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EDUCATION AND DEBATE: Osamu Muramoto Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses BMJ 2001; 322: 37-39 [Full text]

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Rapid Responses published:

Refuse or decline?

Graham Howarth   (5 January 2001)

Re: Refuse or decline?

Osamu Muramoto   (6 January 2001)

to decline or not

Tony Barrett   (9 January 2001)

Re: to decline or not

Osamu Muramoto   (10 January 2001)

the changing word of god

Ian Nesbitt   (11 January 2001)

A Response

Chris Bartlett   (12 January 2001)

Are Jehovah's Witnesses committed to blood policy?

Lee Elder   (12 January 2001)

Re: the changing word of god

Osamu Muramoto   (12 January 2001)

Reply to Chris Bartlett: Obeying God or obeying the Organization?

Osamu Muramoto   (16 January 2001)

Jehovah’s Witnesses and Blood vs. Justification and Responsibility

Marvin Shilmer   (18 January 2001)

Re: Jehovah’s Witnesses and Blood vs. Justification and Responsibility

Osamu Muramoto   (19 January 2001)

Who is really defending dogmas?

Peter Morrell   (21 January 2001)

dogma, smogma

Ian Nesbitt   (22 January 2001)

Re: Who is really defending dogmas?

Osamu Muramoto   (22 January 2001)

Beating the drums of compliance and conformity

Peter Morrell   (23 January 2001)

Re: Beating the drums of compliance and conformity

Osamu Muramoto   (26 January 2001)

Are they really reformers?

George Smithson   (27 January 2001)

The conundrum of the three flasks

Peter Morrell   (27 January 2001)

Re: Are they really reformers?

Lee Elder   (28 January 2001)

Re: Are they really reformers?

Osamu Muramoto   (28 January 2001)

Re: The conundrum of the three flasks

Osamu Muramoto   (29 January 2001)

Re: The conundrum of the three flasks

Thomas Daniels   (29 January 2001)

Re: Are they really reformers?

Sam Beli   (30 January 2001)

Is debating unprofitable?

David Race   (30 January 2001)

Re: Re: The conundrum...

Joseph Watine   (30 January 2001)

Re: Re: Beating the drums of compliance and conformity

Sam Beli   (30 January 2001)

Re: Re: Are they really reformers?

Dave   (30 January 2001)

Re: Re: Re: Are they really reformers?

Lee Elder   (31 January 2001)

Re: Re: Re: The conundrum...

Osamu Muramoto   (1 February 2001)

Re: Re: Re: Are they really reformers?

Osamu Muramoto   (1 February 2001)

Re: Re: Re: Re: The conundrum...

Joseph Watine   (2 February 2001)

Conundrum unsolved and [tenuously] connected matters

Peter Morrell   (2 February 2001)

Re: Conundrum unsolved and [tenuously] connected matters

Lee Elder   (2 February 2001)

Re: Are they really reformers?

Chris Hazard   (3 February 2001)

Information exchange is the key

Osamu Muramoto   (3 February 2001)

A flask, a bucket and a bathtub - not the three flasks

Osamu Muramoto   (4 February 2001)

Re: Conundrum unsolved and [tenuously] connected matters

Thomas Daniels   (5 February 2001)

Re: Re: Conundrum unsolved and [tenuously] connected matters

T L P Watts   (6 February 2001)

Muramoto’s Flying Carpets

Peter Morrell   (6 February 2001)

Re: Muramoto’s Flying Carpets

Joseph Watine   (7 February 2001)

Re: Muramoto’s Flying Carpets

Lee Elder   (7 February 2001)

Re: Muramoto’s Flying Carpets

Thomas Daniels   (7 February 2001)

Re: Muramoto’s Flying Carpets

Osamu Muramoto   (8 February 2001)

No desire to understand JWs

Peter Morrell   (9 February 2001)

Understanding Jehovah's Witnesses

Anne Sanderson   (14 February 2001)

Apology to Dr Muramoto

Peter Morrell   (19 February 2001)

The conscience of the individual Jehovah's Witness as a basis for refusing blood

Rolf J Furuli   (23 February 2001)

Re: No desire to understand JWs ... motives and belief mechanisms explored

Mike Parsons   (23 February 2001)

Re: The conscience of the individual Jehovah's Witness as a basis for refusing blood

Marvin Shilmer   (24 February 2001)

More on Blood

Peter Morrell   (24 February 2001)

Re: The conscience of the individual Jehovah's Witness as a basis for refusing blood

Helen Descombes   (25 February 2001)

Re: Why I accept minor blood fractions

Osamu Muramoto   (25 February 2001)

Reply and questions to Rolf Furuli Re: The conscience of the individual Jehovah's Witness

Osamu Muramoto   (26 February 2001)

Reply to Furuli on “The conscience of the individual Jehovah's Witness"

Lee Elder   (26 February 2001)

Re: More on blood - Conformity, the lost meaning, a darkening tunnel, rewards, the prickly nettle.

Mike Parsons   (1 March 2001)

Why do Jehovah's Witnesses abstain from blood?

Rolf J Furuli   (2 March 2001)

Re: Why do Jehovah's Witnesses abstain from blood?

Marvin Shilmer   (3 March 2001)

Re: Muramoto's reply R. Furuli, The conscience of the individual Jehovah's Witness

Rolf J Furuli   (4 March 2001)

Further question to Patric McShea

Osamu Muramoto   (4 March 2001)

Untitled

Thomas Daniels   (4 March 2001)

Is the individual conscience truly the basis of blood refusal? Questions unanswered by Furuli.

Osamu Muramoto   (4 March 2001)

Re: Furuli's reply to Muramoto

Thomas Daniels   (5 March 2001)

Re: Re: Muramoto's reply R. Furuli, The conscience of the individual Jehovah's Witness

Marvin Shilmer   (5 March 2001)

Re:Muramoto: Questions unanswered by Furuli

Rolf J Furuli   (5 March 2001)

Re: Letters from Thomas Daniels

Rolf J Furuli   (7 March 2001)

Scope of "abstain", fragmentation issues, policing vs reason, moral obligations within JW community.

Mike Parsons   (7 March 2001)

Re: Re: Muramoto: Questions Unanswered by Furuli

Anne Sanderson   (7 March 2001)

Is the WTS a major third-party?

Michael Ramfield   (8 March 2001)

For The Physicians

Marvin Shilmer   (8 March 2001)

On Consistency

Thomas Daniels   (8 March 2001)

Summary and correction of Q&A between Rolf Furuli and the author

Osamu Muramoto   (8 March 2001)

Jehovah's Witnesses Disunited on Blood?

William Edmonds   (9 March 2001)

"Eternal Principle" - an alternate evaluation.

