I'm curious of your opinion - page 3

On another board a group of people are discussing a case. It's about a 25 week premature baby needing a blood transfusion. The family refused the blood transfusion. The court's interceded and... Read More

  1. by   JW-HLC
    "No time to run it through the courts and showcase your religious doctrine."

    You certainly have a way with words - I bet you are a wow with the ladies!

    As I mentioned in my previous posting, not every case can be resolved successfully either with or without blood, but how many children of Jehovah's Witnesses have you dealt with in the extreme circumstances you put forward?

    A general principle must always be to locate the bleeding and stop it as quickly as possible, not wait while you argue with the parents or obtain a court order - you would be amazed how much time is often wasted in trying to change minds rather that solve the problem of the bleeding. The option of volume expanders will always be there and cell salvage will be acceptable to most Witnesses. Indeed where cell salvage is used the resultant reinfused blood will ALWAYS be better than stored blood. Salvaged blood is high in 2,3DPG which enables the blood to carry oxygen; stored blood is extremely low in this and acts almost just as a volume expander for the 1st 24 hours. Being realistic about Hb levels will also avoid unnecessary transfusions.

    At the moment our discussion is academic in most lands because of the legal situation. In the circumstances what Jehovah's Witness parents will ask is that you do your UTMOST to avoid the use of blood. That means STARTING from a view of actively seeking to carry out treatment in accord with the parent's wishes, not seeking to "win out" in a difficult situation just because the courts are there.

    From the legal standpoint I do not envisage a successful case against a doctor for acting in compliance with a JW's wishes. JW's carry legally acceptable "Advance Healthcare Directive" cards, which indemnify doctors against litigation, when acting in accordance with their wishes, similarly consent forms carry such. Jehovah's Witnesses as a body would never support a lawsuit againt a doctor who had carried out the Witnesses express wishes for non-blood treatment.

    We appreciate all that the medical profession do to help our members in difficult medical situations and we appreciate that this puts you under some pressure too. Do you think that you have sufficient support, after-care, call it what you will in coping with your emotions at times like these?
  2. by   GreytNurse
    Hi, I was born 10 wks premature. I needed a complete blood exchange, plus 2 transfusions. I spent 7 wks in NICU inside an incubator. I'm very thankful my parents didn't give up......'whatever it takes'. My Mom was urged to 'give up the fetus', as I was given a 5% survival rate. She had a 'stubborn' streak that my Grandfather teased her about, I'm thankful for that 'family trait'.
    As a Christian, I can certianly understand the religious stance of these parents, however, we must also look beyond that and note that a life is hanging here. Some would call this 'child endangerment, child neglect, etc'......it is such a fine line here, but I agree with the hospital to intervene....that is their duty. As with others, I too say that the baby is the patient and not the parents. That is where S.S comes into play.
    As far as survival rate for the baby? It's hard to say, but with all of the advances today, the baby has advantages! Mine were even more challenging......I was born......(I'm giving my age away here) in 1959! Look how far we have come! The only thing I suffer with is partial hearing loss. My family was told I would be totall deaf, probably blind and M.R.......I wear reading glasses and ,of course, my family would question my 'mind' at times Nobody said our jobs would be easy.......thanks for your dedication and love.......you all are the greatest!!
  3. by   traumaRUs
    For me, I would look at the overall health of the infant and the chances for an adequate quality of life, ie able to breathe without ventilator, walk, talk/be a functioning member of society. I think parental resources should also be figured in the calculation. In the ER, (unfortunately) we delivered 18 week twins about about three years ago. They moved, made feeble, labored gasps and we wrapped them in a blanket and let mom hold them until they died. Although I feel that I did everything possible/responsible, I didn't like the idea of doing nothing.

    But, then I consider all the children I take care of on a daily basis with vents, trachs, g-tubes, persistent vegetative states that have no meaningful lives and I come to grips with it.

    It's hard.
  4. by   JW-HLC
    "... give up the fetus" - "My family was told I would be totally deaf, probably blind and M.R"

    Just goes to show, never trust a doctor!
    Glad you are here to tell us your story.
  5. by   RyanRN
    "never trust a doctor", sorry JW you've missed the point and digressed on a non issue here in an attempt to prove your argument.

