Jehovah's Witnesses

[DropkickMurphy]

The other night I was watching that "True Stories from the ER" show and they had a case of a teenage patient where the parents wouldn't allow blood transfusions on religious grounds and it really seemed to bother the doc. Now, I don't know about anyone else, but I don't see what the big deal or ethical dilemma here is. I see it this way: If you have your head so far up your butt that you are going to get you or those you are responsible for killed- regardless if it is because of your religion or just because you are a total ****** in a general sense- then that's your problem, not mine. If we make it clear that "You do realize you're effectively signing your own death warrant right?" and they still refuse, their blood is on their hands, not mine (pun entirely intended). Granted I will do everything within the limits put upon me to prevent death but if the person buys the farm, I look at this way: That is a reason to submit that person for a Darwin Award. OK, sorry, I just felt the need to rant a little.....

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[EctopicFetus]

The other night I was watching that "True Stories from the ER" show and they had a case of a teenage patient where the parents wouldn't allow blood transfusions on religious grounds and it really seemed to bother the doc. Now, I don't know about anyone else, but I don't see what the big deal or ethical dilemma here is. I see it this way: If you have your head so far up your butt that you are going to get you or those you are responsible for killed- regardless if it is because of your religion or just because you are a total ****** in a general sense- then that's your problem, not mine. If we make it clear that "You do realize you're effectively signing your own death warrant right?" and they still refuse, their blood is on their hands, not mine (pun entirely intended). Granted I will do everything within the limits put upon me to prevent death but if the person buys the farm, I look at this way: That is a reason to submit that person for a Darwin Award. OK, sorry, I just felt the need to rant a little.....

Im 99% sure im right but parents dont have the right to deny medical care to their kid if it might be life threatening. So the general rule is that if a kid needs a transfusion or something *simple* like that then we can do it without the parents consent. What we do here (if we have time (which is rare)) we get ethics to consult, they take custody long enough to consent and thats it.. done.. truth is when i took ethics it was simple.. if it is a minor i can just do it in these simple manners.. the issues can and do get much more complex..

 

[mikecwru]

The other night I was watching that "True Stories from the ER" show and they had a case of a teenage patient where the parents wouldn't allow blood transfusions on religious grounds and it really seemed to bother the doc. Now, I don't know about anyone else, but I don't see what the big deal or ethical dilemma here is. I see it this way: If you have your head so far up your butt that you are going to get you or those you are responsible for killed- regardless if it is because of your religion or just because you are a total ****** in a general sense- then that's your problem, not mine. If we make it clear that "You do realize you're effectively signing your own death warrant right?" and they still refuse, their blood is on their hands, not mine (pun entirely intended). Granted I will do everything within the limits put upon me to prevent death but if the person buys the farm, I look at this way: That is a reason to submit that person for a Darwin Award. OK, sorry, I just felt the need to rant a little.....

A competent adult has the right to refuse this. A minor does not. You would transfuse the child. Now, professionalism dictates that the best way is to try to be nice, calm, and explain as much as you can to the parent.
mike

 

[Apollyon]

Now, professionalism dictates that the best way is to try to be nice, calm, and explain as much as you can to the parent.
mike

Although I can NOT believe that this came from Mike, he is absolutely right.

The reason I mention this (I am not a JW, by the way) is that, to the Jehovah's Witnesses, if they get a blood transfusion, they can NEVER go to heaven. The doors are closed.

Even as we may think that that is not reasonable, it's just like offering a ham sandwich to a Jew or Muslim.

Religious faith (and, recall that faith is "believing without proof") is a strong, strong thing to many people.

 

[DropkickMurphy]

Now, professionalism dictates that the best way is to try to be nice, calm, and explain as much as you can to the parent.

Agreed.....but as my former medical director- one of the best EM docs I've ever seen and a former medic- put it after a similar case (the patient int that case was an adult and nearly died from blood loss during surgery): "Having an intelligent discussion with a fanatically religious nutcase is about as easy as drilling a tunnel through a mountain using your forehead."

 

[FoughtFyr]

Even as we may think that that is not reasonable, it's just like offering a ham sandwich to a Jew or Muslim.