Mike Parsons   (9 March 2001)

Furuli’s deadly shell game – where’s the blood? Part 1

Lee Elder   (9 March 2001)

Furuli’s deadly shell game – where’s the blood? Part 2

Lee Elder   (9 March 2001)

Re: The conscience of the individual Jehovah's Witness as a basis for refusing blood

A Servant   (13 March 2001)

Muramoto's new interpretation of the meaning of the concept "informed consent"

Rolf J Furuli   (13 March 2001)

Response to Furuli

Marvin Shilmer   (16 March 2001)

Autonomy of individual Witnesses should not be sacrificed by "the majority" - Reply to Furuli

Osamu Muramoto   (19 March 2001)

Thank you Rolf Furuli

Lee Elder   (20 March 2001)

Risk of blood transfusion / Illegal breach of confidentiality: Addendum to reply to Furuli

Osamu Muramoto   (21 March 2001)

Final remarks to Dr Muramoto

Rolf J Furuli   (26 March 2001)

Clarification

Thomas Daniels   (26 March 2001)

Regarding Blood Transfusion and Jehovah’s Witnesses, Furuli’s Not So Grand Finale To Dr. Muramoto

Marvin Shilmer   (27 March 2001)

Re: Final remarks to Dr Muramoto

William Edmonds   (29 March 2001)

Reply to Furuli and Concluding Statement

Lee Elder   (31 March 2001)

Final reply to Rolf Furuli

Osamu Muramoto   (31 March 2001)

