Patients often rely on religious faith to help them cope with illness. But for Milwaukee surgeon Dr. Bruce H. Campbell, operating on a Jehovah’s Witness rattled his own faith in himself.
Dr. Campbell tells his story in an article called “Listening to Leviticus” that appears in this week’s Journal of the American Medical Association. It starts off as a detailed look at a surgeon’s efforts to remove a tricky tumor from a patient’s thyroid gland. The reader senses Dr. Campbell’s growing unease as the baseball-size tumor refuses to yield.
The reason for his distress, explains Dr. Campbell, is that his patient is a Jehovah’s Witness, a faith that forbids blood transfusions. Before the surgery, his patient ordered him in no uncertain terms that he was not to be given blood in an emergency.
He looked at me calmly. “Doctor,” he told me, “you have to know that I am a Jehovah’s Witness.” He smiled and matter-of-factly outlined his convictions without any hint of embarrassment or sign that he was primed for an argument; he readily acknowledged that there might be real and serious consequences if he started bleeding during the operation. I was only too aware that the tenets of his faith prohibit the use of any blood transfusions. Despite the risks, he remained completely serene. My anxiety, on the other hand, started at that moment to take shape.
Dr. Campbell considered not doing the surgery. Although the need for a blood transfusion was unlikely, it was always a possibility. He wondered how he would feel if his patient died a preventable death while in his care as a result of refusing a transfusion. He also questioned his own ability to adhere to his patient’s wishes in an emergency.
The surgery didn’t go as well as the doctor had hoped. The man’s muscles had been difficult to separate from the gland, and the tumor was located in a spot that allowed little room for the surgeon’s fingers. He knew that with a little pressure, the mass could be freed easily, yet his anxiety prevented him from exerting sufficient force.
This particular day, more than most, I was working without a net. Each maneuver intensified my awareness of the potential for disaster. Repeatedly, I pressed forward, making sporadic progress, until I was forced to back off once again. With each moment of self-doubt, I would pause, regain my focus, and force my hands to return to the procedure, although my mind was beginning to doubt whether I should indeed continue.
The mass finally moved, and the doctor worried that the maneuver could have caused a hemorrhage. As blood spilled into the cavity, he held his breath, finally convincing himself that all was well.
The story has a happy ending. The patient was fine. But Dr. Campbell was left with his own doubts.
For my part, I had spent two weeks becoming increasingly anxious that I might suddenly be called upon to “protect” this man from his own convictions. What emergency course of action might I have recommended if he had experienced a massive hemorrhage during the operation? Would I have tried to force his family to consider a lifesaving transfusion? I was still not certain.
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Jehovah’s Witnesses elders will investigate and disfellowship any Jehovah Witness who takes a blood transfusion,to say the issue is a ‘personal conscience matter’ is subterfuge to keep the Watchtower out of lawsuits.
Many Jehovah’s Witnesses men,women and children die every year worldwide due to blood transfusion ban.Rank & file Jehovah’s Witness are indoctrinated to be scared to death of blood.
FYI
1) JW’s DO USE many parts aka ‘fractions’ aka components of blood,so if it’s ’sacred’ to God why the hypocritical contradiction flip-flop?
2) They USE blood collections that are donated by Red cross and others but don’t donate back,more hypocrisy.
3) The Watchtower promotes and praises bloodless elective surgeries,this is a great advancement indeed.BUT it’s no good to me if I am bleeding to death from a car crash and lose half my blood volume and need EMERGENCY blood transfusion.
Know this,the reason that JW refuse blood is because of their spin on the 3000 year old Biblical old testament,modern medicine will eventually make blood donations and transfusions a thing of the past.When this technology happens it won’t vindicate the Jehovah’s Witnesses and all the deaths that have occured so far.
The Watchtower’s rules against blood transfusions will eventually be abolished (very gradually to reduce wrongful death lawsuit liability) even now most of the blood ‘components’ are allowed.
