Jehovah's Witnesses' & Blood Transfusions

Who are Jehovah’s Witnesses?

Jehovah’s Witnesses are a group of people who believe in Christian religious beliefs. They refuse blood transfusions as they believe that blood is sacred and cannot be administered intravenously

Why do Jehovah’s Witnesses refuse blood?

They interpret passages such as Acts 15:28-29 ("abstain from blood") as a religious command not to take blood into the body

Transfusing whole blood

Is forbidden

accepting individual blood components (such as red blood cells, white blood cells, plasma, and platelets

• is now considered a matter of personal conscience

• It is essential to recognise that each Jehovah’s Witness will have their preferences regarding what they can accept and refuse.

  As a doctor, it is crucial to clarify these choices with the patient

If the patient has capacity

• Capacity means the ability to use and understand information to make a decision, and communicate any decision made

• They have the right to decline the life-saving blood transfusion, the doctor must respect their autonomy

• To ensure that the patient has capacity, fully explain the blood transfusion procedure to them and discuss the advantages and disadvantages

• Subsequently, give them time to retain this information and ask the patient to communicate this information back to you

• Make sure they have made a full informed decision

• Ensure that they have understood the implications of refusing the treatment and that they are not being pressured by a family member/friend

Why might a patient lack capacity

• Unconscious or drowsy

• Neurodegenerative health condition - e.g. dementia

• Severe learning disabilities - illegal to assume a disabled person does not have capacity

• Mental health condition - schizophrenia

• Capacity is decision-specific and time-specific

What can doctors do if a patient lacks capacity?

• Advanced directive

• Lasting power of attorney

Advanced directive

• A legal document that explicitly states their refusal of blood products, even if their life is at risk

• The advanced directive must be in writing, and it must be signed by the patient themselves in order to be accepted

Lasting Power of Attorney

This is where the patient has appointed a single person to express their decision to refuse the blood transfusion, in case the patient is unresponsiv

No capacity, no advanced directive, no lasting power of attorney

• In this case, the doctor should talk to the patient’s family to see what their choice would be, which can help act in their best interests

If the family is refusing the option of a blood transfusion

• Urgent applications to the Court of Protection can be issued.

• This all depends on how much time the doctor has and the urgency of the patient’s case

If the patient is a child - 16/17

• If the patient is 16 or 17 years old and they have capacity, they are technically able to consent or refuse the blood transfusion procedure.

• However, their refusal of life-saving treatment can be overridden by the court

• Emergency Situations: If it is a true, split-second medical emergency where waiting for a court order would cause death or severe harm, doctors can provide life-saving treatment immediately under common law necessity

If the patient is under 16

• If the patient is under the age of 16, you must assess them for Gillick competence

• In the case of a life-saving situation, where those with parental responsibility have refused the treatment, a doctor can seek an emergency court order to administer the blood transfusion in the patient’s best interests

Autonomy

• Respect the patient’s autonomy

• Advanced directives and a lasting power of attorney further protect the patient’s autonomy

Beneficence

The doctor should aim to act in the patient’s best interests to promote their survival and health. The doctor could also seek alternative treatments to the blood transfusions

Non-maleficence

• Not administering the blood transfusion could lead to the patient’s health deteriorating further

• However, administering the blood transfusion to a Jehovah’s Witness goes against their religious beliefs, and this could harm their mental or spiritual health.

Justice

The doctor should ensure that the patient is being treated fairly and in accordance with the domains of the GMC guidelines. The doctor should aim to seek legal advice and, especially in urgent situations, a decision from the Court of Protection.

Can Jehovah’s Witnesses accept any blood products?

• whole blood, red cells, white cells, platelets and plasma are refused

• many Witnesses will accept fractions such as albumin, clotting factors or immunoglobulins, and some accept cell salvage (where their own blood is collected and returned in a continuous circuit

• preferences vary form person to person, so the doctor must clarify

Alternative treatments

• Volume expanders: This can be used to replace and maintain internal fluid volume. Substances like albumin and saline can be used

• Medication: Erythropoietin can be used to stimulate the production of a greater number of red blood cells.

• Blood clotting medication: Tranexamic acid and clotting factors can be used to reduce the amount of bleeding occurring in the patient.