    Almost all the writers here have agreed with you on trying every alternative first, then consider blood. Also I am sure noone would even remotely suggest that JW parents do not love or not want the best for their childern. Point taken and agreed, no reason to review. No further review needed here on those issues.

    What needs to be addressed is the exception, the minor who truly needs that transfusion, as a last resort, to extend life. You have listed all the positives but we have all read or seen on TV the cases of children who have died as a direct result of not receiving the blood. One cannot deny that these stats are out there are very real. And, after all, we are nurses, our training and actions are geared toward doing all we can to save. I believe we all have good hearts.

    The philisophical questions are raised so that we can come to terms with doctrines that are unlike our own. However, the state can and does enter into this equation and most probably due to the fact that not entering into it may very well result in a death. Who will decide, who will be responsible, where do parents
    wishes begin and end and what are your rights and what are the minors rights? Probably we can debate endlessly.

    My own curiosity lies in the comparative religions. How does one choose certain doctrines to live by as opposed to others. How supportive is your community when one has to actually decide such things. There are consequences, both spiritual and in your day to day life that would affect a JW decision. For instance, shunning or disassociation for not following this doctrine of taking blood. How does one cope? Can one regain the same position after having gone through an unfortunate experience like this?

    My own faith/philosphy directs that I cannot judge another and I
    am here to say that I do not. Which is not to say that I will not question and try to relate and assist you and yours to reach the comfot level you require in your life.
  6. by   live4today
    Hello everyone,

    I lost a granddaughter to death who was born at 25 weeks gestation. She only lived a short while after birth. She was cremated and we held a family burial for her. I have a little album with pictures of her in it where she was all wrapped up in a baby blanket with a soft knitted cap atop her tiny head. Do we discount her life because she didn't survive long enough after birth, or do we count her life as being worth saving if the measures had been available to do so?

    I have many grandchildren, but I still think of the grandchild that died in December 1994 as my deceased grandchild. She was born, her heart was beating, she cried a preemie cry, she breathed for a time, and then she died. She only weighed a little under two pounds at birth. Her parents named her, embraced her, kissed her tiny frame, and then said goodbye to her...all in less than 12 hours time.

    Which one of us wants the responsibility of defining what denotes a "quality of life" for a human being, and at what age?
    We are not The Divine Creator of Life, we are human vessels through which life is born. Only God knows our time of birth, death, and quality of life we will live before we are even created. We should not take it upon ourselves to interfere with this process of life.

    Many famous people were preemies, yet lived to do mankind a world of good. Had they been refused the opportunity to even exist, who should be the judge of the " quality of life" they may not have had, or the 'gift' they were obviously born to share with the world? Certainly not I. Nor should any other human being.

    Should the medical profession get a court order to give blood without parental permission to a preemie or any other minor child? I say, YES. Life should be held precious enough to be given the chance to give life back to others. A baby or very young child cannot make these kinds of decisions on their own, so someone must intercede on their behalf and be the voice they do not have. Parents have the choice "Not to have a baby", but once that life is already in the world, no parent should be permitted to take away that life...no matter what. If it's not meant for that particular baby to survive this life, no blood transfusion will stop that life from leaving his/her little body because the day of our death is predetermined, and the day of our life is predetermined by our Creator, no matter what religious beliefs one has. We all came from somewhere, didn't we?

    Just my own personal take on the whole matter, but certainly NOT in whole.
    Last edit by live4today on Jan 15, '02
  7. by   VickyRN
    In my former unit, we all had the unfortunate experience of watching an elderly female patient slowly fade away before our eyes--a simple blood transfusion would have saved her. H & H of 6/18--refusing blood transfusion because of Jehovah's Witness beliefs. Docs tried everything they could--the whole unit watched this poor woman die and mourned. What a tragedy
    God's will? I don't think so.
  8. by   live4today
    Hello Healingtouch,

    That is so sad. Did she have any family present, or were they JW, too? I think if a blood transfusion will save the life of a person, they should have it, but when that person is of "legal age" and of sound mind to say they do not want to be saved, what else can be done? Do you think the courts should have intervened in this elderly woman's case?

    In the case with the 25 weeker, the infant had no voice, so the courts did the right thing by ordering the baby be given a blood transfusion. In your elderly lady's case, did the hospital seek a court order for her, too?

