Ethical situation with Jehovah's witnesses

[TheShaker]

UW question 783 got me thinking about other situations where I'm not sure about what to do. So, we have a mother and child in a car accident and they are both incapacitated and require life sustaining blood transfusions. The husband says that they are Jehovah's witnesses and then hangs up, not giving any further information. Neither of these patients have JW cards, so, in this emergency situation, we would transfuse them both.

BUT...

What if the husband got to the ED in time, and as the next of kin, tells them to not transfuse the wife? Do we still transfuse her?

If the child has a JW card, do we still transfuse her even if the parents say no? UW says that you should get a court order but I remember reading otherwise a long time ago.

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[ortnakas]

You wouldn't transfuse the wife if she had a card or if the husband clearly gave instructions. Not sure on the daughter.

 

[OnePunchBiopsy]

I am not familiar with the question, but I highly doubt you will be asked whether or not to transfuse a child of a JW. In the real world, there is enough legal precedence that a doctor could provide an emergency transfusion to an unstable minor despite the wishes of the JW parents, and do so without a court order (how will a court decide in time when the patient is crashing). This was information I received from a trauma surgeon I worked with.

If it is a JW adult, and you know they refuse blood, or they are unconscious and the next of kin is present and say they do not want blood, then you legally cannot give blood.

 

[TBV]

In that case you wouldn't transfuse the wife but you get a court injunction to provide life saving care to a minor. Basically take their dumb asses to court over it.

 

[teehees]

always transfuse the child if its emergency even if they say not to. Thats my understanding

 

[deleted480308]

husband, if standing there saying no "it's not what she would want" gets to refuse for the wife

dad and court order be damned, the kid gets saved either way....you don't wait, you don't pass go, you don't collect $200, you just do it

 

[Promethean]

I worked in a pediatric OR. We occasionally had JW kids who might need to be transfused. We did everything possible with fluids, albumin, hextend, whatever, to avoid giving blood. But, if it came down to it, we were going to transfuse a minor, no matter what.

The JW parents were not as opposed to that as you might think. They didn't want their kids to die, and if a transfusion would save their lives, they could make peace with that. They aren't allowed to request it, or even to consent to it, but if it was going to happen whether they wanted it to or not, I think that was a bit of a relief to them. If we made it be totally out of their hands, then the blame fell on us, not them or the child.

As for adults? They have their own choice to make, and we really can't give them the same merciful out that we could offer their children, by forcing the issue. I have heard of JW patients accepting transfusions if it could be done without telling their families about it. Jehovah's Witnesses shun members for violating their rules, and disfellowshipping, or kicking someone out of the church, can be devastating. They really are only allowed to be friends with other JWs, and the church discourages higher education or advanced job training as a waste of precious time that could be spent trying to save souls. So, being forced to leave the church can mean losing one's entire support system and way of life all at once. Their family can't even talk to them, or else they risk being disfellowshipped as well.

So, if you can speak with the (conscious, not in the middle of a trauma) JW patient alone and offer to protect their privacy and confidentiality around receiving a transfusion if it were needed, such as during an upcoming surgical procedure, they may be more open to the idea.