Doctors Helping Jehovah’s Witnesses

During my (what the hell was I thinking?) year in medical school, we would often have small group discussions on medical ethics. A scenario would be posed by the doctor leading the group, and we’d discuss possible ways of handling it.

Inevitably, we’d get a case where religion clashed with medicine. The classic example: A patient comes into the emergency room after having been in a bad car accident. The patient needs a blood transfusion. But wait! The patient is also a Jehovah’s Witness and the religion prohibits such actions. So what do you do?

The other students around me would ask if there were any known alternative procedures… or if there were any loopholes in the religion to allow for the transfusion to occur…

I wanted to empathize. But all I could think was that the hypothetical patient was just being ridiculous. If they needed the transfusion, it was my job to give it to them. If they refused it, then they would (should?) die, and so be it.

I didn’t dare say that out loud.

So, I admit that’s really cold and harsh. It got worse when the hypothetical patient was the child of Jehovah’s Witness parents… and they refused to let their child get a transfusion.

To me, that’s abuse. At that point, I don’t care about their faith at all. My interest is in protecting the child. And I’m not going to let someone’s absurd beliefs get in my way. To hell with any alternatives — let’s just go with what we know works.

I bring this up because of an article I read in yesterday’s Chicago Tribune about doctors who cater to the whims of Jehovah’s Witness patients.

… “A lot of [doctors] don’t want to touch Jehovah’s Witness patients because [they fear] they’ll get sued. I saw that these patients are sincere. They have a right to decide. I think they should be treated with the same respect” as anyone else making a medical choice [said Dr. Michael Tuchek.]

Methods used on Witness patients can create potentially harmful side effects, Tuchek said.

“Make the blood too thick, it can clot and cause a heart attack or stroke,” he said. “On the flip side, if you don’t give [Witnesses] the bone marrow boosting, they’re anemic and have low hemoglobin. They’re pale, they can’t breathe well, can’t exercise, they’re short of breath.”

Doctors and scientists are trying to come up with new alternatives to blood transfusions, he said.

The piece also mentions when Jehovah’s Witness’ children need help:

“If they’re under 18, the hospitals have the right to take custody and transfuse a child, and we understand that,” [Jehovah's Witness Hospital Liaison Committee chairman T.J.] Bullock said. “What the [committee] recommends is that we locate a pediatric doctor who has a good record of cooperation to maximize our position. … What we’re looking for is someone who is willing to push the envelope and do everything they can [to avoid a transfusion]. We try to make sure the court understands it’s not a negligent parent, it’s just a blood issue.

Ok, so I’m all for progress and searching for the alternatives to blood transfusions. That’s great if doctors and scientists can find them. And I’m honestly happy that the doctors in the piece can care for the Jehovah’s Witness patients while still adhering to their beliefs. And it’s nice that there’s a committee in place to help those patients whose religious beliefs require them to undergo special procedures.

So why did this piece make me mad the whole time I read it?

  • Ziggy

    It made you mad because the Jehovah’s Witnesses are taking stupid risks, and the doctors mentioned are enabling them. At least, that’s why it makes me mad.

  • http://religiouscomics.net Jeff

    Will they also have a Christian Science advocate where they purposefully delay treatment to give the Holy Spirit a chance to intervene and do the healing?

    Of course we effectively already have this with the movement to high-deductible health plans. The patients themselves will be delaying going to the doctor to avoid paying the bill. If you then go and pay the bill and doctor delays treatment, then that will cost patients even more.

  • http://anthonyrmiller.com/blog Tony Miller

    You are mad because you know kids will continue to die because of superstition.

  • J Sveda

    What’s the base of JW’s refusal, anyway? Don’t tell me it’s b/c of that one rule in the Torah (more precisely Exodus, IIRC) that forbids (animal) blood consumption.

  • cathy

    Refusing to give your child medical treatment because you’re a loon is negligence.

  • Ulrich

    Straight from one of their pamphlets (I got one some years ago and still have it ^^): They are not referring to Exodus, but to Acts 21:25, which reads,

    As for the Gentile believers, we have written to them our decision that they should abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from sexual immorality.