    When the health profession has done ALL they can medically do for a patient, and a patient dies anyway, I believe it was (is) their "time to go". But, to let a patient die when something could have been done to save their life? Well, that is NOT God's Will at all. Yes, death is a part of life, but it is not up to us to call the shots of when death should occur.

    Would you liken that elderly woman's decision to not receive blood to prolong her life to what Mr. Kovorkian assisted his patients with? Why is it okay for a person to elect death over life when Kovorkian was accused of abiding by the patients' wishes
    to do the same?

    Just thinking here. There are soooooo many loopholes in this kind of decision making...so it seems. What do you think?

    "People demand freedom of speech to make up for the freedom of thought which they avoid."-- Soren Kierkegaard
  9. by   fergus51
    This debate is going to go on for a long time. I can't help but think of one of my nursing instructors who said we shold be less concerned with outcomes than with process. I don't know where I stand, and I am glad I am not the one to make these decisions.
  10. by   JW-HLC
    I think you are being a little harsh with me - my comment "never trust a doctor" was followed by a I would happily have put in more if I thought anyone didn't think I was having a bit of fun in making that comment! (Maybe it's the difference between UK and USA humour?). I think it is great that "Greytnurse"'s parents didn't follow medical advice and abort and it shows what can be done in difficult cases.

    I have repeatedly acknowledged that there is not a solution in every case - nobody can tell me that you get success with every case and just as some have died without blood there are numerous examples of death after blood has been given. I am not trying to avoid the issue, all I am saying is that it is not correct to state that "Blood = Life" it is more complex than that. Dealing with minor children presents its own special problems but even these can and are being overcome without blood, but not in every case.

    I will deal with your other issues in turn I hope you will bear with me:-

    "we are nurses, our training and actions are geared toward doing all we can to save. I believe we all have good hearts"
    I can assure you that never for one moment has it ever occured to me to think any differently, my daughter was a nurse until recently (now almost 9 months pregnant) and we have a number of nurses in the congregations in the city here where I live. I am currently having some investigations carried out in a local hospital and without exception the nurses have been most kind, helpful and professional.
    The Watchtower Society (who print magazines for JW's) produced a magazine for public distribution ("Awake" 8th November 2000) entitled "Nurses - What Would We Do Without Them?". One statement in bold said "Although often taken for granted, nurses are a vital part of health care. What are the joys and the challenges of the noble profession?" Some 11 pages of the 31 page magazine were devoted to the praise of nurses and an explanation of the work that they do. A number of recent magazines have also dealt with the way doctors are helping JW's with bloodless treatments. We truly appreciate all that you do.

    I will not further discuss the legal issues as I think there is little to discuss, the law stands as it is and you are right we could probably debate endlessly.

    You ask "How does one choose doctrines to live by?" - well for me it is just a question of asking "What does the Bible say?" - If I accept that God has given a message to mankind via the Bible then the least we can do is listen to what it has to say. God doesn't make us listen, neither does He force us to do anything. His word specifically tells us about His view of blood - we can listen to that and observe it or we can ignore it, the choice is ours. For me, when God tells me that blood is sacred, it is not to be used for anything except to make atonement for sin and that I must observe His requirements in respect to blood, I observe that. (Although before I became a JW many years ago I was a blood donor). I believe that in many cases differences in doctrine can be put down to how seriously one accepts the Bible, for many people, when it comes to doing something that seriously affects their lives, that is where they draw the line. Let me give you a couple of examples:-

    1) "You, then, are to go and make disciples of all the nations and baptise them in the name of the Father and of the Son and of the Holy Spirit" (Matt:28:19,20 "Phillips") - How many people do you know who follow this COMMAND? Yet there it is in the Bible.

    2) "Thou shalt love ......... they neighbour as thyself" (Luke 10:27 "Phillips") - yet how many "christians" are/have been involved in wars (Rwanda, Croatia, etc etc).

