Caring for Jehovah's witnesses

MegRN84 · Apr 5, 2006

To say that a patient died for their religious refusal to accept a blood transfusion is unfair. You yourself said that the patient had an underlying

cancer diagnosis. Was it not then the cancer, rather than the refusal that led to this patient's death?

Everyday patients with numerous diagnoses receive blood transfusions. In my career as a nurse there were many patients we (the staff) all knew were close to death that were receiving blood transfusions. And they died.

And our hearts broke and we carried on, as we always do.

As nurses, we always encourage pt's to hope. Hope is one of the most successful keys to a cure we possess. Our jobs even provide hope.

That Jehovah's Witness died still believing in his hope. He would eventually died, because we all do. But because you did not force him to accept blood, he died with his hope intact.

You most certainly want to do the same for anyone who was sick and dying in your care.

But please do not blame this man's death on his refusal to accept blood. But the true culprit, the cancer.

BittyBabyGrower, MSN, RN · Apr 10, 2006

Yes, ChayNa, 24 weekers do survive and if the baby has had no problems such as a bleed in the brain, overwhelming infection, etc, then sometimes they need blood to replace what we have taken in labs and the normal breakdown of red blood cells. It isn't that easy to withdraw support on kids, especially if they aren't on their last leg. Without the RBC's, they usually require higher vent settings, don't tolerate feeds, have multiple A and B's and all this can lead to things that can kill this infant, such as NEC, PVL, IVH and BPD. In the many years I have worked in NICU, we have only had to get a court order a handful of times, most of the time the parents do consent.

Now, in a 22 or 23 weeker, it's a different scenario as those kids usually are bad to start.

ICURN_NC · Apr 10, 2006

My family is not JW, but my mother has never believed in blood transfusions or organ donations. She believes that her body is the temple that God gave her for her soul, and she will not change anything- giving or receiving.

She refused blood during her first 2 labors, which were difficult breach deliveries that had to be manually turned becaused since she wouldn't take blood, her docs wouldn't do c-secs. Both she and my brother and sister turned out ok.

My mother never really made a big deal about it. Interestingly, a couple of years ago, I ended up in the ED after hemorraghing and I found that I did not want to accept blood products, yet I administer blood products and never really think anything of it.

goats'r'us, ASN, RN · Apr 10, 2006

Quite a large population of Witness here, have had problems with obtaining surgical consents, ALWAYS have physician and head nurse present these forms and do education on these forms. Physician needs to address need for blood or blood products with patient and family more than one time prior to any procedure, advance directives need to be current, and the patient and the family needs to understand that with modern standards of care, it may lead to a legal battle if blood or blood products are needed to sustain life in the absence of any other major health problem. Several Witness patients chose to autodonate 2 units prior to surgery, especially orthopedic procedures, when given the opportunity. Have had one patient who died because he refused blood, had underlying cancer diagnosis, and family swore in court he would not agree to transfusions. Hope this helps.

i find it interesting that you've had witnesses autodonate prior to ortho procedures. my understanding was that once the blood comes out of contact with the body it's no longer acceptable, whether it's their blood or not.

smk1, LPN · Apr 10, 2006

i find it interesting that you've had witnesses autodonate prior to ortho procedures. my understanding was that once the blood comes out of contact with the body it's no longer acceptable whether it's their blood or not.[/quote']
this is true. I think though that there are a lot of folks who were raised as Jehovah's witnesses and may not be real active in the religion now, but still would consider themselves JW when asked, and may be more likely to accept the blood in a pinch. Also there are some who are studying and associating with the witnesses, but are not yet a JW and are not entirely sure of what is "allowable". In any case, it is wonderful to see so many here that are appreciative of the rights and beliefs of patients and will work in a non judgemental manner with them. As a JW myself It makes all the difference in the world.

bethem · Apr 14, 2006

After reading this thread, doing a little bit of research and then observing two CABG surgeries using the bypass machine, I wondered about JWs and consent. Do you think JW patients (or, for those of you who are JW, would you) consent to a procedure that involved a bypass machine?

I am aware that some believe that an autologous transfusion is acceptable, whereas others believe that as soon as the blood leaves the body, it is impure.

I was quite curious about this and I figured this would be the best place to get some good answers.

Thanks!

PANurseRN1 · Apr 15, 2006

Bypass can be used, as long as it is not primed with blood. As long as the blood remains in circulation, bypass is acceptable.

bethem · Apr 16, 2006

Bypass can be used, as long as it is not primed with blood. As long as the blood remains in circulation, bypass is acceptable.