In 20 years there will be artificial blood and the Red Cross will go on with other noble deeds.
None of these changes will absolve the Watchtower leaders or vindicate their twisted doctrines
—
Danny Haszard born 1957 3rd generation Jehovah’s Witness
(Some educational links provided below:)
http://www.ajwrb.org/basics/abstain.shtml Jehovah Witness blood policy reform site
http://www.towertotruth.net/Articles/blood_transfusions.htm Will you die for a lie?
— Danny HaszardI appreciate this article by the times that was unbiased toward Witnesses. Unlike the entry already posted. We believe what the bible says to abstain from blood. We are willing to obey God at what ever cost. During the nazi era we were willing to obey Jehovah. Some of us died in the concentration camps due to our unyielding faith. People die for what they believe in everyday in wars defending their country and they are respected for their bravery and committment. We are upholding the laws and principles of the highest authority in the universe.
— Truth TellerBarring a totally catastrophic bleed an otherwise healthy patient could be stablized with aggressive fluid and electrolyte replacement therapy with careful monitoring of vital signs. If JVs will use blood fractions, this patient might have accepted cell free human plasma transfusions.
This is the kind of situation where an experimental artifical blood like polyheme might be useful. http://abcnews.go.com/WNT/Story?id=2166664&page=1
— MARK KLEIN, M.D.It is always amazing what people will do when brainwashed to believe certain things. Like believing that the Bible is the inerrant word of God, instead of a collection of stories written by many different humans over many centuries. All this stuff about faith, and keeping the faith, I guess this gives meaning to someone’s life and makes them feel that they are a better human being. They don’t realize you can have meaning in your life and be a good human being without any faith whatsoever.
— JanetThis article isn’t about religion. It’s about what happens when ethic collides with ethic within the same person — and the implications when that happens in health care, specifically.
Anyone introspective enough experiences self-doubt. How many of us face it with another’s life on the line? How must it feel to be a skilled surgeon to lose his faith in his own skill? What happens when any professional is hooked on the horns of the dilemma to choose between two equally important but conflicting tenets?
What would we do? What have we done in our own versions of this dilemma?
Thank you for a thought-provoking article, TPP.
— Carol“Hightest authority in the universe”
Wow. What a statement. “In the universe.” The whole universe? The entire, known universe? Are you sure? Really sure? Are you sure it’s not the tippity topity highest of highest in the galactic universe?
I love this kind of thinking. And the world wonders why America is the most ignorant civilized nation.
Congratualatioins to all who put the “highest authority in the universe” ahead of the physcial health of their fellow man. Way to go!
— MarcusThe problem, Truth Teller, is that your religious beliefs have an effect on the rest of us. What happens when your sincere religious belief clashes, for example, with this doctor’s sincerely held moral duty to save lives? You’ve given this doctor a choice between following his own moral imperative or following yours - if it comes to where he *has* to make the choice, he’ll live with the consequences of either for the rest of his life.
So while you get to feel great and wonderful about following your faith, have some compassion for the rest of us and think about maybe NOT inflicting consequences on us. Consider that maybe if you are supposed to abstain from blood, maybe you should abstain from things that *might* put you in a position where the only way to keep you alive (which the doctor’s religion and/or moral beliefs require) is to violate your stated religious beliefs.
— TheOtherOne135Jehovah’s Witnesses are free to make their own decisions like everyone else, provided they understand the gravity of their decision. I’m surprised this article got published in JAMA, as this really isn’t all that unusual (I’m a physician and have run across this several times). Sometimes the problem can be solved by having the patient donate his/her own blood a month in advance, but in emergencies there’s just not time. We hold freedoms, religious and otherwise, very closely, including the right to refuse a blood transfusion) We also retain the decision to smoke cigarettes, not take blood pressure meds for critical hypertension, or not treat your diabetes (though I don’t believe you can compare a religious tenet such as the refusal of blood products to these). Patients are free to make their own decisions, for better or for worse. In my experience, Jehovah’s Witnesses have been very understanding of these risks, and are quite pleased if you just do the best that you can without blood transfusions. We minimize blood transfusions with other means of hemostasis as much as humanly possible these days anyway, with infections and transfusion related sequale always in the back of our minds. It’s just my job to make sure they are well informed, of sound mind, and are happy with the choice they have made.