    If one of JW's decides to have blood and subsequently did not care about what they had done they would be viewed as one who had left the faith, however they can return if they wish. If they did care and subsequently regreted their actions (perhaps giving in due to emotion or pressure) then they would be helped by the congregation and would continue to be assisted and supported by it. I have dealt with many individuals and families who have been affected by the blood "issue", some who have been helped by other treatments and some where a child has had a forced transfusion. In the later case it is very traumatic but with help and support some healing can take place. (It is perhaps difficult for a non-Witness to comprehend this thought of "trauma" in what is viewed by many as a "life-saving" procedure- an adult Witness in one country was forcibly given a blood transfusion against her wishes - she said it was like being raped - her words not mine.)

    It is right to question - no one should blindly accept what they are told, they should establish the truth for themselves, in their mind and heart. The Apostle Paul met people from ancient Borea, he spoke of them as being "more noble-minded" than many others he met - why? Because they "... studied the scriptures every day to see if what they were now being told were true." (Acts 17:11 "Phillips"). We encourage all Witnesses to do just that; before they become a Witness and at least every year the matter of blood is discussed. Annually in every congregation world-wide each Witness is encouraged to establish and record their individual wishes with regard to blood and to record it in a "Living Will" - this is a voluntary action but most helpful to doctors who may treat the Witness and can see what is or is not acceptable treatment for them.

    I hope that I have answered your questions.
  11. by   rosy
    Originally posted by Peeps Mcarthur
    The parents are not my patient.
    Screw what they think.
    The baby is the patient and therefore gets the benefit of whatever treatment is available to me until such time as it is not my patient.
    If God deems it required to intervene I'm sure He'll let me know.

    Quite a bit of procedure is second to a persons beliefs or personal preferrence, but life and death. No way.
    I thought NICU nurses believed in the whole family approach to care. The parents have a whole lot more invested in this baby than you do, and flipping off their concerns strikes me as pretty insentive
  12. by   JW-HLC
    The instance you describe must have been upsetting for you all but let me try to explain the woman's view. The "elderly" woman had probably made her decision about blood many years before and had lived by that decision for all of those years.
    For her the most important thing would have been to have died faithful in her service to God and that she obviously did.
    Had any efforts been made to prevent her keeping her integrity to her beliefs she would doubtless have been horrified and felt abused by those in whose care she found herself.

    Be upset, but please don't be angry, she will have died fulfilled and she will have believed that having done so she would receive the fulfillment of the promises made in the Bible - NOTHING would have been more important to her .
  13. by   Peeps Mcarthur
    How is it that letting the parents who are untrained, in great distress, and exauhsted, make a decision not to follow standard medical care for a helpless little baby that disregard your position as caregiver "sensitive" as you put it.
    How about a crack baby. Do you let the mother make decisions? Assuming she knows who the father is, do you wait for her to consult with him?
    Something tells me you might get some fairly inconsistant medical advice. Something tells me you may not respect their oppinion. You may just want to reverse their roles and put these selfish "parents" in the incubator. Underweight, suffering the torture of withdrawl. Every orafice inhabited by a tube with little chance to live very long. And that's the GOOD news!
    No, I think you would at least be muttering "screw the parents" under your breath.
    How is taking advice from "crackheads" seriousely any different than religiouse zealots bent on martyrdom for their child? They present just as intoxicated by the fervor of the letter of their gods law. The interpretation of which is usually done by somebody other than themselves. Yea, I'll listen, but if it harms my patient I don't give a crap what they think.
    What about a family of tribesmen from the Amazon. In certain regions the folks there eat dirt. The people there get minerals from eating dirt balls. They may want to include that in the baby's diet. It may be of religiouse significance to them. Do you then seriousely consider the parents wishes and consult an PDD (Parenternal Dirt Doctor)? LOL.....LOL
    Am I being "insensitive" for taking the traditional route and not considering feeding the little one dirt?
    How is that different from considering any other differential modality of choice from parents that don't know any better?

    Certainly, concessions to the parent's wishes can be made as long as it does'nt effect the health and well being of your patient that can not make decisions regarding their treatment.
    You are the advocate for your patient. You can't lay everything at the feet of political correctness.
    If it will harm your patient and you do it(or not do it) YOU ARE RESPONSIBLE. Forget the fact that the parents wishes were followed, no matter how mentally intact they might appear.
    So let me clarify.
    If you want me to forsake my patient to pain and suffering unto death just because you gave birth to them.
    Is that very clear?
    Last edit by Peeps Mcarthur on Jan 16, '02