Education And Debate

Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7277.37 (Published 06 January 2001) Cite this as: BMJ 2001;322:37

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

Dear Dr Muramoto,

You end your letter by the words "all the loyal Witnesses who wrote
their opinions here never returned and followed up their comments, nor did
they answer any of my questions. I sincerely hope that Furuli does not
follow in the footsteps of those fellow Witnesses whose communication is
only one-way traffic."(1) D. Malyon, a member of the HLC of Luton,
Bedfordshire has written an article with a thorough discussion of a
previous article that you wrote.(2) If a Witness has not answered your
previous questions, I can understand his or her reasons, because your
letter is not an inquiry to get answers but rather an attempt to change
the faith of the addressee and all other Jehovah's Witnesses. At least
this is the case with your letter to me.

According to yourself, you are a "'third party"' because you are not
a Witness. I do not consider it appropriate to discuss internal questions
with an outsider who is very critical of our brotherhood of believers.
However, you have by your article directed the attention of the readers of
BMJ to the Witnesses in a way which can create unwarranted suspicion on
the part of doctors, and this may result in an extra burden on an ill
Witness patient. I therefore would like to correct some of your
inaccurate claims and make comments on others.

CONFIDENTIALITY OF JEHOVAH'S WITNESSES PATIENTS

If you as a physician had an HIV-positive patient who dated your
daughter, and they wanted to get married, and you knew that your daughter
was unaware of his sickness, would you tell her? This would be an
extremely problematic situation - your professional confidentiality versus
the health of your daughter - so I shall not advise you. For Witnesses as
well, confidentiality is an extremely important issue. Confidential
matters should not be revealed to others and promises made to one another
should be kept.

Although an outsider may not understand it, the Witnesses learn to
cultivate a love so strong for God and for fellow Witnesses that they are
willing to die for one another and for God. So if a Witness definitely is
on the point of destroying his or her relationship with God, another
Witness will offer to help. In practically all instances, a Witness can
be given spiritual help without revealing confidential matters. But in
extremely rare situations there can be a serious case where a Witness
faces a situation like that with the HIV-positive patient. Another person
cannot give advice to the Witness, but it can happen that he or she views
the situation as 'jus nessisitatis' as you might do with the HIV-positive
patient. Such a situation occurs so rarely that to use the possibility of
it as proof that Jehovah's Witnesses are willing to break their
professional confidentiality is not honest. I am quite sure that among
medical personnel who belong to the 15.000 Witnesses of Norway there is
not a single example of this situation within the last ten years.

IS THERE A DIVERSITY OF VIEWS REGARDING BLOOD AMONG JEHOVAH'S
WITNESSES?

In a letter you write: "Mr. Elder testifies how diverse the views are
on the issue among Jehovah's Witnesses."(3) In your letter to me you
write: "I have personally seen several Witnesses who altered their advance
directive to select different blood products from what the Watchtower
Society permits" and, that according to L. Elder "some anesthesiologists
revealed that up to half of their Jehovah's Witness patients had been
willing to reevaluate their position on blood when a private conference
was held with them." I accept your words regarding what you have seen, but
am doubtful regarding the information you have gotten from opposers. I do
not think that the statistics of persons who pretend to be something they
are not, namely, loyal and cooperative brothers in the congregation,
should be trusted, particularly not when their words are so dramatically
different from what I know about Jehovah's Witnesses through 40 years, and
from the information I get from doctors.

In Norway, we have a very good relationship with doctors. We give
lectures and participate in discussions at hospitals; in addition, we have
personal conversations with doctors. At the yearly meetings of
anesthesiologists and surgeons, we are present for several days with our
information stand, and we exchange information with individual doctors.
At these occasions, some doctors are skeptical. They ask sweeping
questions, and relate different cases to us (without revealing
confidential information). If there were such cases where Witnesses
reevaluated their stand, this would have proved to be a good argument for
the skeptical doctors. However, we do not hear of such cases. In my
first letter I quoted a professor, the head of a team of surgeons, who has
operated on Jehovah's Witnesses for more than 30 years. His statistics
show that one Witness out of every hundred accepts blood or its major
components. This is about the same statistic we get from all the country
and it is a figure that is very far from your figures.

DO" THIRD PARTY" JEHOVAH'S WITNESSES EXERCISE PRESSURE ON PATIENTS
AND PHYSICIANS?

In a stressful situation, persons may behave differently than normal.
Because they do not want blood, some Witnesses may not always do all
things in a reasonable way, in spite of the fact that congregation members
are advised time and again to be balanced, polite and respectful toward
doctors. However, your description of hospitalized Witnesses is extreme,
and differs significantly from my experience. You write: "Most physicians
have experienced enormous pressure applied by the local Witness community,
mainly family, friends and elders who belong to the same congregation.
They insist on bloodless surgery even before the patient himself expresses
his own understanding and wishes . . . It is well known to the medical
community that the congregation members even maintain an overnight vigil
in the hospital to prevent the patient from receiving blood."