    They also point to Matthew 16:25, “For whoever wants to save his life will lose it, but whoever loses his life for me will find it.” to argue that one should not violate God’s commandments to save their life.

    Of course, the Acts verse is horribly vague, and I think a strong case can be made that the biblical Jesus would disagree with their interpretation of Matthew – he repeatedly defends transgressing divine commandments (much more concrete ones than the above one) by essentially stating that human well-being takes precedence over them.

  • Kaylya

    When I saw Jehovah’s Witness in the title, I thought you might be referring to this girl who just died in Canada. Admittedly in that case, it’s not clear whether or not the blood transfusion issue caused her to die, but the delay in her chemo certainly didn’t help.

    But then I found this piece while looking for that one: it seems like the Watchtower Society puts an incredible amount of pressure on people to not take transfusions and then gets into lawsuits about it

    In both articles, the issue about whether it’s really a free choice is brought up (admittedly one of them is co-written by the guy quoted on the matter in the other). If you’ve been convinced that you’re going to hell AND you’ll be shunned by your community here on Earth..

  • http://foreverinhell.blogspot.com Personal Failure

    I don’t see what’s wrong with your attitude. If they want to die, it’s their lives, so be it. Not your problem. The law already covers children, so again, not your problem.

    I think what pisses you off about the article is that valuable resources are being wasted to help people that don’t want to be helped. How about taking that money and those scientists/doctors and finding better ways to treat people who want to helped?

  • Raze

    I’m mad because valuable research time and money is being spent on finding alternatives to well-established medicine that works simply because a small cult dogmatically refuses it. The people working on this shit could be devoting their efforts to problems that affect a much wider population who don’t have a choice in their treatment.

  • http://paravane.wordpress.com jimmy paravane

    ah the moral dilemma between let them die and want them to die. To improve the species, and all that, so…

  • Lost Left Coaster

    I’ll try to look at this optimistically and say that research into alternatives to blood transfusion overall is a worthwhile enterprise because these techniques can also be applied in situations where blood is not readily available, like disasters, war zones, or major trauma situations.

    Hospitals should respect adult patients’ religious freedom and their choices. With that said, the hospital’s ability to accommodate the patients’ beliefs is based on the resources available, period. If a patient has a standing order to decline a blood transfusion or makes such an order while of sound mind, then the hospital should accommodate. But if the hospital does not have any viable alternatives available, and the patient dies after having not received a blood transfusion, then you can hardly blame the hospital!

  • Miko

    Compassion is worth having, folks. You and I may agree that there’s nothing wrong with blood transfusions, but that’s no reason to want people who disagree to die. And saying that JW’s want to die is a gross distortion of their position.

    If I may adapt a Star Trek example, suppose that you have a medical condition requiring the replacement of a damaged part of your brain with a computer. Is it wrong to be concerned about this procedure, or to desire alternatives? Is someone who declines this doing so because they “want to die?” Do they deserve to die?

    If your answer is the same, project even further into scientific fiction scenarios. At what point do you draw the line? And are the choices of people who draw the line elsewhere a difference of kind, or only of degree?

    I, for one, am glad that there are doctors out there who cater to the whims care about the concerns of JW patients.

    I’m mad because valuable research time and money is being spent on finding alternatives to well-established medicine that works simply because a small cult dogmatically refuses it. The people working on this shit could be devoting their efforts to problems that affect a much wider population who don’t have a choice in their treatment.

    It’s not your time and it’s not your money, so it’s not your choice. It is my sincere hope that you are never subjected to the fascist horror of a world in which this distinction ceases to matter.

  • Gabriel G.

    I think you’re mad for the same reason I am, that the doctors are allowing these people’s silly superstitions to continue despite the obvious danger in it. While the most commonly shared superstitions don’t pose much threat to the superstitious or to those around them, the ones like the Jehovah’s Witnesses’ “blood is sacred and it must not be shared (or whatever)” are indeed harmful and to allow them to continue is morally unethical and life threatening.

    They’re not doing what they’re doing to find safer alternatives to blood transfusions (which I do think is something we should be doing), they’re doing it so that a group of people don’t have to be forced outside their comfort zone.

