Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

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Jehovah’s Witnesses and Blood Transfusions: An Analysis of the Legal Protections Afforded to Adults and Children in European/English Human Rights Contexts

European Journal of Health Law ◽

10.1163/15718093-12341417 ◽

2017 ◽

Vol 24 (4) ◽

pp. 368-389

Author(s):

Clayton Ó Néill

Keyword(s):

Human Rights ◽

Religious Beliefs ◽

Case Law ◽

Blood Transfusions ◽

Jehovah’S Witnesses ◽

Related Case ◽

Jehovah's Witnesses ◽

European Court ◽

Adults And Children ◽

The Will

Abstract This article considers the degree to which the religious beliefs of Jehovah’s Witnesses are given consideration in European and English courts. Adults’ refusal of blood transfusions is examined within the context of European human rights jurisprudence. A focus is also placed on the position of Jehovah’s Witness children who refuse blood transfusions in the specific context of English medical law due to the prevalence of related case law in this jurisdiction. It is argued that the European Court of Human Rights has given appropriate protection to the will-rights of competent adult Jehovah’s Witnesses who refuse blood transfusions. The position of children is somewhat different, and it is suggested that the courts should give greater consideration to the rights of competent children to manifest their religious beliefs.

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Early Experiences With PEGylated Carboxyhemoglobin Bovine in Anemic Jehovah’s Witnesses: A Case Series and Review of the Literature

Journal of Pharmacy Practice ◽

10.1177/0897190018815373 ◽

2018 ◽

Vol 33 (3) ◽

pp. 372-377 ◽

Cited By ~ 1

Author(s):

Sean McConachie ◽

Krista Wahby ◽

Zinah Almadrahi ◽

Sheila Wilhelm

Keyword(s):

Case Series ◽

Stable Condition ◽

Complex Nature ◽

Blood Transfusions ◽

Oxygen Carriers ◽

Jehovah’S Witnesses ◽

Clinical Safety ◽

Jehovah's Witnesses ◽

Pharmacologic Management ◽

Oxygen Carrying Capacity

Jehovah’s Witnesses (JW) represent a complex patient population due to their refusal to accept blood transfusions on religious grounds. Pharmacologic management of anemic JW patients is limited to stimulation of hematopoiesis by iron and erythropoietin supplementation and reduction of blood loss by prothrombin complex concentrates (PCCs). Hemoglobin-based oxygen carriers (HBOCs) represent the only pharmacologic modality for JW patients capable of acutely increasing a patient’s oxygen carrying capacity in the setting of organ failure, yet clinical safety and efficacy data are lacking in this population. We report 3 cases in which the HBOC, PEGylated carboxyhemoglobin bovine (Sanguinate®), was requested under emergent circumstances for severely anemic (hemoglobin <5 g/dL) JW patients who refused blood transfusions. Two patients received PEGylated carboxyhemoglobin infusions for severe anemia, while the third patient died prior to receiving the medication. One patient who received Sanguinate died after 5 units of medication. The other patient’s hemoglobin recovered and she was discharged in stable condition. This series demonstrates the complex nature of the critically anemic JW population and highlights the clinical considerations of using HBOCs in clinical practice and the critical need for further research before they can be broadly recommended.

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How to approach orthognathic surgery in patients who refuse blood transfusion

Archives of Plastic Surgery ◽

10.5999/aps.2020.00493 ◽

2020 ◽

Vol 47 (5) ◽

pp. 404-410

Author(s):

Sang Hwan Lee ◽

Dong Gyu Kim ◽

Ho Seong Shin

Keyword(s):

Blood Transfusion ◽

Orthognathic Surgery ◽

Blood Transfusions ◽

Recombinant Erythropoietin ◽

Jehovah’S Witnesses ◽

Jehovah's Witnesses ◽

Hypotensive Anesthesia ◽

Normovolemic Hemodilution ◽

Surgery Center ◽

Bloodless Surgery

Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.Methods Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

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