It stands to reason that you cannot know what "most physicians" who
treat Jehovah's Witnesses in the UK or in the US experience, and you
cannot know the degree of pressure those who feel pressure experience. So
the expressions "most physicians" and "enormous pressure" has nothing to
do with reality, but are extreme exaggerations. The same is true with the
claim of "overnight vigils" which is "well known." I am sure that such a
situation has not happened in Norway in the last ten years, and that such
precautions are extremely rare, if they happen at all, in other countries.

As to the feelings of doctors I will relate the following experience.
Ten years ago, a young man who was badly injured called for assistance.
Another elder and myself went to the hospital. With the help of the
Hospital Information desk at the Watchtower Society in Brooklyn we
contacted a professor in the US who had experience regarding the
situation. We got his advice and several medical articles which we
conveyed to the responsible doctors. We asked about a treatment found in
these articles which was not used in Norway.

"Would you like to try this on the patient?" we asked the medical
team.
"Well . . . "
"Will it harm the patient?" we asked.
"No," the doctors answered.
"So why don't you try it?" we queried.

In the end, the medical team did try the treatment, but the patient
died. However, he died, not because of the lack of blood, but because he
was badly injured.

Five years later, at a meeting of doctors and nurses regarding
treatment of Jehovah's Witnesses, (and after an unfavorable article in a
Norwegian medical journal) a doctor from the team spoke about two members
of the hospital liaison committee who had exercised "improper pressure" in
the mentioned situation. The truth was that we had not spoken with the
young man because he was unconscious, and the only contact between us and
the doctors had been to convey medical information and ask questions about
the treatment. The father who lost his son was not a Witness, but he was
so impressed by the love and kindness he saw - not pressure - that after
the incident he became a Witness. Doctors are also humans, and it is easy
to interpret the behavior of other persons in the way that you expect this
behavior to be. This is the reason why articles similar to the one you
have written may stir up suspicion, and therefore harm the good relation
between doctor and patient. The family and congregation friends of a
patient are not a dangerous "third party" but those who give wrong
information about Jehovah's Witnesses and create suspicion certainly are.

WHO IS IT WHO DO NOT RESPECT THE CONSCIENCE OF OTHERS - JEHOVAH'S
WITNESSES OR THE OPPOSERS?

As you will not reveal the epicrises of your patients to others, I
will not discuss internal congregational matters with you or others. I
will, however, make the general remark that I would respect a position
based on the sincere conscience of another Witness, whether or not it is
different from mine. To respect the conscience of another person,
however, does not mean that I admit that everything goes or that two
diametrically different viewpoints are both correct. If the conscience of
a person, for instance, says that it is right for a Christian to steal, it
is time for him or her to adjust the conscience, as the Bible says (Romans
10:2,3; Hebrews 13:19.

As to those "Witnesses" to whom you give advice, and for whose sake
you want me to write letters to the Watchtower Society, the question about
conscience plays just a minor part. Their situation is not like a person
who comes to his fellow Christians and says that because of his special
illness he needs a solution including neutrophil leucocytes. He states
that his conscience allows him to accept that and he asks that his
conscience be respected. (4) No, those persons whom you represent and who
have written letters in connection with your article actively oppose
Jehovah's Witnesses and express false accusations. One of them wrote: "My
question to you, sir, is this: is the sacrifice of hundreds, perhaps
thousands of JW children a justifiable price for 'greater peace, inner
contentment, and life meaning."(5)

This is a serious accusation, but where is the proof behind it?
Hundreds, perhaps thousands of children killed by Jehovah's Witnesses?
The article in Awake! May 22, 1994, to which the writer refers, does not
speak about children in general, but about youngsters with leukemia and
similar deadly diseases. The lack of blood did not kill the youngsters
mentioned in the article; their disease killed them. If a young person
who already knows that he or she is going to die, does not want to try to
prolong life for a short time with the use of blood but seeks alternative
treatment, how can it be said that Jehovah's Witnesses sacrificed
("killed") this person?

In an editorial, C.D. Kitchens refers to 16 studies with 1404 Witness
patients, and reports that the authors "... implicated a lack of blood as
the primary cause of death in 8 patients (0.6%) and contributing to death
in another 12 patients, yielding a total of 20 deaths (1.4%)." The author
continues, "Other complications were not increased in Jehovah’s Witness
patients". Then he draws the interesting conclusion: "Less clear is how
much morbidity and mortality are avoided by this practice [refusal of
blood], but they probably exceed the risk of being transfused."(6) Because
it can be more dangerous to accept a transfusion than to refuse one, a
person who refuses one and dies for this reason or another, cannot rightly
be accused for suicide, and it is even more illogical to accuse his or her
fellow believers for killing the person.

JW respect the consciences of the opposers when they disagree, but
what you and they ask for is not just that, but you ask for an acceptance
of the correctness of your viewpoints, and that we cannot do. You, on the
other hand, appear not to respect the consciences of the Witnesses when
they abstain from blood, but claiming that many Witnesses do not really
mean what they say in their own signed statements, you suggest that
doctors should try to persuade sick Witnesses to change their minds. If
you respect our consciences, why don’t you not follow your own decision
but leave us alone?

