I just spent a few minutes reading all about Jehovah's Witnesses and what kinds of blood products they will and will not accept. Because I have a patient who needs blood and won't accept any.
"You understand that you need a transfusion."
"I do."
"And without it, you have a much poorer prognosis."
"I do."
"We need to talk about your code status, in case something happens. Would you want to be kept alive artificially."
"Yes."
"And you would want us to do whatever we can do to help you."
"Yes, definitely."
"Except give you blood."
"Right."
"So we should intubate, put you on a ventilator, all of that-- some of which may well be avoidable if you would let us actually treat you the way we are recommending."
"Yes."
"So we should do everything. Except give you blood, which would probably help us avoid needing to do these other, more invasive things."
"Yes."
"So do everything, except the easiest and most useful thing we could do."
"Yes."
"Great."
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Interestingly enough, JW's do accept RhoGam injections which is a plasma dirivative. I worked L&D most of my career and I never had one decline. I even asked one (after the fact) why JWs allow it when they don't allow other blood products?
ReplyDeleteI didn't get an answer to that one....
I always struggle when I'm confronted with this, because it seems so utterly ludicrous to me (as your post illustrates). And yet, it's peoples' interpretation of their religion, and so we have no choice but to respect it.
ReplyDeleteI would be more inclined to respect their religious beliefs if they weren't willing to cause a major, and unnecessary, drain on the system. That is, if the patient said "No, don't spend any more on me than it would cost for the transfusion" then I'm good with that. But it's the height of arrogant selfishness to believe in something that would allow you to take away from other patients just for yourself because your religion says you can/should. No, I will NOT respect their beliefs or choices, but I will adhere to their requests to the best of my ability. And I will curse them in my mind while doing it.
ReplyDeleteI don't understand why this is still so contentious in 2012. They don't want blood and they understand the risks of not taking it. There are numerous papers documenting the fact that they do well without blood. There are precedent-setting legal cases affirming their right to do this and absolving MDs of wrong-doing if things don't turn out well. Why "curse them"? Do you curse people who make themselves DNR too?
ReplyDeletedid polyheme ever make it to clinical use, i no it had a higher mortality than others available at the time but surelly its better than nothing in JW cases.
ReplyDeletevicky
Where is TrueBlood when you need it?
ReplyDeletefrom this anecdote it sounds like you spoke to them alone, but if you didn't, it may be useful to. a professor at our med school told a story of how he had a JW patient refusing blood that, for whatever reason, was absolutely necessary for him to live. he adamantly refused while his family and community members were there but when the prof went back and spoke to him alone, he finally admitted that he DID want the transfusion but couldn't say so in front of his family. anyways, just food for thought.
ReplyDeleteIf they won't accept blood, then there is no reason to give them all the other far more expensive treatments which won't guarantee they will survive anyway. They're Marie Antoinette in reverse: they won't eat bread, but they want LOTS of cake!!! Isn't there a place in our overburdened medical system to say enough is enough? PS. I'm VERY much against futile care for anyone, but JWs put THEMSELVES in that situation.
ReplyDeleteThis is a tough one. As you know...ultimately as long as they're of sound mind and understand the risks, they have the say. Doesn't mean you cant be resentful. You're human and you want to do what's best for them.
ReplyDeleteJW are a thinly disguised cult. That sounds radical, but their actions are exactly what a cult does. They make you leave your family, lose all contact with them if they also don't convert, and if you want to stop being a JW you usually aren't allowed to do so. There's information all over the net about it.
ReplyDelete