Refuse or decline? 5 January 2001
Graham Howarth, Head: Bioethics, School of Medicine, University of Pretoria School of Medicine, University of Pretoria Send response to journal: Re: Refuse or decline?	Informed consent has now become ethically and legally ensconced as a patient`s right. During the process of informed consent information is divulged to a patient and this is often followed by a recommendation. The patient is then given the opportunity to accept or reject the recommendation in part or in its entirety. If the patient decides against the therapy, authorisation and hence consent is withheld. There is a tendency in the medical literature to refer to this rejection as refusal. Despite being utilised as synonyms there are distinctions between their meanings. Refuse is the stronger of the two and often stresses firmness, at times rudeness; to refuse to obey an order, to refuse to lend somebody money. Decline on the other hand, means to reject politely or courteously and is applicable to social events or an offer to help; to decline a dinner invitation. The doctor-patient relationship is usually propitious and courteous. If one acknowledges this and the distinction between refuse and decline, one realises that patients seldom refuse treatment. If indeed on occasions patients do refuse in the sense that they have to be rude to express themselves as unwilling to accept something, then have we not erred in our consent taking process? Our tendency to use the term refusal, when a patient politely and courteously rejects our offer of treatment may more be an indication of our feelings rather than a reflection of the patient`s sentiment.
Re: Refuse or decline? 6 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: Refuse or decline?	I appreciate Professor Howarth's comment and agree that the word "refusal" has underlying confrontational tone. In most situations of informed consent, "decline" seems to be more appropriate. However, in case of Jehovah's Witnesses, their sentiment against use of blood is much stronger than "decline." It is true that most Jehovah's Witness patients are polite and courteous as long as the care does not involve blood products. However, when blood transfusion becomes at issue, they generate intense emotional aversion against blood. Such intense emotion is well described in their own personal testimonies. The following quotes are all from the official publication of the Watch Tower Society which praises the attitudes of these patients. Severely wounded in a motor vehicle accident, a Jehovah's Witness woman who required a major surgery wrote as follows: "For nine days the battle regarding a blood transfusion continued-my fight to live in harmony with my conscience by refusing it, the doctors' fight to convince me to accept it."[1] A Jehovah's Witness girl with leukemia was quoted as saying, she "would fight and kick the IV pole down and rip out the IV no matter how much it would hurt, and poke holes in the blood."[2] While "decline" may be appropriate in other cases of informed consent, sentiment and attitude of Jehovah's Witnesses against blood is far from "decline." It is best described as "refusal." References 1. Watch Tower Bible and Tract Society. Overcoming life's challenges in South Asia. Awake! 1994;Jan 22:21 2. Watch Tower Bible and Tract Society. Youths who have "power beyond what is normal". Awake! 1994;May 22:13
to decline or not 9 January 2001
Tony Barrett Send response to journal: Re: to decline or not	I understand the fear of the vast majority on the issue of blood, since I am one of Jehovah's Witnesses. The question is not, "How can I hide my choice of taking blood or blood products from the congregation; it is "How can I hide it from God?" The Holy Scriptures, that we believe to be what it is, the Word of God, states that "all" true worshipers of Jehovah God must abstain from blood. If one makes the choice to ignore this "command" from God, he makes the choice to disassociate himself from the ones that "do" follow the command. There are many scriptures that can be sighted in this matter. And I am sure that you would agree that everyone must make a personal decision based on the information that they have. If anyone were to speak with one of Jehovah's Witnesses on this matter they would be happy to show what this is based on.
Re: to decline or not 10 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: to decline or not	Mr. Barrett's response as a Jehovah's Witness raises important questions. You reiterated the Watch Tower policy, but you do not address the fundamental issues this paper and reform-oriented Witnesses are raising. That is, which part of the blood is it that the "Word of God" tells one to abstain from? Whole blood or parts of blood? If you must abstain from only certain parts of blood and not the other parts, which "command" from God tells you to do so? You wrote there are many scriptures that can be cited in this matter. Which scripture can you cite to show that you should abstain only from certain parts of blood? I agree with you that this is a matter of personal choice and decision. Suppose a Jehovah's Witness believed that there is no "Word of God" to pick and choose which part of blood to abstain from, and therefore he personally decided to take one part of blood for his medical treatment. If that part of blood he chose happened to be not included in the parts of blood the Watch Tower Society determined acceptable, is he ignoring God's command? If he does not believe he is ignoring God's command, since there is no such "Word of God", he does not need to "hide it from God", yet if he is forced to disassociate himself from the community, to be ostracized and shunned by family and friends, is it not understandable that he would want to "hide it from the congregation"? I am asking those questions to highlight the points of this debate to other readers.
the changing word of god 11 January 2001
Ian Nesbitt, anaesthesia newcastle Send response to journal: Re: the changing word of god	before july 1st 1945, there was no restriction on the acceptance of blood by jehovahs witnesses. after that, the biblical phrases "no soul of you shall eat blood", "...abstain from meats offered to idols, and from blood, and from things strangled, and from fornication.." were interpretated to mean that blood transfusion was sinful. The Watchtower Society has had a hard job reinterpretating the word of god ever since. For example, in the not too distant past, vaccinations and aluminium were campaigned against by the WTS as sinful, but are now fully accepted. it seems that not all componants of blood are sinful now, although who has made that decision seems uncertain: what is the betting that in another decade, the WTS will have abandoned this untenable and intellectually dubious position and this will be an issue of historical interest only?
A Response 12 January 2001
Chris Bartlett, Information Architect Digital Harmony Technologies Send response to journal: Re: A Response	Certainly, this is a well though-out technical discourse but I find it lacking in emotional truth and not balanced as to the subject matter. Your position of negativity towards Jehovah's Witnesses, while perhaps unintended, comes through loud-and-clear. Your choice of words like "ostracize", "shun", "interrogation", and even "dissident witnesses", while perhaps technically accurate, are not well chosen to represent a balanced attitude found in the local Kingdom Halls. It is my hope that, to research your views, you removed yourself from the "paper" trail and actually spoke and spent time in these same congregations that you boldly criticize before your final draft. The reality, I suspect, is that you did not. From my point of view as one of Jehovah's Witnesses, I fear your comments do not represent the balanced, less-sensationalistic view that I have come to embrace as part of a true Christian's faith. This is especially so in your comments considering disfellowshipping/disassociating from the Congregation. Specifically, I would like to address the following statements/terms: Disfellowshipping as opposed to disassociation Internal dissidents "A member may be automatically shunned…" "Simply put, if the act of receiving blood is kept strictly confidential, disassociation is highly unlikely…" "Implication of the new policy on medical confidentiality" (section) Number 1. "No discipline seems for the present to be joyous, but grievous; yet afterward to those who have been trained by it it yields peaceable fruit, namely, righteousness."-HEBREWS 12:11. In both cases, the attitude towards disfellowshipping and disassociation is a loving one. It is a case of someone who previously made an adult decision to dedicate their life to God and, therefore, his teachings in the Bible who then unrepentantly turns his back on those same teachings to follow his own path and not God's. What you refer to as "rights" and "freedom" is not accurate when you have personally taken the step to dedicate yourself to God's way of doing things. This person had the "right" to declare his dedication and retains the "right" to turn away. Yet there remains consequences. Disfellowshipping is a loving act provided in the Bible in helping those that have turned away from God see their error and humbly return to Him. "The wise older men" of the congregation, its elders, have the painful task of the judiciary meeting. Should the person show remorse and repentance than they may determine a reproof is all that is needed. It is only when the person is unrepentant (or not sorry for going against God's teachings) that they are disfellowshipped. Even then, there is not an eternal "cutting-off" from that person. Yes, we do remain distant so as not to stumble ourselves and our own faith, but we remain loving and encourage the person to continue meetings if he has stopped committing his error and to repent. Should they repent, even several years later, they are re-instated and there is a great rejoicing to have a 'lost sheep' return to God. (2 Corinthians 7:8-13) Hence even if I saddened YOU by my letter, I do not regret it. Even if I did at first regret it, (I see that that letter saddened YOU, though but for a little while,) 9 now I rejoice, not because YOU were just saddened, but because YOU were saddened into repenting; for YOU were saddened in a godly way, that YOU might suffer no damage in anything due to us. 10 For sadness in a godly way makes for repentance to salvation that is not to be regretted; but the sadness of the world produces death. 11 For, look! this very thing, YOUR being saddened in a godly way, what a great earnestness it produced in YOU, yes, clearing of yourselves, yes, indignation, yes, fear, yes, longing, yes, zeal, yes, righting of the wrong! In every respect YOU demonstrated yourselves to be chaste in this matter. 