    Compassion is a virtuous thing, but if you’re being compassionate just to keep grown adults comfortable, then, it seems to me, that’s just counterproductive.

  • Tom

    Just wanted to mention here, amid discussion of medical professionals choosing how to approach these situations, a brief anecdote about my family’s experience.

    This doesn’t regard the MD’s input or reaction, but I hope it doesn’t seem off topic.

    My SIL could have died during childbirth, and needed a blood transfusion. She herself is a JW, but in her state – was seeking help in making her choices from the two advocates she had at hand: her mother, and her husband.

    Her mother unhesitatingly said it was preferable for her daughter to die than to get a transfusion – also accepting that her (not 5 minutes born) grandchild would be motherless. Her husband wanted to first order the transfusion, and second murder the MIL. Thankfully, the technical power of attorney fell to my BIL (and I’m sure the MDs sided with him).

    My SIL doesn’t regret the transfusion at all, thankfully – as this would be another can of worms.

    When people tell me belief is harmless and personal, I bring up this story.

    As a side-note, the outcome may have been different if we still lived in a time when expectant dads passed the time, during their wife’s delivery, yucking it up in the hospital smoking lounge.

  • jemand

    it doesn’t really matter the motivation, research into blood transfusion alternatives eventually WILL help lots of people (war zones, locations with low blood banks after a disaster or something, people with rare blood types, people too imunocompromized to safely take any sort of blood, etc.) The “experiments” as it were are just being done on the JW.

  • SarahH

    I’m glad this is happening, but I think I understand why you might be mad – as others have said, it’s still maddening to know that children will continue to die because of these beliefs.

    I’m all for research into ways we can save adults who refuse blood transfusions, but I don’t think there’s a middle ground when it comes to minors. If a child is denied a blood transfusion at the request of the parents (even at the request of the child), I think that’s abuse – and if it leads to death, it’s grounds for negligent homicide.

    It’s a bit squicky to read about these steps towards a compromise without the EXPLICIT acknowledgment that it won’t be applied in the case of kids. No one should be “pushing the envelope” in this area, any more than snake handlers should be “pushing the envelope” by giving the kids the less poisonous snakes to hold during worship.

  • http://thehappyhuman.wordpress.com John

    You and I may agree that there’s nothing wrong with blood transfusions, but that’s no reason to want people who disagree to die.

    Nobody wants them to die. That’s exactly why we’re talking about it.

    And saying that JW’s want to die is a gross distortion of their position.

    No, I’m sure they don’t explicitly desire death, but they prefer it over getting a life-saving transfusion, which isn’t very different in my eyes.

    It’s not your time and it’s not your money, so it’s not your choice. It is my sincere hope that you are never subjected to the fascist horror of a world in which this distinction ceases to matter.

    Oh for fuck’s sake – saying “X is stupid and I wish people would not do X” is NOT the same as saying “people should not be allowed to do X.”

  • Plainfieldrob

    Perhaps I’m shaded in how I read the article…but it I think the journalist who wrote it did a good job at pointing out the Jehovah’s position without trying gloss over the absurdity of it.

    If you want articles that bring to light the unvarnished religious beliefs of our fellow citizens, this was pretty good.

  • TXatheist

    Hemant, as a former JW you have to realize they are 100% convinced that they are going to a better place and it’s a temporary separation. It’s why JW’s and Mormons are properly labeled cultists.

  • http://www.onesigmaoff.net AP Ferguson

    I was raised a Jehovah’s Witness. Looking at that article the thing that made me angry was what the doctor said about the non-transfusion treatments’ risks:

    “Make the blood too thick, it can clot and cause a heart attack or stroke,” he said. “On the flip side, if you don’t give [Witnesses] the bone marrow boosting, they’re anemic and have low hemoglobin. They’re pale, they can’t breathe well, can’t exercise, they’re short of breath.”

    I remember reading about why Witnesses wouldn’t accept blood, and these alternative treatments were always touted as virtually miraculous and far better than transfusion for restoring blood.

