Rationing Organs for Religious Refuseniks

Since new medical advances always catch my attention, I read with interest this article about “bloodless” lung transplants being pioneered at some hospitals – that is, salvaging and re-infusing the patient’s own blood, rather than relying on transfusions from donors. It’s being sold as a cost-saving technique and a way to lessen the risk of allergic reactions or other rare side effects, plus it conserves donated blood so that more is available for emergencies. But the technique was developed for a different reason, which I bet you can guess:

Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

I must be jaded, because the idea of a Jehovah’s Witness refusing blood and dying because of it doesn’t shock me any more. But this story had a gut-wrenching twist: Rebecca Tomczak, the Witness who’s the subject of the article, was adamant that she wanted the lung transplant, but not a blood transfusion, even at the cost of her own life. She forced her surgeon to agree that if there was a disaster, if she started to hemorrhage on the operating table, he had to stand back and let her die:

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

In most cases, this would be a tragedy, but not an outrage. People have the autonomy to consent or refuse treatment as they wish, and if an adult of sound mind wants to throw their life away, that’s their choice to make. But this isn’t just any surgery; this is a transplant, which brings a very different set of criteria into the picture.

I don’t want to sound uncompassionate, because I want all people to live and to flourish regardless of their religious beliefs. But organ transplants are a triage situation, which means we have to make coldly logical choices. Maybe in a few decades, when tissue engineering is more advanced and we can manufacture new lungs or hearts on demand, this won’t be an issue. But for the foreseeable future, human organs are a scarce and precious resource, and that means that when one becomes available for transplant, priority has to be given to people who have the best chance to survive. Giving an organ to someone who’s likely to die anyway not only means their death, but the death of another person who might have lived if they’d gotten it instead.

And the “likely to die anyway” criterion weighs against Jehovah’s Witnesses who insist that if they start bleeding to death, their doctor is forbidden to intervene. By refusing potentially lifesaving care in the event of an emergency, they make themselves poor candidates for transplant surgery. (Just the same way, I’d argue that a person with a history of not following doctors’ orders is also a poor candidate for a transplant, since it’s less likely that they’ll stick to the regimen of anti-rejection drugs.)

I’m not saying that the medical profession doesn’t recognize this. As the article says, hardly any surgeons will even consider performing a bloodless transplant, and Dr. Scheinin, one of the few who will, carefully screens patients for those with the fewest risk factors. Combined with the blood refusal, JWs who are in poor health will probably exclude themselves. But even for those whose prognosis is good, it does strike me as unfair that people who willfully reject lifesaving care for irrational reasons should get to be in line ahead of people who want to live and are willing to follow their doctors’ orders. What do you think – should a person’s stated willingness to accept medical intervention (or their stated consent or refusal to donate themselves) be a factor in deciding their priority for receiving organ transplants?

Image: The May 1994 issue of Awake!, the Watchtower’s magazine, which was devoted to celebrating children who died after refusing blood transfusion. Yes, really. Via.

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About Adam Lee

Adam Lee is an atheist writer and speaker living in New York City. His new novel, Arc of Fire, is available in paperback and e-book. Read his full bio, or follow him on Twitter.


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