12 Certainly, although I wrote YOU, I did it, neither for the one who did the wrong, nor for the one who was wronged, but that YOUR earnestness for us might be made manifest among YOU in the sight of God. 13 That is why we have been comforted. However, in addition to our comfort we rejoiced still more abundantly due to the joy of Titus, because his spirit has been refreshed by all of YOU. Disassociation is similar but can only happen if the individual declares himself as such. There is not done "automatically" (see below) and there is no declaration of why he is doing so. Theoretically, a person could hide his blood transfusion indefinitely. Declaring himself "disassociated" is all he needs to do, he does not need to reveal why he is doing so. Again, even though they declare themselves disassociated, he is welcome to take in our meetings if he has stopped committing his error and if his heart changes towards repentance he, too, will be reinstated and welcomed with open arms. (2 Corinthians 2:5-11) Now if anyone has caused sadness, he has saddened, not me, but all of YOU to an extent-not to be too harsh in what I say. 6 This rebuke given by the majority is sufficient for such a man, 7 so that, on the contrary now, YOU should kindly forgive and comfort [him], that somehow such a man may not be swallowed up by his being overly sad. 8 Therefore I exhort YOU to confirm YOUR love for him. 9 For to this end also I write to ascertain the proof of YOU, whether YOU are obedient in all things. 10 Anything YOU kindly forgive anyone, I do too. In fact, as for me, whatever I have kindly forgiven, if I have kindly forgiven anything, it has been for YOUR sakes in Christ's sight; 11 that we may not be overreached by Satan, for we are not ignorant of his designs. Finally, in both cases, if the person remains unrepentant and continues down a path that is in contradiction to Bible teachings, then the Christian congregation must expel and limit all contact with the individual. The person's apostate mental attitude must not be allowed to stumble others. (2 John 9-11) Everyone that pushes ahead and does not remain in the teaching of the Christ does not have God. He that does remain in this teaching is the one that has both the Father and the Son. 10 If anyone comes to YOU and does not bring this teaching, never receive him into YOUR homes or say a greeting to him. 11 For he that says a greeting to him is a sharer in his wicked works. (1 Corinthians 5:11-13) But now I am writing YOU to quit mixing in company with anyone called a brother that is a fornicator or a greedy person or an idolater or a reviler or a drunkard or an extortioner, not even eating with such a man. 12 For what do I have to do with judging those outside? Do YOU not judge those inside, 13 while God judges those outside? "Remove the wicked [man] from among yourselves." (Proverbs 4:14-19) Into the path of the wicked ones do not enter, and do not walk straight on into the way of the bad ones. 15 Shun it, do not pass along by it; turn aside from it, and pass along. 16 For they do not sleep unless they do badness, and their sleep has been snatched away unless they cause someone to stumble. 17 For they have fed themselves with the bread of wickedness, and the wine of acts of violence is what they drink. 18 But the path of the righteous ones is like the bright light that is getting lighter and lighter until the day is firmly established. 19 The way of the wicked ones is like the gloom; they have not known at what they keep stumbling. Number 2. The term of "dissident witnesses" is false. There can be no such thing. What I think you are referring to are those who have been disfellowshipped or have disassociated themselves from the congregation. They may have the attitude of a dissident (but that would suggest they are unrepentant) so they are no longer witnesses if they remain as such. They have placed themselves ahead of God's teachings and no longer show humility towards serving Him. (Job 8:13-15) Thus are the pathways of all those forgetting God, And the very hope of an apostate will perish, 14 Whose confidence is cut off, And whose trust is a spider's house. 15 He will lean upon his house, but it will not keep standing; He will take hold of it, but it will not last. (Proverbs 11:9) By [his] mouth the one who is an apostate brings his fellowman to ruin, but by knowledge are the righteous rescued. Number 3. A member of Jehovah's Witnesses can not be "automatically" shunned without self-declaration that they are disassociating themselves from the congregation. If the person does not make this declaration, then a discussion must be held by the Elders to decide what, if any, action should be taken under the circumstances. You imply that through simple hearsay members might find themselves automatically shunned and that is simply not accurate. (from "A lesson in how to handle problems", Watchtower magazine article) 1. A loving Christian does not assume at the outset that a brother's problems are of his own making. Harsh criticism of past mistakes-whether real or imagined-can totally discourage a person who is struggling to keep going. The depressed soul needs to be 'consoled' rather than berated. (1 Thessalonians 5:14) Jehovah wants overseers to be "a hiding place from the wind," not "troublesome comforters" like Eliphaz, Bildad, and Zophar.-Isaiah 32:2; Job 16:2. 2. We should never make an accusation without clear evidence. Hearsay or suppositions-like those of Eliphaz-are not a sound basis for giving reproof. If an elder, for example, makes a faulty accusation, he could well lose credibility and cause emotional stress. How did Job feel about having to listen to such misguided counsel? He gave vent to his anguish with the ironic exclamation: "O how much help you have been to one without power!" (Job 26:2) A concerned overseer will "straighten up the hands that hang down," not make the problem worse.-Hebrews 12:12. 3. Counsel should be based on God's Word, not on personal ideas. The arguments of Job's companions were both incorrect and destructive. Instead of drawing Job closer to Jehovah, they led him to think there was a barrier separating him from his heavenly Father. (Job 19:2, 6, 8) Skillful use of the Bible, on the other hand, can set things straight, invigorate others, and offer real comfort.-Luke 24:32; Romans 15:4; 2 Timothy 3:16; 4:2. Number 4. Your article states: ""Simply put, if the act of receiving blood is kept strictly confidential, disassociation is highly unlikely…" Well, of course, that is an obvious statement and has nothing to do with the blood issue but everything to do with one's faith. Your statement is a blanket for any sin against God for if that sin is willfully kept hidden then there will never be discipline from your fellow man. So you neglect two very crucial parts of this "equation". The first is that nothing is hidden from God and he will judge us accordingly. A Christian is in bad shape if he conceals his sin successfully against man and remains unrepentant for it is God who will judge him in the end based on his works. (1 John 3:4,8) Everyone who practices sin is also practicing lawlessness, and so sin is lawlessness. 8 He who carries on sin originates with the Devil, because the Devil has been sinning from [the] beginning. For this purpose the Son of God was made manifest, namely, to break up the works of the Devil. Secondly, someone who has dedicated his life to serving God would certainly be weighed down in conscience in these matters. Willfully concealing their sin over any length of time would be damaging to their relationship with God and most likely they would seek help from the "experienced and wise" to repent their sins, regardless of the discipline involved. If they are not bothered by conscience then they have probably already disassociated themselves from God , whether they have made a public declaration of that position or not. (Psalm 37:13) Jehovah himself will laugh at him, For he certainly sees that his day will come. (1 Samuel 16:7) But Jehovah said to Samuel: "Do not look at his appearance and at the height of his stature, for I have rejected him. For not the way man sees [is the way God sees], because mere man sees what appears to the eyes; but as for Jehovah, he sees what the heart is." Number 5. "Implication of the new policy on medical confidentiality" (section) There is too much here that is incorrect. For one a person always has total control over their confidentiality- we are beings of free will and we choose to follow God's way or our own without any help from others. Of course all decisions have consequences. If you choose to violate God's will then you should expect to pay the price, small or large. I think it all comes down to the "light" that is getting brighter and brighter. Understanding the Bible is a life-long endeavor, passed on to generations, and we must understand that. What we know now about God's will is so much clearer than what humankind knew in the past. There is a difference even between now and 50 years ago and it will be different 50 years from now as well. God has said that things will be revealed to us over time. Being revealed in the "light" that is getting brighter and brighter. It is important, therefore, to readjust our understanding to reflect this. Re-examining the blood issue is a natural step in this process, just as re-examining the damage of smoking was in the 70's and many other issues. In this time of the end, God is revealing many things to us and we owe it to ourselves, as worshippers of God and Christ, to pay attention. Your article sounds like criticism of the Watchtower Bible & Tract Society for not remaining 'rigid' or otherwise entrenched with their doctrinal tenet of 50 years ago. In other words, it appears that you are putting more value on holding on to tradition than to the adjustments that God has commanded us to take when understanding his handbook, the Bible. (Proverbs 4:18) But the path of the righteous ones is like the bright light that is getting lighter and lighter until the day is firmly established. (Mark 7:9) Further, he (Jesus) went on to say to them (the Pharisees): "Adroitly YOU set aside the commandment of God in order to retain YOUR tradition. All together, I do appreciate some of the points you make as it encourages everyone to decide for themselves whether or not to take on the risk of blood transfusions. I am thankful to be a servant of the true God, Jehovah, and am glad to take in the knowledge of Him by receiving the publications, the "spiritual food", from the organization of brothers of Jehovah's Witnesses. Chris
Are Jehovah's Witnesses committed to blood policy? 12 January 2001