ARE JEHOVAH'S WITNESSES BRAINWASHED OR DO THEY FOLLOW THE BIBLE?

You write: "The Scriptures alone have little authority for JWs"(7)
and "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)."(8)

It is a bold and utterly false claim to say that the Watchtower
Society is the authority for Jehovah's Witnesses and not the Bible. This
is something which is the very opposite of what the Witnesses themselves
say and believe. I have a mag. art. degree in Semitic linguistics, which
is about the same as an American Ph.D.; in addition, I am currently doing
research for the higher Norwegian doctoral degree. I teach the biblical
languages Hebrew and Aramaic on the university level, and I have mastered
the third Biblical language, Greek. I continually study the Bible in its
original languages. Should I not know the basis for my faith and the
faith of other Jehovah's Witnesses? Should I be brainwashed? My basis for
being a Witness I find in the Bible and in the Bible alone, and this is
the same for my fellow Witnesses. You have completely misunderstood the
theocratic arrangement among Jehovah's Witnesses and misinterpret it as
some form of spiritual dictatorship. However, the truth is that
responsible persons function as teachers and not as prophets.

RESPECTING AUTONOMY AND PERSONAL DECISIONS

Your assertions that "In biblical times ‘blood’ only meant whole
blood, not any blood fractions or components, major or minor. In biblical
times ‘abstain from blood’ meant from eating blood, not from using it to
treat medical conditions" are not true. The medical condition which caused
the death of Jesus Christ, could have been that his heart burst. This can
explain the words of John 18:34 that "blood (haima) and water came out"
when the soldiers jabbed his side with a spear. If a volume of blood is
allowed to stand undisturbed for a time, the red cells sink to the bottom.
Evidently the red cells are called ‘blood’ in the quote, and the plasma,
perhaps mixed with lymph is called ‘water’.(9) A Biblical law can cover
practices which are new and did not occur in the past; the law against
‘porneia’ can, for instance, be applied to to a situation where a woman
artificially is fertilized by semen from a man with whom she is not
married.

When a Witness needs surgery, it is his or her conscience that
matters, so the ethical question is whether the will of the Witness shall
be respected or not. Whether you, who is not a Witness, or another person
who claims to be a Witness, agrees with the beliefs of the patient is
beyond the point. So all your words about ‘Witnesses’ who disagree just
cloud the issue and shows that you have an agenda, namely to try to change
the mind of as many Witnesses as possible so they accept those blood
components which you think they should accept. You have the right to work
for your own interests, the reason why I react, is that you paint a
picture which does not represent reality, where extreme possibilites which
almost never occur is portrayed as normal among the Witnesses. This also
includes the claim that "many" Witnesses, in one context "up to half of
the Witnesses" will change their mind regarding blood if the right
questions are asked. I do not doubt that practically all Witnesses stick
to their decision also in a situation of stress or when someone tries to
persuade them to change their mind. My concern is that doctors get a false
picture of the Witnesses and that a good relationship therefore can be
hampered from the start. This is the reason for my present comments.

(1) Muramoto, O. http://www.bmj.com/cgi/eletters/322/7277/37, 26
February 2001. All quotes from Muramoto without special reference is from
this article.

(2) Malyon, D., "Transfusion-free treatment of Jehovah’s Witnesses:
respecting the autonomous patient’s right", Journal of Medical Ethics,
1998, vol 24, No 5. pp. 302-307.

(3) Muramoto, O. http://www.bmj.com/cgi/eletters/322/7277/37, 19 January
2001.

(4) I am using this as an example of different attitudes and not as a
‘case’.

(5) Pseudonym, Elder, L. http://www.bmj.com/cgi/eletters/322/7277/37, 7
February 2001

(6) Kitchens, C. D., "Are transfusions overrated? ", American Journal of
Medicine, 1993, 94:117-119.

(7) Muramoto, O. http://www.bmj.com/cgi/eletters/322/7277/37, 4 February
2001.

(8) Muramoto, O. http://www.bmj.com/cgi/eletters/322/7277/37, 21 January
2001

(9) The Hebrew word mayim and the Greek word hydor are generic terms which
can refer to liquids such as juice and urin. That the red cells were
specified as ‘blood’ in this verse, would not necessarily, according to
Semitic thought, rule out that the hydor (water) or a part of it could be
called ‘blood’ in other contexts. Regarding the Hebrew word nephesh
("soul", "life") Leveticus 17:11 says that the soul is ‘in’ the blood
while verse 14 says that the blood ‘is’ the soul. This does not mean that
the rest of the creature is not ‘soul’, because verse 15 shows that men
‘are’ souls, and 19:28 speaks of a ‘deceased soul’, a creature which had
been a soul. So in John 18:34 the red cells are specified as ‘blood’,
without excluding that other parts could be specified as ‘blood’ in other
contexts.

Competing interests: No competing interests

04 March 2001
Rolf J Furuli
Research fellow in Semitic languages
University of Oslo