— fromtheERCouldn’t the patient have given some of his own blood in advance? Or, is that not allowed?
From TPP — I’m not sure what the official rules are but the doctor explained the patient’s views on this in the essay, which unfortunately is available only to subscribers. However, here is the relevant portion.
— Dick MonahanI find it hard to believe that God would want people to die rather than accept blood.
Remember, the Bible was written long before modern blood transfusions were possible. The authors could not have been writing of transfusions when they referenced blood.
I do believe that patients should have the right to refuse transfusions. But I hope that they choose life instead.
— brown99cTo Truth Teller:
I’m pretty sure you folks don’t follow all biblical directives - it does not appear, for instance, that you kill people who work on the sabbath, or offer virgins to bad guys (i.e., Lot, I think)or other of the many rather draconian things that the god of the old testament thought reasonable, so I wonder how you rationalize following some and not others of these directions - and who selects which to follow and which to ignore?
Also, if a doctor ordered a transfusion against the wishes of a JW patient, would your god punish the doctor? If so, how? If not, why not?
— CASWell, that makes even less sense. Why would you — and HOW could you — abstain from your OWN blood?
— a_boyerI agree with Carol. Very thought provoking. I’m not a Jehovah’s Witness; but I admire any person who stands by his or her convictions. Some scoff, citing science, or claiming brainwashing. The doctor had the choice to not do the surgery - He agreed that he would follow the patient’s wishes. To some people, there are worse things than dying. You and I may not understand that. We may not get another person’s faith; but that does not remove the validity of it. Ethic vs. Ethic occurs every day, but rarely so dramatic. Thanks.
— Mary#2, these are YOUR beliefs, not “the” beliefs stated in Leviticus. Please don’t attribute your life-threatening interpretations to a text considered sacred, and life affirming, by others. That said, if J’s Witnesses are determined to sacrifice themselves on the altar of their own self-styled fundamentalism, then MDs should recongize that the decision is rightly the patient’s and, assuming legal documents to this effect are signed, let the patient’s wishes determine the course of action, without angst or guilt on the MD’s part.
— beckyHere’s a controversial proposal - we as a society decide when some action (whether pursuing sincerely held beliefs or not) is contrary to the good of some other individual. OK we can’t ban suicide. If a JW wants to commit suicide and not involve anyone else (say by not calling 911 when bleeding profusely) ok. But if they are trying to involve a medical professional in their suicide then that is an unconscionable burden on the Dr.
It is not appropriate to ask doctors who are trained entirely to save life and preserve life and life-quality to actively kill a patient by omission of a clear act that would likely save them - then we have stopped them from being doctors. I don’t know what they’ve become but they’re not doctors.
So you can look at a series of practices - refusing treatment outside the concept of palliative care, circumcision, female genital mutilation, partial birth abortion and polygamy - and we can as a society decide if each of those is within the range we can tolerate as a matter of taste (because that’s all conscience is, a taste for a particular set of values) or whether it is outside the reasonable range of taste and into the bounds of compromising another person’s person or profession.
Some of those practices would be uncontroversially illegal in the US. Some are uncontroversial ROUTINE. But there’s been no debate within this framework about any of them.
I would argue that this taste for refusing blood not only affects the Dr profoundly, it also harms social values so profoundly that it can be legitimately banned. Not all acts of conscience are equal, some are beyond the pale otherwise we’d be letting willing doctors do female genital mutilation in the US.
— JillyFlowerIt’s really quite simple. THousands of years ago they tried blood transfusions
— jkellyand some worked and some did not.
They never figured out the blood types
though. So when a tranfusion worked it was a miracle (type O) In many cases it did not work because of mismatched blood types and death ensued. So as you
figured out the it was off to the races with the stories.