No, it's worse than offering a ham sandwich to a Jew. The Jewish faith has an overriding principle that any biblical law (expect praying to idols or denying God) may be "waived" to save a life. Almost all rabbinical councils have allowed use of porcine heart valves if no alternative existed. If a jew truly eats a ham sandwich "by accident" the doors of "heaven" are NOT closed to them. As for the Muslims I'm not exactly sure how their faith would view this.

- H

 

[AmoryBlaine]

Agreed.....but as my former medical director- one of the best EM docs I've ever seen and a former medic- put it after a similar case (the patient int that case was an adult and nearly died from blood loss during surgery): "Having an intelligent discussion with a fanatically religious nutcase is about as easy as drilling a tunnel through a mountain using your forehead."

I'm not sure that being a Jehova's Witness and refusing a blood transfusion automatically makes someone a "fanatical religous nutcase."

 

[deleted21609]

I'm not sure that being a Jehova's Witness and refusing a blood transfusion automatically makes someone a "fanatical religous nutcase."

I'm pretty sure it does.
Anyone who will commit murder or suicide for some religious nonsense is a nutcase. People are idiots and can die if they want, but if some father dies to pursue his irrational beliefs, his orphans are the ones who pay. That's just wrong.

 

[TxMed]

this thread has just been given the award for most ethnocentric on SDN. please come up to the stage and accept your swastica.




tm

 

[AmoryBlaine]

I'm pretty sure it does.
Anyone who will commit murder or suicide for some religious nonsense is a nutcase. People are idiots and can die if they want, but if some father dies to pursue his irrational beliefs, his orphans are the ones who pay. That's just wrong.

Murder? Suicide? What are you talking about?
Alot of these "irrational beliefs" are a huge part of many, many of our patients lives and we should respect that.

 

[docB]

this thread has just been given the award for most ethnocentric on SDN. please come up to the stage and accept your swastica.




tm

And the Nazi card is played on post #9. Now that's gotta be an SDN record. Plus throwing out the Nazi accusation is so much more speedy than actual cogent disagreement.

My problem with the whole JW thing is that I couldn't care less what they do. I just don't want to be liable for it. When they are refusing a transfusion for their kids it becomes very hard for me to avoid that liability. If I transfuse the kid I'm setting myself up for a suit from the parents and the kid (he'd be dead but now he's suing). If I "respect" the parents demands and the kid dies child welfare will be all over me. I may even have criminal charges filed. There's no way to win. Calling child "welfare" is generally useless in my area and even if they did get involved the legal system doesn't work on an emergency medicine timeline. The sad fact is that as an EP you are just really unlucky if a critically anemic JW stumbles in your door.

 

[vish07]

"Having an intelligent discussion with a fanatically religious nutcase is about as easy as drilling a tunnel through a mountain using your forehead."

how true...

 

[SoCuteMD]

Once a JW has received a blood transfusion, he/she is ostracized from the faith. Because of the social structure, it means that they can no longer interact with their family. Thus - infant of JW parents receives blood and is pretty much abandoned. Dad worked nearby, so occasionally dropped by. Mom never showed after the transfusion. Saw this for myself at one of my school's teaching hospitals this summer. Now, I'm not saying they shouldn't have transfused the kid, I'm just saying that most of us who are of Judeo-Christian heritage (I don't know enough about other religions) are used to there being "exceptions" for the preservation of life.

 

[DropkickMurphy]

Murder? Suicide? What are you talking about?
Alot of these "irrational beliefs" are a huge part of many, many of our patients lives and we should respect that.

I respect their right to die early because of their idiotic beliefs. At least they aren't hurting others....

 

[leviathan]

I respect their right to die early because of their idiotic beliefs. At least they aren't hurting others....

If it's an adult JW, then it is understandable. In this case, you have a minor who is not old enough to make her own decisions, and guardians of the minor making a decision which assures her death.

 

[DropkickMurphy]

True.....personally I think the parents should be prosecuted for child endangerment or neglect in cases such as this (only because taking them out and putting a bullet in their heads isn't an option )

 

[leviathan]

True.....personally I think the parents should be prosecuted for child endangerment or neglect in cases such as this (only because taking them out and putting a bullet in their heads isn't an option )

So true.