Lee Elder, Founder AJWRB Send response to journal: Re: Are Jehovah's Witnesses committed to blood policy?	This week more than one million Jehovah's Witnesses (JWs) in the U.S. alone will once again be asked to sign a health care proxy/advance directive/Durable Power of Attorney stipulating that no blood transfusions be administered under any circumstances. The Watchtower Society (WTS), the controlling organization of JWs, has made it very clear that all JWs should execute this legal document and distribute copies to their doctor, relatives, friends and church officials. In a letter to all bodies of elders in the U.S. dated Dec. 1, 2000, the WTS explains that the new DPA (Durable Power of Attorney) conforms to the material discussed in the June 15, 2000 Questions From Readers article and the Oct. 15, 2000 Watchtower. These are the changes discussed by Dr. Muramoto regarding the acceptability of all blood products fractionated from red cells, white cells, platelets and plasma. Even more significant is this further comment from the WTS: "only a small percentage of brothers have filled out the Society's DPA form." This recent statement from the WTS is very important in that it shows that the level of commitment to the WTS policy is very small. If a JW is unconscious and exsanguinating and no DPA can be presented, I believe a very strong argument exists that the person is not committed to the WTS policy. Especially in light of this recent disclosure by the WTS which reveals dwindling support for its partial blood ban policy. It is also noteworthy that nearly a year after ceasing its policy of disfellowshiping Jehovah's Witnesses who accept blood or the blood products that are still forbidden; the WTS has never informed the general membership of the change. Only congregation elders have been informed to date. Since 1997 AJWRB (The Associated Jehovah's Witnesses for Reform on Blood) has lobbied on behalf of dissident Jehovah's Witnesses who believe that there is no biblical basis for banning the use of blood or certain blood products. We believe that JWs should have a free choice in their medical care, without the threat of controls or sanctions (disassociation) from the WTS that would separate them from their JW family members and friends. Lee Elder (leeelder@ajwrb.org) AJWRB (www.ajwrb.org) ********************************************************************* The Associated Jehovah's Witnesses for Reform on Blood, is a diverse group of Witnesses from over 25 countries, including elders and other organization officials, Hospital Liaison Committee members, doctors and members of the general public. All have volunteered their time and energies in an effort to bring about an end to a tragic and misguided policy that has claimed thousands of lives, many of them children. Website: http://www.ajwrb.org Email: info@ajwrb.org Please support our educational work, send your contribution to: AJWRB - P.O. Box 190089 - Boise, ID 83719-0089 U.S.A. *********************************************************************
Re: the changing word of god 12 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: the changing word of god	Regarding the "changing word of God", the controlling organization of Jehovah's Witnesses (the Watch Tower Society) teaches its members that God (Jehovah) reveals the truth through the Watchtower organization . Thus any "changing of the word of God" is completely accepted by the followers no matter how illogical it might appear. Once a member accepts the fundamental tenet that God speaks only through the Watchtower organization, or that the organization is God's representative, then under this tenet, God is not changing his mind, but rather revealing the truth gradually through the organization. The Bioethical dilemma comes from this fundamental aspect of the religion, in which the controlling power of the religious organization is almost as great as God's. The authority of God's representative knows no boundaries even in the realm of personal conscientious decisions and medical confidentiality. As Tony Barrett mentioned in his letter above, the difference between hiding from God and hiding from the religious organization becomes so ambiguous that they feel there should be no hiding from the organization as much as there should be no hiding from God. The challenge I see here is how to respect and protect personal freedom of choice and confidentiality in such an intolerant "theocratic" community in the midst of our tolerant democratic society.
Reply to Chris Bartlett: Obeying God or obeying the Organization? 16 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Reply to Chris Bartlett: Obeying God or obeying the Organization?	I appreciate Mr. Bartlett's detailed response, since it typifies responses I receive from Jehovah's Witnesses (JWs) and representatives of the Watch Tower Society (WTS). Before responding to his individual points, let me clarify several general points he brought up. Bartlett stated that my choice of word is not balanced. Whether wording is balanced or not depends on where one stands in the debate. As he admits, my wording is "perhaps technically accurate", even though it may lack "emotional truth" which is of course highly subjective. He also questioned whether I researched Jehovah's Witnesses' views by speaking and spending time in congregations. Yes, I have attended numerous meetings, assemblies and conventions and spoken to many JWs on regular basis including JW patients, in addition to studying most of the publications and exchanging correspondence with JWs. Mr. Bartlett should rest assured that my research is not based on mere "paper trail." I believe it is inappropriate for me to expand religious debate in a medical journal such as BMJ. However, I will try to help the readers understand why Bartlett claims my presentation as "incorrect" and "false" even if he cannot show any factual error. I hope this explanation will help the medical community untangle this seemingly complex debate. I believe that one of the keys to understand Bartlett's reasoning as a Jehovah's Witness is to read his many comments by replacing the word "God" with another word "the Watchtower (WT) organization". As I wrote in my response to Nesbitt's letter above (Re: the changing word of god), the authority of "God" and the authority of "the organization" are not differentiated in the mind of JWs. Thus any organizational control, whether invasion of privacy, breach of confidentiality or undue punishment of free medical decisions, is all justified by replacing the word "the organization" by "God." For example, referring to dissident Jehovah's Witnesses, Bartlett wrote, "they have placed themselves ahead of God's teachings and no longer show humility towards serving Him." Referring to confidential and conscientious medical decisions, he wrote, "if you choose to violate God's will then you should expect to pay the price..." If one replaces the words "God" and "Him" with "the WT organization" in these sentences, one can clearly see the difference between Bartlett and dissident JWs. Dissident JWs can separate between "God" and "the organization" whereas Bartlett and loyal JWs, intentionally or unintentionally, use two concepts almost interchangeably. Thus, for Bartlett, dedicating his life to God means dedicating his life to the WT organization, and showing humility towards God means showing humility towards the authority of WT organization. Violating the organizational policy of the WTS is immediately translated as "violating God's will." In contrast, dissident JWs also dedicate their lives to God and show humility towards God, but they may not do so to the WT organization. Incidentally, Bartlett's comment, "the term of 'dissident witnesses' is false. There can be no such thing" is outright "false." I have personally met with many dissident JWs who have never been disfellowshipped or disassociated. It is quite understandable that Bartlett has never met such a person, because those dissident JWs would never confide their position to JWs such as Bartlett who are loyal to the WT organization. I am glad that Mr. Bartlett gave his systematic response, as his statements illustrate how little most loyal JWs are aware of the seriousness of the control done by "the organization" under the name of "God." Once the readers understand that "the organization" is viewed as equivalent of "God", they can understand most of his enigmatic comments and discrepancies. Confidentiality against the organization is non- existent as God knows no confidentiality. Going against the organizational policy is viewed as going against God's will. Repentance means conforming to the organizational policy, but it is euphemized as being sorry for going against God's teachings. Organizational punishment is euphemized as "God's loving provision." Organizational policy change is equivocated with God's revelation of "brighter light." Such ambiguous language can go on and on, as seen here in Bartlett's comments. It may seem that the focus of this debate is the faith in God, but it is not, according to the dissident JWs. For them the matter has nothing to do with their faith in God. It is only the matter of mixing up the WT organization and God, and the WT organization applying undue pressure to free speech, choices and confidentiality under the name of God. That is the heart of the debate of JWs and blood refusal. Finally, I would like to correct a Bartlett's misunderstanding. He wrote that I criticize the WTS for "not remaining 'rigid' or otherwise entrenched with their doctrinal tenet of 50 years ago." To the contrary, I and dissident JWs are all welcoming the policy changes made by the WTS. Each change over the past 50 years has saved more lives which might have been lost if the WTS remained rigid. The only regret we have is the fact that many lives have been lost, and are still being lost today, based on the constantly mutating policy. If God has been revealing "brighter light" so frequently, should JWs wait for a yet "further brighter light" before sacrificing their lives for the soon-to-be-darker light?
Jehovah’s Witnesses and Blood vs. Justification and Responsibility 18 January 2001