Thanks, PANurseRN1, that satisfies my curiosity.

atiam3 · May 3, 2006

Hey, heard there are laws or principles about Nurses' rights to refuse to give treatments against their spiritual beliefs. Has anyone encountered these? Please share.

aimeeinorbit · May 3, 2006

after reading this thread, doing a little bit of research and then observing two cabg surgeries using the bypass machine, i wondered about jws and consent. do you think jw patients (or, for those of you who are jw, would you) consent to a procedure that involved a bypass machine?
i am aware that some believe that an autologous transfusion is acceptable, whereas others believe that as soon as the blood leaves the body, it is impure.
i was quite curious about this and i figured this would be the best place to get some good answers.
thanks!

oh my gosh im so excited about this topic. these are really great questions!

first of all, i am an witness and an rn also. i am soooo glad to see that there are so many of us on here. i would love to get to know you all. its good to have the support.

as far as on pump cabg goes...

yes, technically the blood leaves the body, but a lot of witnesses view the pump as a temporary extension of their circulatory system since the integrity of the system is never actually broken. there was an article in the awake magazine about this in 1989 (i think it was 89). it boils down to this: the bible commands us not to "eat" blood, which would obviously include iv infusions. the bible does not specifically mention things like: on pump cv surgeries, albumin, cell savers, dialysis, etc... these things are left to the patient to make a personal decision about. they have to consider their understanding of the scriptures and they have to become educated regarding the treatment modalities. then they make a decision based on their own conscience. this is why you will see some accept one thing that another would refuse. hope this helps.

transducen, BSN, RN · May 3, 2006

I'm glad this topic came up b/c I have been wondering about this myself. I would like to say as I did in another post that there are over 100 bloodless hospitals worldwide. This shows that there are alternatives to blood transfusions and people should realize that. Also, I had a friend of mine who was in a car accident and needed surgery. The physicians did not want to do it b/c her hemoglobin count was too low. The nurses pressured her to take blood and were nasty to us, her friends, and made the situation worse for her by trying to make her feel dumb for not taking it. Some friends of mine got together and made a juice(pure)from beets, carrots and raw eggs and gave it to her for a week. Just after a couple of days, her count started going up and after the week, was good enough to do the surgery. Was it the juice? Well, research shows that beets do have blood building properties. The nurses had to eat their words. The point is that there is not ONLY ONE SOLUTION to a problem. Just b/c a popular solution is used, doesn't mean it is the best or the only one; blood transfusion or not, professionals and patients should look for other solutions to a variety of ailments.

4yrstogo · May 19, 2006

I realize that it has been a while since this post has been visited, but I thought I would offer my experience...

I too am a Jehovah's Witness and my first daughter was born at 27 wks gestation and weight 1lb 9oz. I didn't go into preterm labor but, by chance, had a routine ultrasound that found that the fluid in my amniotic sac was low and during following tests they found that Kaylee's heart rate dropped substantially and was irratic and so they performed an emergency CS.

My husband and I not only had to deal with her prematurity and adjusting to the situation but had to confront our beliefs of not accepting blood under any circumstances. The first hospital she was born at said they would transfuse at about 40 hematocrit level. She was tranferred to Sunset Kaiser in LA and they said they would let it drop to 30 before tranfusion was forced. We maintained hourly contact with her doctors and nurses and hand in hand with our liason committee kept track of her status. We did what we could to find alternative procedures and was even able to organize meetings between her doctors and other MD's who had dealt with the situation before.

We assured the doctors that alternative treatments were acceptable to us and they proceeded with EPO, iron, and other blood boosters. We were able to get them to agree to minimize blood draws and focus on her status rather than just the numbers.

She was then transferred to a bloodless unit in Encino/Tarzana Regional Medical Center where they assured us they would do what they could but if all else failed the only alternative was transfusion. We held firm to our stand, but realized the doctor's did not have a choice, for their own ethical reasons, and had her best interests at heart.

She underwent a surgery to fix the PDA that medicine could not. It was during this surgery that we feared the worst. They came out and we breathed a sigh of relief when they said she made it through okay and again when they said they were able to do the surgury without blood loss. Her hematocrit dropped to 11 in that hospital... and then it started rising on it's own. The EPO and alternatives began working, along with her own body.

She suffered no brain bleeds, no brain damage, no CP, no ROP... the only signs she has of being a preemie is the scar from her surgery and asthma. All without blood. We understand that we were very fortunate and that other families, JW or not, have had to face other circumstances.

We encountered doctors that were kind... as well as those who chastized us for our beliefs. We endured threats of medical custody being taken away from us. But we will always be grateful to the doctors, nurses, administrative staff and others who were so willing to help us through the hard times.

We have kept in touch with the hospital Kaylee was born at. Since that time, they were able to write new procedures for dealing with preemies of JW parents and even held a staff conference to educate them on what to do in the event they were faced with the situation again. We can be happy that our stand will help other families in this same situation in the future.

I hope this helps...

-Lisa :)