 

[SoCuteMD]

If it's an adult JW, then it is understandable. In this case, you have a minor who is not old enough to make her own decisions, and guardians of the minor making a decision which assures her death.

This has been taken to court repeatedly in the US. Parents can not refuse life-saving transfusions for a minor in this particular instance.

Thus, they can't be prosecuted for child endangerment or neglect.

 

[DropkickMurphy]

this thread has just been given the award for most ethnocentric on SDN. please come up to the stage and accept your swastica.




tm

Two things......it's not ethnocentric, because it's not involving ethnicity. And it's "swastika".

 

[dhb]

All JW kids should be given blood to be saved from the cult, now that would be a humanitarian action!

 

[leviathan]

Two things......it's not ethnocentric, because it's not involving ethnicity. And it's "swastika".

Txmed failed at his usage of pop culture terms.

 

[DropkickMurphy]

Yes, because we all know that little nuts tend to grow up to be big nuts.

 

[DropkickMurphy]

Txmed failed at his usage of pop culture terms.

If you're going to accuse someone of being a Nazi, it would be best to not do it to me....

 

[flighterdoc]

Once a JW has received a blood transfusion, he/she is ostracized from the faith. Because of the social structure, it means that they can no longer interact with their family. Thus - infant of JW parents receives blood and is pretty much abandoned. Dad worked nearby, so occasionally dropped by. Mom never showed after the transfusion. Saw this for myself at one of my school's teaching hospitals this summer. Now, I'm not saying they shouldn't have transfused the kid, I'm just saying that most of us who are of Judeo-Christian heritage (I don't know enough about other religions) are used to there being "exceptions" for the preservation of life.

We had a couple of JW's come and speak in our medethics class (it was less trouble than the professors actually, you know, teaching....)

There don't seem to be any hard and fast rules about transfusions...its pretty much left up to the patients belief systems.

In your example, the parents are the ones abandoning the child, and I suspect that G-D might have something to say to them about that, eventually.

 

[DropkickMurphy]

I think it would be funny if one of them died because they refused a transfusion on "religious grounds", and they get to the Pearly Gates and St. Peter looks at them and goes "You *****! What were you thinking? Say hi to Satan for me!" *cosmic bitchslap*

 

[AmoryBlaine]

I respect their right to die early because of their idiotic beliefs. At least they aren't hurting others....

It's not "idiotic," it's a part of their faith. If we are all so not into respecting religion and culture and how they play into health care maybe we should just go back to the old system when docs just pretty much made all the decisions w/o really consulting pts

 

[DropkickMurphy]

It's not "idiotic," it's a part of their faith. If we are all so not into respecting religion and culture and how they play into health care maybe we should just go back to the old system when docs just pretty much made all the decisions w/o really consulting pts

I wouldn't object to that in certain circumstances.

 

[The White Coat Investor]

Once a JW has received a blood transfusion, he/she is ostracized from the faith. .

Does this mean no one knocks on their door on Saturday mornings?

 

[Miami_med]

Two things......it's not ethnocentric, because it's not involving ethnicity. And it's "swastika".

Ethnocentric actually refers to a belief that your culture is superior. Ethno- as a prefix refers to culture (ethnogenicity, ethnocentric, ethnography, etc...) Thus, your statement, right or wrong, is in fact ethnocentric, as you are stating that the value in your culture (saving a life) is superior to the value in their culture (Not receiving a transfusion). I am not saying that being ethnocentric in a belief is wrong (most of us are), but that statement is in fact Ethnocentric.

Sorry, my anthropology roots just couldn't let that be

 

[DropkickMurphy]

Does this mean no one knocks on their door on Saturday mornings?

I've found that if you have your girlfriend lay down on the sidewalk and you trace a chalk outline, scatter some religious pamphlets (Watchtower, etc) around, put up some yellow crime scene tape and liberally apply fake blood to the ground, you can sleep until noon.