    The blood issue took me longer to kick than anything else I was taught as a Witness, and reading this makes me realize that even years out I’ve never bothered to check up on these alternative treatments and read about the risks associated with them.

    Thanks for the link. Maybe I’ll dig up some more, myself.

  • ckitching

    Other passages that prohibit “blood consumption”:
    Genesis 9:4 – But flesh with the life thereof, which is the blood thereof, shall ye not eat.

    Leviticus 17:10 – And whatsoever man there be of the house of Israel, or of the strangers that sojourn among you, that eateth any manner of blood; I will even set my face against that soul that eateth blood, and will cut him off from among his people.

    I suppose we do need to test new upcoming blood substitutes, and if the JWs are volunteering to be guinea pigs, should we stop them? There are a lot of good reasons we should want to have the technology to do so (including blood shortages, blood borne illnesses, etc).

  • RPJ

    The other students around me would ask if there were any known alternative procedures… or if there were any loopholes in the religion to allow for the transfusion to occur…

    I wanted to empathize. But all I could think was that the hypothetical patient was just being ridiculous. If they needed the transfusion, it was my job to give it to them. If they refused it, then they would (should?) die, and so be it.

    Although I agree with most of your sentiments, I would advocate what the other students had done. As a doctor, your responsibility would not be to give a specific treatment, but to do whatever is in your power to treat them. If they don’t give consent, though, it’s not within your power.

    A blood transfusion would be the most efficacious route, but if that was unviable, then one should look for alternatives. This is not out of deference to religion but to your job. Perhaps it’s not what you meant, but what it seems that you are saying is that you would only give the transfusion, and if they refused that they would die and you could say “I told you so”.

    The patient was being ridiculous to be sure, but regardless, the doctor should find any way possible to treat them – spite be damned. That is the doctor’s job.

  • http://hoverfrog.wordpress.com hoverFrog

    A simple solution (and I hate to even suggest this) is to treat the medical condition unles explicitely told by the patient or their legal guardian not to. A variation on “don’t ask, don’t tell”. The emphasis for the medical practictioner is to treat the patient, not to pander to their delusions.

    If a patient refuses treatment then you provide the best alternative (I see no reson why they shouldn’t have to pay for the extra costs involved) and talk to them about the different options. If there are no options left then you provide palliative care while you wait for them to die.

  • Delphine

    As the court just decided on the Native American child’s case, parents do NOT have the right to refuse live saving medical help on behalf of their children for religious, moral, or ethical reasons.

    If I were a doctor and someone comes in and refuses medical help for himself for any reason, SO BE IT. You live, you die, life moves on. If you don’t want to live, I won’t stand in your way to death.

    However, if a parent comes in and tells me she doesn’t want me giving her sick child antibiotics, I’d ignore her and tell her what she is doing is 100% child abuse no matter which way you cut it.

  • ATL-Apostate

    Few things chap my ass more than dealing with idiotic superstitious beliefs, Jehovah’s Witnesses being a chief example.

    In my line of work, we do open heart surgery on kids. You simply cannot do that without a blood transfusion. If you have a 2kg kid and need to put them on bypass for surgery, the amount of blood necessary to run the bypass pump is greater than the kid’s ENTIRE circulating volume. You simply cannot do it without getting at least 4 units of blood to prime the machine’s circuit – minimum.

    I’ve had JW parents look me in the eye and tell me they’d rather not let their child receive potentially life-saving surgery because of the reality of receiving a transfusion during the case. At which point I begin proceedings to take protective custody of the child and perform the surgery against the parent’s wishes.

    Unfortunately, I run into this frequently. Who are these parents to think they can sentence their kids to death over their own silly supersitions?

    I’m with you Hemant. It is infuriating to read, and even more infuriating when you stare stupidity and ignorance right in the face on a semi-regular basis.

  • ATL-Apostate

    Another interesting sidenote: When I was in med school, we had similar discussions as Hemant. At one point, we actually invited a couple of JW “bishops” or whatever you call them to come present their side.

    One of the smarty-pants med students, who will remain unnamed, asked these preachers if receiving a bone marrow transplant was acceptable.

