Jehovah's Witnesses & blood transfusion

[carebeth]

I work in a Level 4 NICU.

Last night, we got a baby transported to us from another nearby hospital.

The baby was just about 8 hours old by the time we got him, born at 36 5/7 weeks. The infant was born with multiple anomalies. But our first priority to address was the platelet count of 8000 (normal value for our hospital is 150,000-450,000). This child needed a platelet transfusion, however, the mother is a Jehovah Witness. She refused the transfusion even after talking to our neonatologist who explained the risk for IVH, and subsequently death should no transfusion be administered due this very critically low platelet count. Social workers were involved, as well as another neonatologist. They were in the process of getting a court order, however, due to the child's deteriorating signs, (lethargic, bruises all over, desaturations, emesis), the neonatologist that night overwrote the mother's wishes and got another neo to ok the order to give the platelet transfusion to the infant. I gave the platelet transfusion after getting all the appropriate doctor's orders. and the transfusion completed with out any complications.

Our hospital law states that in an emergency, when parents refuse blood transfusion for their child, doctors are able to 'overwrite' the parents religious beliefs with two attending MD (in this case two neonatologist) signature, while awaiting the court order.

What are your thoughts?

What would you have done?

What is your hospitals policy regarding this?

[rn/writer, RN]

Tough situation, however, in the case of a newborn (or any young child), I think they made the right call. The parents are entitled to their religious beliefs, but the baby doesn't have any yet and would probably like to survive. It's too bad that the infant's needs bump up against their beliefs, but the baby deserves a chance to live long enough to make his own decisions.

[BittyBabyRN]

Although I am not a Jehovah's Witness...

I have been told by our chaplin, that the parents believe that if they consent for such a transfusion, they are knowingly "damning" the child. However, if it is done "against their will" the child can be forgiven. So in many emergency cases... the parents or family may not truly object to the transfusion, they just don't want to wear that burden on themselves, and are hoping for someone else to make the decision. Many are aware that if it is an absolute necessity, it will be done, regardless (via court order, or in similar cases to yours).

Don't know if this helps... but just FYI! :)

[wtbcrna, MSN, DNP, CRNA]

This has been tried in court several times and the verdict is always the same. An adult can martyr themselves for their beliefs, but a child cannot be martyred for beliefs of their parents/guardian.

[ittybabyRN, RN]

This happened once in my unit on night shift, baby had been born at home with a midwife, after a few days the baby was not eating well and lethargic, finally brought him in (3days old). He looked BAD. Docs wanted to give blood, family refused, by the time they got the court order for it and gave it, it was too late. Baby died 5 hours after he came on the unit and it was a big, messy code don't know if they ever figured out what was wrong with him.

[PMFB-RN, RN]

This is easy. The kid gets what they need. Our medical center has an expidited process to make the child a ward of the state and we give them whatever blood products they require reguardless of the parents wishes. I have had JW parents thank me. They get to have their cake and eat it too. They get to refuse the transfusion and save their child.

You guys did the right thing.

[Coffee Nurse, BSN, RN]

My unit does the same thing. I have been told (and for the record, this is secondhand information at best) that most Jehovah's Witnesses will be OK (though not thrilled) with this arrangement, since they are not actually consenting to the transfusion. YMMV, of course; it doesn't change the fact that you are taking a major decision out of the parents' hands, which they may well regard with resentment rather than relief.

ETA: Whoops -- yes, basically what everyone else said.

[llg, PhD, RN]

Although I am not a Jehovah's Witness...

I have been told by our chaplin, that the parents believe that if they consent for such a transfusion, they are knowingly "damning" the child. However, if it is done "against their will" the child can be forgiven. So in many emergency cases... the parents or family may not truly object to the transfusion, they just don't want to wear that burden on themselves, and are hoping for someone else to make the decision. Many are aware that if it is an absolute necessity, it will be done, regardless (via court order, or in similar cases to yours).