Of course, the other recourse is simply to spike their communion wine with heparin. (I'm am NOT advocating this.....just being a smartass)

 

[DropkickMurphy]

Ethnocentric actually refers to a belief that your culture is superior. Ethno- as a prefix refers to culture (ethnogenicity, ethnocentric, ethnography, etc...) Thus, your statement, right or wrong, is in fact ethnocentric, as you are stating that the value in your culture (saving a life) is superior to the value in their culture (Not receiving a transfusion). I am not saying that being ethnocentric in a belief is wrong (most of us are), but that statement is in fact Ethnocentric.

Sorry, my anthropology roots just couldn't let that be

Duly noted. I apologize for my misunderstanding, as I was operating under the belief that there was some specific term for religious aspect of it.

 

[crewmaster1]

Had a JW on the ambulance the other day with a GIB and HCT of 8, going to the OR refusing blood! Good luck with that one.

 

[DropkickMurphy]

Had a JW on the ambulance the other day with a GIB and HCT of 8, going to the OR refusing blood! Good luck with that one.

Ah.....Darwin was right after all.....

 

[TxMed]

Ethnocentric actually refers to a belief that your culture is superior. Ethno- as a prefix refers to culture (ethnogenicity, ethnocentric, ethnography, etc...) Thus, your statement, right or wrong, is in fact ethnocentric, as you are stating that the value in your culture (saving a life) is superior to the value in their culture (Not receiving a transfusion). I am not saying that being ethnocentric in a belief is wrong (most of us are), but that statement is in fact Ethnocentric.

Sorry, my anthropology roots just couldn't let that be

just tuned back in...good to see some more anthro roots in the crowd. where did you do your anthro?

tm

 

[hoboken]

Had a JW on the ambulance the other day with a GIB and HCT of 8, going to the OR refusing blood! Good luck with that one.

My attending told me to talk to the family and find the most reasonable one then get him or her alone to sign the blood transfusion permit. If that doesn't work or you do not have time you need to transfuse children, single parents and pregnant women if medically indicated. Anyone else you could get sued for transfusing them but they are unlikely to prevail if you can document a strong medical need to transfuse the patient, however if you let them die because you didn't transfuse them when clearly indicated you can get sued and you will probably loose.

 

[mikecwru]

Although I can NOT believe that this came from Mike, he is absolutely right.

The reason I mention this (I am not a JW, by the way) is that, to the Jehovah's Witnesses, if they get a blood transfusion, they can NEVER go to heaven. The doors are closed.

Even as we may think that that is not reasonable, it's just like offering a ham sandwich to a Jew or Muslim.

Religious faith (and, recall that faith is "believing without proof") is a strong, strong thing to many people.

I'm not expert, but I believe if they are "bulldozed" over by the doctor for their kids, then it is not "their" or "their kids" "fault." Because we've had some JWs thank us after the issue was forced.

mike

 

[desoto]

I'm not expert, but I believe if they are "bulldozed" over by the doctor for their kids, then it is not "their" or "their kids" "fault." Because we've had some JWs thank us after the issue was forced.

mike

I was told that if it was not their choice, and they went to church and repented. they would then be eligible to go to heaven again.

 

[Jeff698]

I had a string of shifts last year, over about a week or so, where I kept getting patient after patient coming in for a variety of complaints but they were all anemic with Hgb under 9, some WELL under 9. Each one was a JW.

It turns out there was a JW conference in town for the week.

Good thing there wasn't a building collapse. Although it would have been a great story. Sort of like the plane load of epileptics that crashes into a glass store full of hemophiliacs.

Take care,
Jeff

 

[DropkickMurphy]

Sort of like the plane load of epileptics that crashes into a glass store full of hemophiliacs.

....and that sets off a fire that spreads to the chemical factory.....

 

[paramed2premed]

My attending told me to talk to the family and find the most reasonable one then get him or her alone to sign the blood transfusion permit. If that doesn’t work or you do not have time you need to transfuse children, single parents and pregnant women if medically indicated. Anyone else you could get sued for transfusing them but they are unlikely to prevail if you can document a strong medical need to transfuse the patient, however if you let them die because you didn’t transfuse them when clearly indicated you can get sued and you will probably loose.