    These two preachers scratched their heads and decided that, yes, a bone marrow transplant is not the same thing as a blood transfusion and is therefore acceptable.

    Of course, as anyone who’s had a basic anatomy or biology course will know, the bone marrow contains the cells that MAKE THE FRIGGIN BLOOD. Sheer ignorance to the nth power.

    We all chuckled at the preachers, but nobody bothered to call them on their outright stupidity. We were told to be polite, afterall.

  • andrew

    Let them die….

  • http://religiouscomics.net Jeff

    Simple. Pick an age that a person legally becomes an adult. If the person is “underage”, then the doctor makes the decision about the blood transfusion. If the person is an adult, conscious, and is able to make a decision, the patient can make the decision not to get the transfusion but must sign something to free the doctor of any malpractice. Otherwise, the doctor makes the decision.

    In general, I think adults should have control over their own bodies regardless of their beliefs.

  • Richard Wade

    ATL-Apostate,
    By not making sure that the JW preachers understood that bone marrow produces blood, you and the other med students lost the opportunity to see what their decision would have been if they were more fully informed, and to see how they think.

    Instead, the med students all got a lesson in passive-aggressive contempt for ignorant people, a lesson which may be negatively influencing their interactions with ignorant patients today, as doctors.

    Superstitious, stupid, short-sighted, self-centered and ignorant people are very frustrating to most helping professionals, but giving in to that frustration, dismissing those people and failing to take every opportunity to try to effectively enlighten them is not fully serving their needs or the needs of the general community.

    Yes, their ignorance can be daunting by its sheer mass, its static inertia, but we must keep chipping away at it, must not throw up our hands and console ourselves by snickering at it. We must somehow help others to be better, not just confirm that we are better than others.

  • Cecilie

    I’ve been reading your blog for a long time, Hemant, and I do believe this is the first time I’ve actually disagreed with your opinion, which I don’t find befitting of a ’friendly’ atheist at all, but rather uncharacteristically biased.

    As a medical student and future doctor, I am offended to be described as “catering to the whims of” Jehova’s Witnesses by respecting their refusal of blood transfusions. This is not a question of acquiescence to obscure religious conventions, but of following a legal and ethical obligation to respect the autonomy of my patients. The medical curriculum includes subjects such as ‘Medical Ethics in the Third Reich’ for a good reason (pardon the violation of Godwin’s Law); to imprint indelibly in the mind of young doctors the ethical imperative that no person should force medical treatment onto another person against his will (the specialty of psychiatry has a few exceptions to this rule, of course, but that is not the issue here.) As a doctor, my focus must remain on the patient, not the condition for which he is treated, and so my job can never be just to give it to them, but rather to collaborate with the patient to find a solution to his medical problem according to his wishes and my medical knowledge. I cannot perform a specific treatment on the patient against his will, just like the patient cannot demand a specific treatment I am unwilling to perform due to ethical or medical concerns. This is a key principle of medical ethics.

    I can’t believe you’re actually serious when stating that if patients refuse a specific treatment on religious grounds, they deserve to die – should I then deny these patients all other treatments or medications which may save their lives only because their reason for refusing one type of treatment clashes with my personal beliefs? What kind of doctor would I be then? (Answer: one unworthy of my profession.) A doctor must always respect the autonomy of her patients and stay clear of medical paternalism, which is a sliding slope to a much, much darker place where humanity will hopefully never venture again.

    As for children of Jehova’s Witnesses, though, it’s a different matter. In my country, the hospital will gain temporary custody of the children in case of emergency and perform blood transfusions if necessary, while elective treatment will take into consideration the parents’ religious beliefs as much as possible. Again, this is not catering to religion, but an understanding of the social dynamics within these religious communities and caution against parents keeping their children from receiving necessary medical treatment for fear of having doctors jump them with transfusion syringes as soon as they set foot inside the hospital doors.

    In a perfect world, religion would be inconsequential to doctors. But in the real world we’re walking a fine balance between treating a patient to the best of our abilities and respecting that patient’s autonomy to refuse treatment for whatever grounds he chooses, even if we disagree.

