Bloodless

I recently had the pleasure of a cordial and eye-opening conversation with a Jehovah’s Witness during our shared flight. I have always been wary of proselytizing and evangelism, despite my appreciation and respect for many faiths. Normally, I choose to ignore those who are very vocal about their religions. The “Do You Know About The Bible” pamphlet he held out to me initially set me on guard, but something compelled me to listen to what he had to say: the necessity for a doctor to listen and understand others, and the drive for a physician to test and examine the reasons and guidelines by which people choose to live. Two years ago, I would not have been so interested or patient, bringing to me the realization of how much I have changed during the first stages of my medical training thus far.

Upon confession of my ignorance of the teachings and principles of Jehovah’s Witnesses, the man was happy to concisely and conversationally explain the main differences between Jehovah’s Witnesses and mainstream Christian faiths (for example, he grew up a Catholic and compared the two). My curiosity led me to the issues regarding Jehovah’s Witnesses and medicine: in accordance with their efforts to live according to the principles of early Christianity, they place upon themselves the requirement to abstain from blood transfusions. “For the life of the flesh is in the blood… No soul of you shall eat blood,” (Leviticus) both literally and figuratively in the transfer of blood from one body to another. Not long ago, I was disturbed that my Pathology curriculum seemed to repeatedly enforce a pathognomonic connection between homosexuality and HIV/AIDS. This notion urged me to explore further the case of Jehovah’s Witnesses. As medical students (or as consumers of medical TV shows), we are most frequently introduced to this group in the ethical case setting in which a Jehovah’s Witness parent declines a life-saving blood transfusion for his or her child, forcing the doctor to make a choice between respecting their faith and providing medical care as they find necessary.

There is much I have yet to learn about medicine and clinical reasoning, and I would not find it prudent or correct for me to judge whether one or the other side is correct. Nonetheless, there are many layers that remain undiscovered by the superficial learner or observer. First, the religious requirements of Jehovah’s Witnesses appears to have spurred the development of bloodless surgery. One medical benefit to this technique is obvious: without the transfusion of blood, there is little or no risk of accidentally transmitting blood-borne diseases such as HIV, hepatitis B, hepatitis C, Chagas, etc. However, the risk of transmitting these diseases is, at this time, exceedingly small, and the slightly greater (but still small) risk lies in transmitting new diseases that are not yet known or identified. Secondly, as the technology of developing blood products advances, the specificity of the requirements of Jehovah’s Witnesses is tested: can Jehovah’s Witnesses be administered Factor VIII without violation of their beliefs? It seems that Jehovah’s Witnesses may not accept whole blood (rarely used), blood cells (red or white), platelets, or plasma, but they may be able to accept fractions of these components or anything that is not a “significant” component. The definition of “significant” is unclear (unless there are more defined specifications that I have yet to find). Their religious principles may allow them to accept these fractions, but they may still have individual moral objections.

Some physicians, seeing the beliefs of Jehovah’s Witnesses and others in black and white terms, may shun treating such patients. Others may treat them with a heavy hand, wielding the staff of Aesculapius like a bludgeon to beat dissenting views into silent acceptance. However, the man I spoke with rightly pointed out that men and women of his faith hold their bodies to be sacred gifts, and they are often much healthier and more conscientious and compliant as patients than others. For this group, there is but this one issue of transferring blood: would it be so difficult to respect this one request? He took out his wallet and showed me the medical directive card with a big “No Blood” symbol on the front.

Upon applying to medical school, perhaps I didn’t fully appreciate the opportunity to continue a lifelong goal: to see and understand men and women of many faiths, nationalities, cultural backgrounds, and beliefs; to walk in their shoes, and to extend my own hand in brotherhood and humanity.

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