Huh? Like other posters have said, the matter of the child in need of a transfusion isn't much of a discussion, except in terms of tactics. The last time I checked though, the law hasn't considered women to be child-like in terms of their competence since they gained the right to vote or own property.

What do you think your attending was getting at? Perhaps this wasn't a verbatim quote.

Also, I'm not sure that just any family member can sign consents for transfusions, as a routine matter. Might be a different matter if hospital administrators are backing you up, I guess.

 

[deleted109597]

This has been taken to court repeatedly in the US. Parents can not refuse life-saving transfusions for a minor in this particular instance.

Thus, they can't be prosecuted for child endangerment or neglect.

In emergent fashion, no. But if their kid is diagnosed as anemic at a clinic, and they are told to go to the hospital for a tranfusion but don't actually do that, then yes they can. Just like they can attempt to refuse cancer treatment and have their child run off to Mexico.

 

[DropkickMurphy]

In emergent fashion, no. But if their kid is diagnosed as anemic at a clinic, and they are told to go to the hospital for a tranfusion but don't actually do that, then yes they can. Just like they can attempt to refuse cancer treatment and have their child run off to Mexico.

Although I think anyone who names their son 'Starchild' needs to have their sanity questioned, let alone pulling some stunt as boneheaded as refusing cancer therapy.

http://www.cnn.com/2006/LAW/08/11/cancer.fight/index.html

 

[deleted21609]

It's not "idiotic," it's a part of their faith. If we are all so not into respecting religion and culture and how they play into health care maybe we should just go back to the old system when docs just pretty much made all the decisions w/o really consulting pts

Their faith is idiotic. Just because people place so much emphasis on the most nonsensical parts of their lives doesn't protect them from the obvious observation that they are idiots. or brainwashed. or just irrational. or whatever.

 

[DropkickMurphy]

Their faith is idiotic. Just because people place so much emphasis on the most nonsensical parts of their lives doesn't protect them from the obvious observation that they are idiots. or brainwashed. or just irrational. or whatever.

I choose E. All of the Above.

 

[Jeff698]

....and that sets off a fire that spreads to the chemical factory.....

...releasing toxic fumes that float ominously toward the Sisters of Perpetual Wheezing Academy for Boys....

 

[DropkickMurphy]

...releasing toxic fumes that float ominously toward the Sisters of Perpetual Wheezing Academy for Boys....

....leading to all of the respiratory therapists at Scott and White being called in on their days off....

 

[desoto]

I think the issue with, single parents and pregnant women, is the fact that their death will directly affect more people than the patient. Therefore like a child they may not be able to truly consent to not getting medically indicated transfusions.


Single parents have dependants who rely upon them for their sole parent for support. If you fail to transfuse them and allow their mother to die the dependants can sue you for the loss of their sole source of support and most likely will win.


If you fail to transfuse the pregnant mother then you are allowing a potentially viable fetus to die which the absent father could sue you for harming. While this is not as likely as getting sued by a dependant child most of these groups have a very strong pro-life views.

 

[DropkickMurphy]

most of these groups have a very strong pro-life views.

Except when it requires a transfusion to sustain apparently

 

[paramed2premed]

I think the issue with, single parents and pregnant women, is the fact that their death will directly affect more people than the patient. Therefore like a child they may not be able to truly consent to not getting medically indicated transfusions.


Single parents have dependants who rely upon them for their sole parent for support. If you fail to transfuse them and allow their mother to die the dependants can sue you for the loss of their sole source of support and most likely will win.


If you fail to transfuse the pregnant mother then you are allowing a potentially viable fetus to die which the absent father could sue you for harming. While this is not as likely as getting sued by a dependant child most of these groups have a very strong pro-life views.

No.

We are discussing criminal and ethical matters here. Tort stuff is not relevant - it doesn't matter if someone sues you for performing an action which is both unethical and illegal.

Which is precisely what transfusion of a non-consenting competent adult is.

 

[dchristismi]

....leading to all of the respiratory therapists at Scott and White being called in on their days off....

...while the brakes suddenly failed on a schoolbus transporting a busload of kindergardners with osteogenesis imperfecta on a class trip...