Marvin Shilmer, Elder Jehovah's Witness Send response to journal: Re: Jehovah’s Witnesses and Blood vs. Justification and Responsibility	Jehovah’s Witnesses and Blood vs. Justification and Responsibility I am one of Jehovah’s Witnesses (JW) and have read Dr. Muramoto’s article with much interest. Presently the Watchtower Bible and Tract Society (WTS) recognizes me as an active elder (pastor) in a congregation of Jehovah’s Witnesses. Jehovah’s Witnesses desire to be loyal to God. Like most other people we are willing to die in defense of or loyalty to certain issues. As Christians we are willing to lay down our life in order to remain faithful to our Creator, Jehovah. This attribute is often played out in hospitals of the world by JWs as they demonstrate time and time again their willingness to die or let their children die rather than accept some sort of infusion of blood or of some portion of blood. Is this action justifiable under the pretext of loyalty to God? Without a doubt that is a question for every single parent among Jehovah’s Witnesses and it is one they must justify in absolute terms before deciding to let a child die over accepting or rejecting an infusion of blood or of some portion of blood. Aside from parents, in their own behalf each individual Jehovah’s Witnesses should have likewise performed the same mental process of absolute justification. What is the present state of that justification? Intentionally or unintentionally Doctor Muramoto’s article highlights a critical flaw in the justification most often used by Jehovah’s Witnesses on this subject. Physicians acquainted with this topic are very familiar with the words "We [JWs] reject blood because the Bible says that Christians must abstain from blood." Those words are repeated time and again by many Witnesses because their conviction of rejecting blood stems from the Biblical tenet to "abstain from… blood." (Acts 15:28, 29) Within that simple tenet lay their perceived mental justification for facing death rather than accepting blood or portions of blood; the problem is: Intentionally JWs do not ENTIRELY abstain from blood! That discrepancy alone invalidates the perceived justification because it defies the invoked simplicity and implied encompassing nature of the tenet to "abstain from… blood." Do most JWs perceive this logical discrepancy—indeed a contradiction? Sadly my experience is that most JWs do not understand the depth and breadth of the WTS’ actual official position regarding the use of donated blood for medical reasons. Among my fellow JWs and elders the fact that we do not entirely abstain from blood is rarely recognized as the critical contradiction that it represents. Yet physicians immediately realize the contradiction for what it is; a critical flaw in the mental task of justification. To test my assertion that most Witnesses are ignorant of this critical flaw, physicians can do something as inoffensive and simple as asking the patient "Do Jehovah’s Witnesses entirely abstain from blood?" I contend that at least 99% of JW patients will immediately answer, "Yes." Because physicians can read our official publication (The Watchtower) for themselves then they can readily know that an answer of "Yes" is incorrect, which completes the test of whether the mental justification process is accurate, complete and rational. If a JW patient THINKS that we entirely abstain from blood then they betray incomplete knowledge and therefore an incomplete process of justification. Certainly knowledge that JWs do not entirely abstain from blood is critical information when a JW patient is otherwise under an impression that our position is simple, strong and absolute and that it is based upon entirely abstaining. (And JWs must ask themselves, "If it is not based upon entirely abstaining then what is it based upon?") Naturally physicians are careful about how far they push this issue with a patient. Because continued life depends upon more than just blood then no physician can guarantee survival based upon that one factor. That is, if a physician is asked, "Can you guarantee that I will live if I accept this blood?" he cannot do so. But the same could be said of food, oxygen, water, organs like hearts or lungs, or any other necessity of life. Life is dependent upon many necessities, but taking away only one of them causes death. For that reason, in indisputable cases a physician can do no more that guarantee that rejecting blood will cause death. Because physicians are well acquainted with life and death and because they understand the importance of respecting spiritual feelings in the process of living and dying, then they are careful not to unduly upset a patient’s state of spirituality because it can be such an important part of healthy living and healthy dying. For this reason a physician may not be too active in trying to rationalize with a patient that one of their long held spiritual justifications is critically flawed. But any reluctance on the part of a physician does not change that a critical flaw exists in the justification process, and certainly a physician’s acquiescence in no way is a justification in itself of a patient’s conviction. Because Dr. Muramoto’s article highlights the fact that Jehovah’s Witnesses abstain from some portions of blood but do not abstain from other portions of blood then his comments highlight a critical flaw in the process of justification most often used by Jehovah’s Witnesses. Considering all that that WTS has written on the subject of blood and all the discussions held among JWs about this subject, why and how has this simple though critical flaw remained unaccounted for in the minds of most Witnesses? We can only speculate about an answer, but the fact remains that a burden rests upon those who teach, and it is the WTS that teaches JWs on the merits of this subject through the pages of The Watchtower journal, its main official publication. Therefore a high degree of responsibility rests upon our organization, the WTS, to answer the question posed about why and how such a critical flaw is left unaccounted for in the minds of so many JWs. (Why would/do so many answer "Yes" to the litmus test above?) Frankly, though sadly, language the WTS applies to our use of portions of blood is most often couched in terms that take away from the bald truth, that bald truth being that JWs do use blood that has been donated by others. What bearing does this have for physicians on the subject of medical ethics? Since I am not a qualified physician I am not sure just how to answer that question. But a good question is, who has any responsibility to educate in plain language people holding death dealing convictions when their justification is lacking or incomplete? My untrained opinion is that physicians do not hold the most responsibility for providing that education but they do have some responsibility for providing it. At the very least physicians should be willing to ask JW patients the inoffensive and simple question, "Do Jehovah’s Witnesses entirely abstain from blood?" If the patient answers with a "Yes" then in my opinion that physician has a responsibility to the patient to explain that the WTS does not require that they entirely abstain from blood and that you can prove it if they want to see it. You can then do something as simple as showing them one of the latest WTS provided Durable Power of Attorney forms where it indicates the option of accepting applications and infusions of substances made from blood or portions of blood. Physicians should remind them that other people donated the blood necessary to make, have and apply those life saving substances. At least that action provides some clear and unambiguous thoughts for the JW patient to complete their personal process of justification on such an important subject. On the other side of this subject is the WTS. Primarily that agency has the responsibility to better educate JWs about this subject so that the simple fact that JWs do not entirely abstain from blood is understood and can be accounted for in the justification process. The problem with that fact being highlighted in unambiguous terms is that it runs contrary to the seemingly simple idea that "we abstain from blood," and it makes people think more deeply about the very basis for the proposed justification for dying rather than accepting a particular portion of blood (or living by accepting a different portion of blood that is not prohibited by the WTS’ published position). I know that the British Medical Journal is not a platform for religious ideology, but the WTS would do well to address well-reasoned scriptural discussions of this subject, one of which can be found online at www.jwbloodreview.org. Many of my fellow JWs and elders have read the contents of such articles and realize the magnitude of what appears to be a terrible mistake on our part. If the WTS’ published views are right then no JW has anything to fear about facing up to such well written and reasoned material and either accepting it or refuting it, but we cannot just ignore it and be honest as Christians should be. We can only be honest by recognizing and responding to well reasoned information. I thank Dr. Muramoto for taking time to write his article. Unlike another responder, I believe Dr. Muramoto must have some close contact with JWs to have so precisely represented the present state of affairs as accurately as he has. As a trained and appointed elder among JWs I can testify to the accuracy of his presentation. It is not highlighted in Dr. Muramoto’s article, but the record shows that the population of JWs did not universally agree with the WTS’ decision to have congregations of JWs begin imposing its "abstain from blood" policy back in 1961. The Watchtower journal admits that prior to that time individuals among Jehovah’s Witnesses were conscientiously accepting transfusions of blood. (See: Questions From Readers, The Watchtower of August 1, 1958, page 478) The same journal also admits that some individuals among the Witness population were, at the time, requesting that the practice of blood transfusion actually be sanctioned (authorized). (See: Letter, The Watchtower, May 1, 1950, page 143) What do those facts mean in terms of the question of autonomy and the Jehovah’s Witness patient? The presence of those admissions above says much about whether Witnesses agreed fully with the policy from the beginning. Unfortunately I felt compelled to write this response using a pseudonym. I do not have the luxury of revealing my real name as have other JW responders to Dr. Muramoto’s article who have practically endorsed the WTS policy in full. If I did so then I would undoubtedly face some sort of tribunal for having openly presented the flaws I have above—and those flaws are just a few of many on the subject. At the very least my motives would be questioned and I would undoubtedly be stripped of any responsibilities as an elder—not that that is an important consequence. It is taught and understood that JWs can freely offer objections about a teaching directly and privately to the WTS. But, sadly, no matter how well reasoned a view or question, we are not permitted to discuss serious objections by openly insisting upon a resolution without the imminent risk of being labeled a troublemaker and probably ostracized and shunned as a result of that questioning on a sensitive issue. For this reason I expect that some of my fellow JWs will most likely question the veracity and genuineness of this response of mine. When the WTS reads this—and they will—I hope they come away with one thing, that I am interested in my brothers in faith and our individual and collective godly loyalty. Otherwise I would not work so hard as an elder in spite of the facts and views expressed above. Some of my peers at our world headquarters in Brooklyn, New York may even feel they know who I am. Please, I beg you, reconsider what we are doing on this subject. Marvin Shilmer
