any advanced directive signed by a minor. Likewise, I would support hospital policy to administer blood products to any individual who expresses uncertainty about the consequences of refusing blood and blood alternatives in any medical situation.

I certainly empathize with the frustration felt by attending physicians in the emergency department, since I too became annoyed listening to a fundamentalist perspective which could not be permeated by reason and rational discussion. Like the doctors in the VUIMC emergency department, I too would tend to err on the side of the medical professionals and administer blood when in doubt. I would be more compelled to accept the decision to honor an advance directive to refuse blood products in a surgical setting if the patient had given true informed consent, meaning they were fully aware of the risk involved in refusing blood and blood products.

It was interesting to learn that no physician has been sued by a Jehovah's Witness for failing to administer blood in a patient with a signed advance directive. I am much more sympathetic to their plight outside of the emergency department and would question their ability to give true informed consent in an emergency medical situation without being faced with the reality of the situation.

Certainly, standard surgical procedures allow more time and discussion of the alternatives and consequences that may result in failure to administer and/or accept blood products and transfusions. In that situation, I would support the advance directive of an adult over the age of 18 and respect their decision to refuse blood products regardless of the physician's professional judgment. I would request that they sign an organ donor card in keeping with their religious convictions.

All in all-I guess I just don't get it!