    My professor once told me, ’the biggest obstacle to treating diseases is the damn patients!’ Sadly, this is true, and unlikely to change anytime soon. :/

  • Dallas

    I was halfway agreeing with Hemant and ATL-Apostate until Richard Wade and Cecile reasoned (rather than knocked) some sense into me. Way to go, Richard and Cecile!

  • http://friendlyatheist.com Hemant Mehta

    Cecilie — Thanks for the comment. It makes sense for the doctor and patient to work together to treat the patient. But when it comes to emergency situations, where a transfusion is the best and safest way to go, the JH wishes seem to be a needless obstacle.

    How is the blood transfusion request any different from someone whose faith demands they don’t want anesthetics? How far do we let religious people go to dictate their own care before doctors can’t do much of anything? I just feel this is one case (the blood thing) where religion goes overboard.

    What about Hmong people who think epilepsy is just a “spirit catching you” and refuse treatment? Do we respect their religious beliefs or help the patient?

    I don’t know that it’s possible to do both, and in some cases, the way to best save the patient may be to follow standard protocol instead of “respecting” their beliefs.

  • ATL-Apostate

    Richard – As usual, you are correct. We missed a GREAT opportunity in exchange for being snarky for snarkiness’ sake.

    Most med students, Cecile being an example, are idealistic and compassionate. Unfortunately, there is often an aire of superiority that goes along with medical training. I think most docs are able to get over themselves at some point. Intern year usually accomplishes that with doses of humility galore. But I’m sure you all know a few who missed out on the humility part.

    I will say that at the time of this discussion with the JW preachers, I was still a practicing Christian. So it was very hypocritcal of me to look down on the JW’s quirky beliefs when I probably believed many of the same things they did.

    I would hope that if confronted with the same situation today, I will be able to face it with more humanity and compassion – as Richard suggested.

    Of course, when I’m dealing with parents who don’t want their kids to receive life-saving treatments, the time for education and compassion is a bit constrained. Thus we often resort to court orders to get these kids the treatment/surgery they require. I’m in a bit of a unique situation because my patients are not legally recognized as having either the capacity or competency to make their own healthcare decisions. Kids are truly helpless in this regard, and as a result I have no qualms with using the heavy hand of the law to overcome silly superstition.

    I’d like to carry a portable Richard Wade around with me to consult with at times such as these. His advice is sage, to say the least.
    :-)

  • TC

    I see nothing wrong with investigating alternative treatments for JH patients. It’s possible that these alternatives could, one day, become the best treatment. Not likely, but possible.

    Patients that refuse consent can be pleaded with, but their decision is paramount. I’d extend that to children as well. If the parents refuse treatment, so be it.

    It’s not that such patients should die. It’s just that they likely will die. That distinction is critical.

    That refused consent may lead to death is troubling, for sure, but informed consent is a bedrock principle that must not be compromised, even for the patient’s benefit.

    Doctors can be angry at the perceived stupidity of these patients, sure. But they’ve fulfilled their ethical obligation when they’ve fully informed the patient.

  • http://hoverfrog.wordpress.com hoverfrog

    Hemant wrote

    I don’t know that it’s possible to do both, and in some cases, the way to best save the patient is not to respect their beliefs.

    I don’t think it is a matter of respecting beliefs but of respecting the wishes of patients. If someone holds a belief that places them in danger we can argue against it, state the facts, provide evidence, etc. We don’t have to give their beliefs any respect at all. If they still refuse medical treatment then they do some from an informed position and not from one of ignorance.

    By way of example some cancer patients refuse treatment after months or even years of painful and debilitating chemotherapy and/or surgery. We know that treatment may extend their life and so do they but they don’t want the treatment anymore. You might say that this is a different case entirely but it is still a matter of respecting the wishes of the patient even when they go against their best interests and likely survival.

  • Jen

    Shakespeare said it better than I could- first, let’s kill all the lawyers. I can’t believe how many people are going to die because of a fear of lawsuits.

    As for the rest, why do all these JWs tell everyone what happened to them at the hospital, why tell the truth? My medical history is no one’s business but my own- of course, I am not in a cult, so maybe I just don’t get it.