Re: Jehovah’s Witnesses and Blood vs. Justification and Responsibility 19 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: Jehovah’s Witnesses and Blood vs. Justification and Responsibility	I appreciate Mr. Shilmer's comment as an active Witness elder. Compared with Mr. Bartlett's letter, the opinions of Mr.Shilmer and Mr. Elder testify how diverse the views are on this issue among Jehovah's Witnesses. Since Mr. Shilmer raised the question of partial abstinence from blood, I would like to add one example to show how the new WTS blood policy is NOT abstaining from blood. As I stated in this paper, and as clearly stated in the new version of the Durable Power of Attorney form printed by the WTS and distributed to the JWs in the United States last week, the new policy allows JWs to accept "all fractions" of "any primary component." The WTS has emphasized in its literature that those "fractions" are "small" and therefore acceptable. When I ask JWs why those "fractions" are acceptable, most would reply, "because they are tiny fractions." Under this new policy, the most important "fraction" JWs are now permitted to accept is hemoglobin-based blood substitutes, which had been prohibited until recently. How "small" is hemoglobin as a fraction of the blood? Let me quote a simple sentence from a college- level anatomy textbook: "Discounting its water content, an erythrocyte [red blood cells, which WTS determined unacceptable] is over 97% hemoglobin, the molecule that binds to and transports respiratory gasses.[1] If God commands to abstain from red blood cells, as the WTS teaches, why does the WTS also teach that accepting 97% of what God prohibits does not violate God's command? Reference 1. Marieb E. Human anatomy and physiology. 4th ed. Menlo Park, CA: Addison Wesley Longman Inc; 1998:630
Who is really defending dogmas? 21 January 2001
Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, ST4 2DE Send response to journal: Re: Who is really defending dogmas?	Sir, It is very sad to behold the sniping from the side-lines and reflex denunciation of religious people [regardless of what they say], that this article [1] seems to have triggered, without very much acknowledgement, from the medical side, for the type of underlying rationale anyone might justifiably have for not wanting to have ‘foreign impurities’ like chemicals, vaccines or someone else’s blood injected into their veins. Whither the fundamentals behind this issue? Although their viewpoint might well be viewed as a form of anachronistic medical medievalism, yet there is a genuine issue attached to this matter, just as there was in the 19th century on the part of those who were opposed to routine vaccination. The issue, so far obscured, is that many religious people [not just Christians] believe that "the body is sacred and belongs to God" [2]. Naturally, this implies that the integrity and purity it manifested at birth, should be respected. That is the nub of the matter. Is it universally proven beyond all doubt that blood transfusions cause no long-term, subtle, systemic harm to human beings? Would modern- day materialistically minded physicians even be capable of seeing such ill -effects if they existed? And would they be prepared to face the professional discomfort that would flow from admitting such ill-effects if they saw them? Are not such questions just about as futile as asking if Gulf War Syndrome is a real condition, or that depleted uranium does induce some ill-effects? There seems a suspiciously strong desire in medical circles to loudly beat one drum and to drown out with that drum any voice of discontent or challenge to the accepted orthodoxy on such practices. Or, alternatively, are we watching an example of “physicians' ignorance of patient preferences, ineffectiveness at communicating with their patients, and failure to satisfy patients' expectations” [3]; “a societally sanctified imbalance of power in the relationships between doctors and patients.” [3] inducing physicians to ruthlessly defend a cherished belief/dogma of modern medicine, regardless of the possible validity of any dissenting viewpoint? Is it any wonder therefore that critics of modern medicine sometimes emit sounds like this: “Medicine...is doctor dominated...and patients...are passive victims pitted against tyrannical doctors”[3]? It would be worth knowing with greater certainty where the truth really lies on this complex issue, because both sides seem to be speaking languages pretty incomprehensible to the other. More tolerance and open- mindedness might not go amiss either. Sources [1] Education and Debate, Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses, Osamu Muramoto, BMJ 2001; 322: 37-39 http://www.bmj.com/cgi/content/full/322/7277/37 [2] Gatrad AR, Muslim customs surrounding death…, BMJ 1994; 309: 521- 3 [20 August] http://www.bmj.com/cgi/content/full/309/6953/521 [3] The Lancet Dec 7, 1996, The Power of Life or Death: A Critique of Medical Tyranny, by Fabiano Tassano, book review by Miriam Schuchman
dogma, smogma 22 January 2001
Ian Nesbitt, anaesthesia newcastle Send response to journal: Re: dogma, smogma	On issues of fact and dogma: Morrell accuses Doctors of defending dogma and beating drums loudly to still the opposition. Maybe some basic research would have helped before posting. Blood transfusion can kill: no-one disputes this, and most undergraduate textbooks attest to this. Blood transfusion can be (often is) life saving. This is fact, not dogma. The longer term effects of blood transfusion are not unknown. (Physicians regularly publish on this topic: look up Medline). It will be impossible to ever prove beyond doubt that transfusion has no ill effects (it is after all, difficult to prove a negative). Similarly, how can anyone prove that God doesn’t exist? If the body is sacred and belongs to God (therefore no impurities should be put into it); why has the Watchtower Society withdrawn its opposition to aluminium, vaccinations, most parts of blood transfusion (and probably in the not too distant future, all parts of blood?). Why not extend this purity to the rest of life: food additives, other drugs, organ transplantation etc? If the issue of impurity is relevant, at least be consistent, even for a few years at a time. The history of the WTS opposition to blood transfusion reads less like the ever changing, gradually revealed, word of God and more like “another fine mess” that someone got themselves in. The failure by the WTS to disseminate full and up to date information to its general membership about what is acceptable speaks volumes about the difficulties the society finds itself in. Interests etc: Not religious. Seen a few people bleed to death. Would accept a transfusion, since I’d rather survive with the possibility of mild long term effects than die without.
Re: Who is really defending dogmas? 22 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: Who is really defending dogmas?	I am afraid Mr. Morrell's comment misses the entire point of my article and the debate that ensued. I have never questioned freedom of choice in medical care, even when the choice runs contrary to modern medical knowledge or, in Morrell's words, the "dogma of modern medicine." That is not the issue we are discussing here. Nor is the safety of blood products the issue either. Any medical intervention, whether it is blood transfusion, vaccination, use of antibiotics or circumcision, requires careful balancing between expected benefits and risks. Every physician knows that modern medicine is still incapable of seeing all the risks and benefits involved in those interventions. Morrell may be quite right that "long-term, subtle, systemic harm to human beings" might exist in blood transfusions. Nonetheless, we have to make decisions based on probabilities in order to deal with life and death situations. It is the current practice of most physicians, including myself, to carefully balance the benefits and risks based on available information and present them to the patient. We respect the informed and autonomous choice of each individual patient after this consideration, even if the choice is contrary to the recommendations of "modern-day materialistically minded physicians." If Morrell is questioning this basic and widely accepted tenet of medical ethics, he simply misinterpreted my article. We are not debating here whether physicians should respect unpopular medical decisions, or whether blood products have any unknown long-term and subtle problems. The answers to those questions are affirmative and there is little room for debate. The heart of this debate is the external factors affecting the informed and autonomous decisions of each JW patient. The most important external factor is not physicians "ruthlessly defending a cherished belief/dogma of modern medicine", but the inconsistent and mutating policy of the controlling organization, the Watchtower Society (WTS). This organization ignores and suppresses free speech - the dissenting voices inside the religious community - and unduly punishes informed and autonomous decisions that do not conform to the policy, and even encourages violation of medical confidentiality. That is the ethical challenge that I hope Mr. Morrell come to learn from this article and debate. I entirely agree with Mr. Morrell in his last sentence, "more tolerance and open-mindedness might not go amiss either." I hope that more Jehovah's Witnesses and representatives of the religious organization, the WTS, will come forward and open-mindedly debate this complex matter.
Beating the drums of compliance and conformity 23 January 2001
Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, ST4 2DE Send response to journal: Re: Beating the drums of compliance and conformity	Sir, It is a pity that my preliminary thoughts on this subject [1] were rashly interpreted as my ONLY thoughts on it. While I accept the points made by Muramoto [2] and Nesbitt [3], there does remain an issue about this subject. Firstly, there is an issue about anyone interpreting anything in any way they like. It is not wise to dictate to others about what their article is *really* about. Let the people decide. Would they as arrogantly force on the populace their cultural view about a Picasso painting? People have the right to interpret things for themselves and to formulate their own viewpoints on any subject - no matter how peculiar, offbeat or off-topic it might appear to be. That is how we all learn from one another in a pluralistic society. If an argument is constructed with grace, architecture and intelligence then it gets my vote, regardless of whether I agree with it or not. Therefore, on those grounds alone, what I said before does have some merit and is connected more than tenuously to the topic in hand. People are at liberty to disagree with what I said, of course, but one's right to compose useful responses to an article or email remains valid and - to me - sacrosanct. Secondly, there is an undoubted issue in this topic about 'beating the drums of compliance and conformity'. There is clear conformity within medicine. One would be hard-pushed to find a more conformist profession. Patients are expected to conform and to be deferential [4], but so also do doctors conform [5, 6] to the social norms of their profession. Carl Gray [6] asks, in his amusing article, ‘how far should professionals determine style and conformity in a medical career?’. Yet he also notes that ‘Mavericks, non-conformists and the person who disagrees…are secretly valued.’. And woe betide anyone who doesn't conform. ‘flamboyant weirdness is captivating but also confusing’ [6]. Any head that lifts itself above the common herd and expresses an alternative view may get cracked loud and hard! Look at the poor doctor who is currently being criticised for questioning the safety of the MMR vaccine. A very brave man indeed, and precisely because of the dominant drum-beating of conformity within the profession. There is also clear conformity within all religions and JWs are no exception. Even science is not immune from this conformist drum-beating tendency. While the Pope fell out with Galileo four centuries ago, and science prides itself on a long history of challenging and defying dogma, yet, in the modern world, it has become something of a papacy in its own right that enforces its own dogmas and spawns eager young Inquisitors to root out and pour scorn upon any anti-science heretics they can finds. Thus, in all these senses, what I previously wrote is amply in keeping with the spirit of the original article and the eletters to it. Finally, the fundamental point I made about blood transfusions and other 'contagions' introduced into the blood was a valid slant on this topic. While the JWs might well have started out as anti-contagionists on this issue, these days they have clearly wished to see it more as a mark of their own religious identity, that sets them apart. Thus, the function of their refusing blood transfusions, has been transformed from being a purely biological issue, into a social aspect of their own religious identity - a badge they proudly wear ‘as a sign of rebellion or conformity…to show group membership’ [7] - and reflects not their antipathy towards biological impurity per se, but their attitude towards attacks upon their beliefs and their self-identity as a religious group in society distinct from a hostile host society. While I recognise that, I also see the defence of dogma in medical circles by doctors stating that vaccination is safe and a blood transfusion is safer than bleeding to death [which it clearly is]. One can view these facets BOTH as scientific facts and as features of the social identity of physicians. I would go further, and say that for some people their identity as a conformist physician is more important for them to maintain [and be seen to maintain] than is the biological truth or falsity of the doctrine itself. That is precisely where belief turns into dogma and the drum beating commences. No doubt the same holds true for JWs. In other words, as Muramoto has said, the religious refusal of transfusion has become as much a mark of their religious identity [conformity with beliefs of their Elders], as it is a mark of their rejection of biological contamination. I think this summarises in more detail my own attitude to this complex and interesting matter. Sources [1] BMJ letter, 20 Jan 2001, Peter Morrell, Who is really defending dogma? [2] BMJ letter, 21 Jan 2001, Re: Who is really defending dogma? Osamu Muramoto [3] BMJ letter, 21 Jan 2001, Dogma, smogma, Ian Nesbitt, [4] LETTERS, Taking medicines: concordance is not compliance, David Dickinson, Patricia Wilkie, and Miriam Harris, BMJ 1999; 319: 787. [Full text] </cgi/content/full/319/7212/787> [5] CAREER FOCUS, The crisis of conformity, Douglas Carnall, BMJ 2000; 321: 2. [Full text] </cgi/content/full/321/7252/S2a-7252> [6] Career focus, Eccentricity and conformity, Carl Gray, BMJ 1999; 319: 2. [Full text] </cgi/content/full/319/7220/S2-7220> [7] Art: Body Art: Marks of Identity, Janice Hopkins Tanne, BMJ 2000; 320: 64. http://www.bmj.com/cgi/content/full/320/7226/64
Re: Beating the drums of compliance and conformity 26 January 2001
Osamu Muramoto, Regional Ethics Council Kaiser Permanente, Interstate Medical Office East, Portland, OR 97227, USA Send response to journal: Re: Re: Beating the drums of compliance and conformity	I do not believe I have any major disagreement with Morrell. He has every right to respond to my article in any way he would like. I simply indicated that what he wrote was not in the scope of what I and others were discussing here. Morrell looked at it differently, and that is his own perspective. I have no intention to demand "conformity" from Morrell. I agree that conformity exists in many groups in the human society, including religion and academia. Whether it is good or bad, it is a fact. Also, there has always been a struggle between conformists and non- conformists throughout human history. This is also a fact. Jesus Christ was a typical non-conformist of his days, struggling with the conformists of the existing religious authority. History shows that his self-claimed "successors" became typical conformists, "beating the drums of compliance and conformity" by enforcing their own dogma. Likewise, when JW religion was created by Taize Russell in Pennsylvania in late 19th century, it was a typical non-conformist group. However, it soon became a typical drum- beating conformist, enforcing the religion's own creative dogma such as the blood policy as I reviewed here. History of the communist world is full of the cyclical transformation from non-conformists to conformists. In this respect, the JW religion may be a small scale model of how a non- conformist group transforms into a dogmatic conformist in a short period of time. I also agree with Morrell in his comment that the blood policy is "a mark of their own religious identity, that sets them apart." This aspect of the blood refusal was well described by a Dutch sociologist Richard Singelenberg in 1990.[1] The policy is still a powerful underlying source of cohesiveness among the members. By signing the so-called "blood card", the members pledge their own lives and children's lives for "Jehovah." By readying themselves to die for the religion, JWs make a uniquely intense commitment to the religion, which is not seen in most other religions. This very nature of the blood card as religious identity also raises the question regarding the validity of the card as a medical advance directive. In fact it is a well-known fact among JWs that the blood card has been used for identification purposes. For example, when a new book was released at the 1993 JW district conventions it was in short supply. The blood card was used to identify those who had more than a certain number of years as JWs and so qualified to receive the book. Finally, Morrell's characterization of the blood refusal as "transformed from being a purely biological issue into a social aspect of their own religious identity" is inaccurate. The policy has always been primarily a religious issue throughout the history, though biological issue or "anti-contagionists" stance has been extensively deployed to fan general fear against blood transfusions among JWs. Reference [1] Singelenberg R. The blood transfusion taboo of Jehovah's Witnesses; origin, development and function of a controversial doctrine. Social Science and Medicine 1990; 31:515-23.
Are they really reformers? 27 January 2001
George Smithson Send response to journal: Re: Are they really reformers?	Sir: For the past several years, I have followed the publication of numerous items describing so-called "reform" Jehovah's Witnesses and their "struggle" to have the Watchtower leadership approve blood transfusions for their membership. Frankly, I find the whole discussion and their Web site rather ridiculous for the following reasons. First, when I think of reformers I am immediately reminded of people like Luther, Tyndale, and Wycliffe, as well as countless other men and women who were willing to die a painful death in order to engender reform in what they believed was a harsh and tyrannical organization. However, the so-called "reform" Jehovah's Witnesses hide behind a web site and do not have the courage to identify themselves. If they were truly concerned about the number of Witness lives that are being lost as a result of refusal of transfusion, they would not be hiding behind an electronic front. Of course, that might mean that they would be ostracized or even "disfellowshipped" for speaking out. But if they were truly concerned about the loss of Witness lives, of what concern would that be. They should be willing to do anything in their power to elicit change. But they are not! What is the explanation for this? To me it can only be explained in one of two ways. Either they are not really active Jehovah's Witnesses, as they claim, or they are not truly interested in "saving lives" but are simply determined to stir up bad publicity for Jehovah's Witnesses with no real concern about any lives. Second, when I first began to read the material from the JW reformers, their spokesperson called himself "The Liberal Elder" and claimed to be an active Jehovah's Witness elder. However, as time went on he admitted that he was not an elder or even an active Jehovah's Witness. This type of deception casts doubt over the claim that active Jehovah's Witnesses are involved in this movement. Third, Dr. Muramoto is not honest in his declaration of competing interests. While he mentions that he has relatives that are Jehovah's Witnesses, he does not mention that these "relatives" are his wife and daughter. Some time ago, I read on another Web site a discussion by Dr. Muramoto of his efforts to dissuade his wife and daughter from being Witnesses. I think it is dishonest for Dr. Muramoto not to disclose this when he writes articles about issues involving Jehovah's Witnesses. He is not a neutral party. In conclusion, I