It’s simply they did not have the intelligence to figure it out back then.
Now that the stories are etched in stone it is hard to get humans to understand what really happened because
they don’t want to understand.
You can lead a horse to water but you can’t make them drink.
On the other hand thousands of people get transusions everyday and live so losing a few here and there is nothing to even care about.
Here we have another example of the illogicality of faith interfering with the scientific method. It is absurd that JW’s abandon other tenets of their faith, such as not killing unruly children, murdering adulteress wives, or destroying a whole city because people of different religions live there. If they can pick and choose which aspects of their own religion to follow, why not abandon this ridiculous argument?
— Gene Conroy-JonesI’m curious to know what the malpractice insurer’s position would be. Personally, I would mandate somehow that if the JW is making this kind of decision, then he/his estate is precluded from any kind of lawsuit stemming from any injury or death that results from not performing a transfusion.
— JennyI’m not JW—in fact, I vehemently disagree with many of their beliefs, including the blood transfusion ban—but I want to congratulate the New York Times on a great article. It is at the same time informative and non-judgmental, both on the part of the doctor and of the patient. Kudos to Tara Parker-Pope on a her wonderful treatment of a touchy subject.
— JeffWhile I personally take issue with formalized religion, and while I find this “no blood transfusion” policy strange, I don’t think anyone else should impose their beliefs onto others. If someone doesn’t want a blood transfusion, their wishes should be respected, much the same way a dying patient may want their life support turned off at a certain point, or the same way a cancer patient may decide to forego chemo/radiation. We all have the right to decide such things.
That said, I certainly don’t envy the position that that surgeon found himself in. As was mentioned here, apparently thee are other ways to mitigate blood loss, and I would hope and trust that the doctor was aware of those, and had them at the ready, should the patient have suddenly lost alot of blood.
Another thing that comes to mind though is…so long as JW’s have this rule (which non-JW doctors will obviously have a problem with), why don’t they have their own hospitals/doctors to go to? I mean, I know that Hassidic jews have their own ambulances (and perhaps hospitals too), so why not the JWs then as well?
— yippee1999Fascinating article and I truly can sympathize with the ethical dilemma faced by this surgeon. I wonder why so many secularists post disparaging comments about faith on NY Times boards. So many lament the perceived bias toward them but jump at every opportunity to dismiss those of faith as stupid or ignorant. Our society is big enough to allow individuals to make their own choice about their faith or lack thereof. I am not a JW but I respect this patients absolute right to determine his own care.
— David NYCSince the described surgery was elective, both doctors (surgeon and anesthesiologist) and patient have the luxury of taking the time to attain a mutual understanding concerning transfusions. Most hospitals have agreements that the patient must sign (prior to surgery) in order to receive or refuse transfusions. If any of the physicians participating in this patient’s care cannot comply with the patient’s desires, they should withdraw. There are many interpretations (by JW patients) of what is acceptable with respect to transfusions. It is mandatory that each physician understand the different modalities available and how they comply (or don’t comply) with the patient’s needs or the tenets of the patient’s religion.
Michael Diamant, MD
— Michael Diamant, MD16, they tried blood transfusions thousands of years ago? I know they cut open people’s skulls for various reasons, but I hadn’t heard about ancient blood transfusions.
I’m curious as to why JWs are allowed to use some blood products, but not blood.
From TPP — I don’t know the answer but Dr. Campbell does talk about the basis for the belief in his article. Here is is:
— Lisa HallettWhat about the children of JW who are in need of a blood transfusion? In Canada, the Supreme Court as ruled that hospitals (doctors) must procede with blood transusions if the life of a child is at risk.
— Andrew L.There is something to be said about the right to refuse treatment, as yippee1999 points out, but what about cases when a child’s life is in danger? A decision having to be made for the child, do we have the right as a society (through the doctor), to let parents decide to, in no uncertain terms, kill their child?
— Mamo