Interesting thread. A couple points:
1) not all JWs are created equally. Many will take albumin, cryo, cellsaver, novo7, and even red cells. Some will not take anything. The church's official position is that the decision is up to the individual. There was a special issue of Anesthesia and Analgesia addressing this issue and might be worth a read:
it's proprietary, so I can't put up the link, but your library may have an e-subscription. It's the April, 2007 issue, and below, I will try to cut and paste the editorial from the JW committee on blood reform.
2) We get a lot of JW pt's at my hospital and I always make sure to ask them about blood products when no one else is around. For many of them, the fear of death outweighs their religious convictions, but not if it means being looked down on by their peers. That is, they might accept blood if it remains confidential.
here's the editorial
Coagulopathy After Cardiopulmonary
Bypass in Jehovahs Witness Patients:
Management of and for the Individual
Rather than the Religious Institution
Lee Elder
Jehovahs Witnesses read with interest the case study by Sniecinski et al.
(1) concerning advances in treating patients who refuse certain products
made from blood. Some Jehovahs Witnesses fit this profile. Accordingly,
we are grateful to medical science for advances facilitating safe perioperative
care for patients with this preference.
Sniecinski et al. (1) report the cases of two Jehovahs Witness patients,
both of whom accepted transfusions from the donated and stored blood
supply. This transfusion of products made from donor blood naturally
leads one to question claims, made by some Jehovahs Witnesses, of
abstaining from donor blood. This difficulty is amplified when reading
power of attorney documents published by the Watchtower stating that
Jehovahs Witnesses have the option of accepting literally everything from
a given unit of donated blood so long as it is sufficiently fractionated
beforehand. Understandably, health care providers are left wondering
how a person can lay claim to abstaining from blood as an underlying tenet
of faith and yet at the same time declare a preference to accept literally
anything and everything from donated blood so long as it has been
sufficiently fractionated. An added distraction for physicians trying to
understand the Jehovahs Witness patient is the Watchtower organizations
marketing of itself as representing Jehovahs Witnesses when it
comes to medical use of blood.
In the report by Sniecinski et al. (1) it is important to point out the
distinction between treating Jehovahs Witnesses as individuals rather
than as part of a population within a religious institution that has strict
proclamations on treatment options. In their presentation, Sniecinski et al.
(1) treat official Watchtower teaching as though it represents the conviction
of all individuals within the Jehovahs Witness population. In fact, the
Watchtower organization no more represents the entire population of
Jehovahs Witnesses in respect to blood than the Roman Catholic Church
represents the entire population of Roman Catholics in relation to birth
control techniques. A difference between these two religious institutions is
that one interjects itself as representing an entire population with respect
to a specific teaching while the other makes no claim that its position
reflects the convictions of its members. Despite Watchtowers religious
teaching, physicians experience many Jehovahs Witness patients willing
to conscientiously accept transfusion of any donated blood product
(including whole blood, red cells, white cells, platelets, or plasma) so long
as the choice is kept confidential. This is based on a conscientious
conviction that the choice is consistent with biblical imperatives. Furthermore,
these individuals desire autonomy rather than having the Watchtower
organization deciding for them what they can and cannot accept
medically as a matter of conscience.
A little advertised fact is that the entire population of Jehovahs Witnesses
has never universally assented to the Watchtower organizations religious
position on blood transfusion. From the teachings inception until today,
individual Jehovahs Witnesses have lobbied the
Watchtower to allow all uses of donor blood for
medical purposes. Again, the point here is that the
doctrine issued by the Watchtower organization is
representative of its own hierarchy, and not of the
entire population of Jehovahs Witnesses.
Members of Associated Jehovahs Witnesses for
Reform on Blood applaud efforts such as those depicted
by Sniecinski et al. (1) to advance medical
practices in an effort to improve medical therapies and
outcomes for patients with peculiar religious convictions.
However, we also remind medical doctors to
treat Jehovahs Witnesses patients as each individual
prefers rather than as a religious organization prefers
them to be treated. In this respect clinicians should
take the necessary measures to ensure that choices are
autonomous personal decisions rather than transposing
organizational religious ideology as though it represents
individual conviction. At a minimum, treating physicians
should arrange for a private meeting with patients
so they have an opportunity to speak for themselves, free
from religious pressure and in the absence of family
members who are also Jehovahs Witnesses. Again,
doctors are looking to confirm an individuals preference
regarding blood product transfusion and not the preference
of family members or a religious organization.
Clinicians should likewise avoid pressuring the patient
to act contrary to his or her own convictions.
REFERENCE
1. Sniecinski RM, Chen EP, Levy JH, et al. Coagulopathy after
cardiopulmonary bypass in Jehovahs Witness patients: management
of two cases using fractionated components and factor VIIa.
Anesth Analg. 2007;104:7635.
758
From the Associated Jehovahs Witnesses
for Reform on Blood, Boise, Idaho.
Accepted for publication November 9,
2006.
Address correspondence and reprint requests
to Lee Elder, Associated Jehovahs
Witnesses for Reform on Blood, Boise, ID.
Address e-mail to
[email protected].
Copyright © 2007 International Anesthesia
Research Society
DOI: 10.1213/01.ane.0000255256.22554.e9
Vol. 104, No. 4, April 2007 757
Editorial
Ps, I'm no physician either.
. I know it is made from discarded human blood and then Hgb is extracted and purified...so, I don't know if it will fly. I'll keep you informed.
. The Crit is still crap though. 12.5