  • Aj

    It would be interesting if random people were told to refuse random treatments with no legimate reasons, asking doctors to try all alternative methods available however unlikely and costly.

  • Cecilie

    @ Hemant:

    Thank you for your reply. You ask how the refusal of a blood transfusion is any different from refusing anaesthetics on religious grounds or believing in demonic possession, and the answer is, it’s not. You’re preaching to the choir, for I’m as atheist as they come and I find such obscure religious conventions silly and dangerous in equal measure. If any of my friends expressed such beliefs, I’d needle them endlessly about it and refuse to accept any religiously dictated limitations to our interactions. But when I put on my white-coat, I take on a whole new set of responsibilities and obligations to the patients in my care, and I cannot let my personal preferences dictate how I act towards them.

    The patient-doctor relationship is one of ultimate trust. I trust the patient to accept my diagnosis and treatment plan, and to be compliant with my instructions on medication, and in turn the patient trusts me to treat him/her to the best of my ability with no regards to social, political or religious status, to honour the patient-doctor confidentiality, and to respect his/her autonomy, the right to dictate solely and supremely over his/her own body. The trust inherent in the relationship between doctor and patient is absolutely crucial to proper medical treatment, and patients will (and should) tell their doctor secrets they might not share with those closest to them, perhaps not even with the person to whom they’re married.

    To force treatment upon a patient against their will is not only a betrayal of that profound trust, it is an incredibly traumatising violation of that person’s bodily integrity, an abuse so grave it is rightly compared to rape.

    The thought of being forcibly subjected to medical treatment is a staple of horror fiction; how many books and movies do not have the protagonist being hospitalised against his will, or even waking up on the operating table with a surgical team surrounding him and someone remarking, ‘it’s for your own good’? I can’t imagine anyone who would find this less than absolutely terrifying; to be in a position of extreme vulnerability and dependency on another person, and said person taking advantage of your situation to discount your autonomy and, touting personal beliefs and a paternalistic ‘I know better’-attitude, doing things to your body you don’t want them to.

    So how far do we let religious people dictate their own care? All the way. If the patient refuses blood transfusions, we try to manage without. If the patient refuses anaesthetics, we must pursue non-surgical interventions. If the patient refuses conventional treatment for epilepsy/cancer/indigestion and turn to a witch doctor instead, we do our best to convince them otherwise and let them go with a sad headshake. And when they return upon finding that the mumbo-jumbo of alternative medicine has no effect, we must not say ‘I told you so’, but quietly welcome them back, save what we can and offer palliative care for what we can’t. Such is the doctor’s lot in life.

    (Children are an entirely different matter, though.)

  • Aj

    So why did this piece make me mad the whole time I read it?

    It makes you mad because at the end of the day for a government subsidized health service patients demanding more money and time than others for no legitimate reason is hurting other patients. When governments switched to MMR patients demanded the three independent jabs that were already more expensive, but even more so now they weren’t bought in bulk. If they had just accepted the MMR jab that’s money that could go on life saving equipment. The worst part was that the reasons were so obviously spurious.

    This isn’t an autonomy question involving examples of Nazism, or being wary of paternalism that has plagued the health profession in some gruesome examples. Patients ask for antibiotics when they should really be used as sparingly as possible to prevent resistance. Patients demand antibiotics for anti-virals, and that doesn’t even make sense, and some doctors give in because they’re so bloody afraid of practicing medicine. Who prescribes the treatment, doctors or patients? The autonomy of patients should allow them to refuse, not demand what treatments they get unless they pay for it privately.

    If doctors are taught in medical school to pander to irrational beliefs then I’m going to audaciously demand every scan you can possible have, including fMRI three times. I know it’s expensive and someone with actual problems might need it, but apparantly that doesn’t matter. Oh wait, I don’t have a massive pressure group and a bunch of religious idiots on bioethics boards because religion equals morality in some people’s minds.