Don't know if this helps... but just FYI! :)

I did an ethics paper in grad school on this topic and interviewed a clergyman of the Jehovah's Witness faith. That's pretty much what he said. While he didn't go so far as to say that parents actually secretedly wanted health care providers to "take over" the situation and take the decision-making responsibility from them ... he did emphasize that it was the decision to receive the blood products that was the sin and not the actually receiving of the blood.

He emphasized that the child and parents would not be blamed or shunned or anything like that in cases where health care providers take control. In such cases, they believe the health care provider has committed a sin by taking control, but recognize the health care provider's right to make that decision for him/herself -- and the Jehovah's Witnesses generally agree to abide by the laws of the community in these matters.

So ... in short he said that while they would never choose to receive blood ... they would not be harmed if someone else made that decision for them.

[PMFB-RN, RN]

of course; it doesn't change the fact that you are taking a major decision out of the parents' hands, which they may well regard with resentment rather than relief.

*** I would never say so at work or indicate to the parents that I felt this way but I really could not care less about their resentment. I am very happy to respect their religious beliefs as I do people of all religions, but not to the point where it results in the death of a child. I have seen older JW have bad outcomes that very likely did not have to be bad if they had accepted the blood. I am fine with an adult making that decision for themselves.

[Coffee Nurse, BSN, RN]

*** I would never say so at work or indicate to the parents that I felt this way but I really could not care less about their resentment. I am very happy to respect their religious beliefs as I do people of all religions, but not to the point where it results in the death of a child. I have seen older JW have bad outcomes that very likely did not have to be bad if they had accepted the blood. I am fine with an adult making that decision for themselves.

Oh, I agree, of course; just saying that while most parents are probably relieved to "have their cake and eat it too," as another poster put it, not all will necessary react that way.

[CHAVNY]

I am a NICU nurse. (I too did research on this topic for a school presentation, but received a totally different impression than mentioned above, impressions however are irrelevant)

I work in a culturally diverse area. Many parental beliefs, religious or otherwise, often arise. We are always instructed to respect these because they are fundamental to the patient --and for us by extension the parent.

I understand each of us must decide where we draw the line when it comes to a conflict of what we believe to be right and the parents wishes. But don't muddle the line with broad sweeping assumptions.

I find the assumptions made here disturbing. You cannot blatantly decide how a parent will feel based on what a chaplan or one minister tells you. That's like saying all nurses believe this, because someone once told you a nurse said this, or because a nurse gave you an impression they felt this, or even one nurse does believe this. One person does not speak for all, especially when it comes to their spiritual beliefs.

To realize something is beyond your control does not mean you secretly wish it to be or "want your cake and eat it too". It merely acknowledges your limited responsibility. But limited responsibility doesn't mean you don't feel hurt or suffer because of what happened. Being relieved that no harm was done is not equal to glad it happened.

I can't imagine anything more difficult or violating than to take away the choices affecting your child's life. When all a parent longs for is to protect and nurture their child. Then to imply you secretly wished it that way, when all your control has been taken away. That is insult to injury. Its like saying the rape victim secretly "wanted it". Please don't do that.

Treat your patient and their parents as individuals. Find out what they really feel: themselves. What they really want. Talk to them. Educate them (and yourself) on all the options. Don't decide you are doing them any favors by taking the decision out of their hands or violating what they hold to be true.

Healthcare providers do have to make choices based on what they feel to be right. But if we take that parent's responsibility away, let's own it. Let's not soothe ourselves with: they "wanted it".

[PMFB-RN, RN]

I understand each of us must decide where we draw the line when it comes to a conflict of what we believe to be right and the parents wishes. But don't muddle the line with broad sweeping assumptions.

To realize something is beyond your control does not mean you secretly wish it to be or "want your cake and eat it too".

*** This is a case of wishful reading. That is reading what you wish was written rather than what was actually written. You have jumped to conclusions not supported by what people have said. You have made broad, sweeping assumption unsupported by the comments people have made. You put quotation marks around my comment but then changed the comment inside the quotation marks so that it not a quote at all. By changing my comment then placing it in quotation marks you have attributed things to me that I did not say.

You accuse me and some others of making broad, sweeping assumtions when I clearly stated that my conclusion where based on what actual parents had told me, not what I thought, or assumed they where thinking.