  • Art

    My father needed an aorta bypass and refused blood. The Doctors did it without blood and the procedure worked out very well. He lived another 20 years. No risk of any blood related complications or risk of any disease.
    I know of a hospital in Texas where they don’t use blood at all on anyone. The AMA admits that many people die from blood transfusions every year. Blood products are overused. Follow then money trail and you’ll understand why. Having said this admittedly sometimes blood is necessary in many cases and worth taking the risk.

  • http://alitheiapsis.wordpress.com/ Aly

    They also point to Matthew 16:25, “For whoever wants to save his life will lose it, but whoever loses his life for me will find it.” to argue that one should not violate God’s commandments to save their life.

    (This is from way up at the top of the thread.)

    So why aren’t they against self-defense as a defense of murder?

  • Cecilie

    @ Aj:

    I fail to see what MMR vaccinations have to do with Jehova’s Witnesses refusing blood. One issue is patients demanding treatment which doctors refuse to give because it’s impractical/unnecessary. The other issue is patients refusing treatment and doctors forcing that treatment on their patients regardless. There’s a difference, though subtle, and yes, it is one of autonomy.

    You can demand all the MRIs you like, you won’t get them unless you need them. However, I can’t perform medical research on you without your consent either, which I’m sure you appreciate. Do you see the difference?

    Doctors should rightly be wary of defensive medicine, the ordering of tests/prescription of medication without medical indication to please patients and avoid lawsuits, because it’s expensive and the patients run an unnecessary risk of complications. But to advocate offensive medicine is much worse; should we then force people to stop smoking too, because it’s better for them? Force them on a diet? Make everybody do exercise every day and eat 5 fruits/vegetables? We’d end up living in the Soviet Union or some Huxlean dystopia!

    Doctors are not taught to pander to irrational beliefs, but we are taught to respect our patients’ beliefs – the operating table or sickbed is not appropriate for atheist conversions anymore than for other religious conversions.

  • JB of Brisbane

    @Art -
    Let’s play “Spot The JW”. Ah, there’s one!

    “My father needed an aorta bypass..” – how do you bypass the aorta? It’s the biggest artery in the body. What would you bypass it with?

    “The doctors did it without blood…” – what did they use instead?

    “I know of a hospital in Texas where they don’t use blood at all on anyone…” – but you did not commit its name to memory. How did you find out about this hospital? Does it even exist in reality? Tell us more.

    “Blood products are overused…” – most days of the week the Red Cross Blood Bank makes appeals for blood donors, noting which types are “low”,”very low” and “critically low”. I have read in JW literature that normal saline can substitute for most blood products. If that were so, surely the Red Cross would not have to set up blood banks with meticulous typing and expensive storage, and hospitals would only need plants for the manufacture of salty water.

  • Aj

    Cecilie,

    MMR is irrationally feared and another treatment is demanded. Blood transfusions are irrationally feared and another treatment is demanded. My definition of unnecessary/impractical is patients demanding alternative treatment for no good reason.

    Adult patients have a right to refuse treatment offered. Doctors should not be required to offer alternative treatment, especially if it’s more expensive, when patients have irrational beliefs about the prescribed treatment. I don’t think that leads to a Stalinist nightmare. I also don’t think alcoholics should get liver transplants if they’re still abusing alcohol. I guess I’m advocating forcing them to stop drinking.

    What if I refuse a cheaper test and do need prefer a MRI scan that is equivalent but much more expensive? Also what if it’s statistically unlikely but still significant that two tests would be better than one, can I demand two?

  • Galey

    If Jehovah’s witnesses wish to kill themselves that’s fine by me. However, if they are killing their own children through some mad doctrine than that is a totally different matter and should be stopped immediately.

    Let’s not forget that these are the same barking mad bunch of lunatics who believe that 144,000 of them will be saved and sent to heaven. They also believe that being gay is a sin, and Jehovah forbid anyone in this completely insane cult to abandon their poor, indoctrinated ways; for they will be forever abandoned by their families.

    If there is indeed a place called hell, I hope these idiots rot there for eternity!

  • Natily

    What?  You went to medical school?  And you left?  Why!  It’s fantastic.  I can’t imagine my life without it.  No, really, I can’t.  Tell me, what is the outside world like?  I don’t remember anymore…


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