The conscience of the individual Jehovah's Witness as a basis for refusing blood
As a member of the hospital liaison committee in Oslo, Norway for the
last ten years the question about medical ethics and the use of blood is
very important for me. When I stand at the bed of a critically ill person
who has called for my assistance, I feel strongly the responsibility for
building on a firm Biblical foundation - life is not something with which
to play. Dr. Muramoto’s article presents several facts regarding Jehovah’s
Witnesses, but its setting has a certain twist which may harm the
relationship between the doctor and the Witness patient. Every researcher
knows the importance of seeing the subject of research from the inside,
and the fact that his informants are opposers, and that he lacks personal
experience from inside the Witness organization, can perhaps explain why
the article sends several wrong signals to doctors. There are also
several misunderstandings in the comments to Muramoto’s article in BMJ, so
allow me to present the ground on which I stand.
PROPHETS VERSUS TEACHERS AND PRESSURE VERSUS INFLUENCE
I and my fellow Witnesses believe that each person should decide
which ethical values he or she wants to follow without being pressed by
others. However, it should be stressed that in all areas of life, our
choices are very much influenced by others; this is simply unavoidable! If
we want to use the Bible as our sole ethical foundation, still we are
dependent upon knowledge accumulated by other human beings: We are
dependant upon those who wrote the autographs, that they did a faithful
job, we are dependent upon those who copied the text, and upon those who
made the modern critical editions of these text copies. Further, we are
dependent upon those who made lexical and grammatical studies of the Greek
and Hebrew text, and we are dependent upon those who translated the Bible
into our modern tongue.
But this is not all. In connection with any subject which has to be
learned, there is a need for teachers to guide us through the knowledge
which is accumulated by others, and to point out important data for us.
Similarly, there is a need for guidance when we are going to work out our
ethical principles on the basis of our English translations of the Bible.
And here is one area where Muramoto errs: the responsible persons among
Jehovah’s Witnesses who organize the world-wide community are portrayed as
prophets who force their arbitrary decisions upon the individual Witness,
while they are no more than teachers, whose teaching can be checked by the
individual Witness. There can be two reasons why the individual Witness is
very receptive to what is written in the literature from the Watchtower
society and what is said in the congregation: 1) Each member is
brainwashed and does not use his or her thinking ability, or 2) what is
written and said accords with his or her Christian conscience and
viewpoints based on the Bible. As an example why I advocate 2) I will
point to an incident some years ago: At a gathering of members of many
hospital liaison comittee members a particular understanding of a side of
the blood issue was presented, and my reaction was: «This simply is not
correct, and it cannot be accepted!» Fortunately it turned out to be a
mistake. So it is possible to be sympathetic to a source which I have
experienced allways has given true information without being slaves of
men!
TO TAKE OR NOT TO TAKE BLOOD
As a linguist I am painfully aware of the fact that language is
ambiguous. One reason why teachers of the Bible are needed, is that most
people do not master lexical semantics (word meaning), particularly not as
far as Greek and Hebrew are concerned. To illustrate why I see our
standpoint regarding blood as consistent and not arbitrary, I will use an
example as to word meaning from a text where blood is also mentioned.
Acts 15:29 in the New Testament gives the law «to keep abstaining
from things sacrificed to idols and from blood (Greek haima) and from
things strangled and from fornication (Greek porneia)». A person who wants
to base his ethics on the Bible may logically ask: «What is the meaning of
the Greek word porneia which is translated by the English word
fornication? Any lexicon will show that immoral sexual practices are
involved, but this is rather vague. The word evidently involves sexual
intercourse between a married person and one who is not one’s mate, but
does it involve sex between persons who are unmarried? And does it include
homosexual acts and bestiality? The sexual drive of some persons may
influence their answers to the questions, so it is not guaranteed that we
can get a good answer just by reading definitions in lexicons.
Witnesses who knew the Biblical languages struggled with the word
porneia for a long time; it can seem strange for non-linguists, but
sometimes it is extremely difficult to pinpoint the semantic range of a
single word. The study concluded that ‘fornication’ is an immoral use of
another person’s (or an animal’s) sexual organs, and it includes all the
four areas mentioned in the last paragraph. Apart from this, there may be
‘grey’ areas, such as how unmarried persons will show affection for one
another, but such cases are a matter of the individual consciences, where
each person must bear his or her own responsibility.
Just as the ethical interest of Jehovah’s Witnesses in the law ‘to
abstain from fornication’ revolves around the question «What is included
in the concept porneia?», similarly the ethical interest in the law ‘to
abstain from blood’ revolves around the question «What is included in the
concept haima?» Thus what Muramoto calls a ‘policy change’ which allows ‘a
wider selection of acceptable blood products’ (p. 38) is hardly more than
a clarification of the important ethical question of what the Greek word
haima really includes in a situation where ever more new products are
manufactured from blood.
The Encyclopedia Britannica, Micropedia II (1974) p. 89 defines the
major blood components as «plasma, red blood cells (erythrocytes), white
blood cells (leucocytes), and platelets (thrombocytes)». I can see no
reason to exclude any of these components from the concept haima, and
therefore, from the second World War1 when blood transfusions bacame
common, Jehovah’s Witnesses have abstained from whole blood and from any
of the mentioned components. However, in the last few decades fractions
and extracts have been synthesized from the aforementioned components, and
naturally questions have arisen: Immunglobulins, coagulation factors,
albumin, stem cells, interleucines etc, are they included in the concept
blood (haima)? We cannot answer this question with certainty because
these factors did not exist as products in Biblical times, and therefore
the answer has been that the use of these components is a matter of
conscience. This does not mean that the Watchtower Society or a group of
humans has authorised the use of these components, but rather that they
have pointed out that they represent a grey area where each Christian
conscience must decide.
There has been a steady development of the use of blood from vaccines
to the transfusion of whole blood, and to the extraction and synthesizing
of components from blood which occur at present. Because the witnesses all
the time have been continually faced with new products and new uses, a
continual study of the blood issue has been necessary. In the course of
the study several roads have been explored, such as which components of
blood can be said to be nutrients, the role played by particular blood
components in the body2, and whether we can differentiate between
erythrocytes and hemoglobin when 95 % of the dry weIght of an erythrocyte
is hemoglobin3. The answer to such questions may influence some person’s
choice of using or not using a particular component, but the fundamental
position has all the time been the same: What clearly is blood (haima) we
do not accept! So the conclusion of the study which was published in The
Watchtower June 2000 June 15:29-31 is in my view logical and consistent;
everything except the major blood components is a matter of conscience.
A THIRD PARTY CAN HARM THE RELATIONSHIP BETWEEN THE DOCTORS AND THE
WITNESS PATIENT
To abstain from blood is deeply rooted in Jehovah’s Witnesses; so
deeply that even many persons who no longer are Witnesses stick to it in
situations of crisis. Because of this and because of actual experience, my
estimate is that less than 1 % of the Witnesses would accept blood in a
situation of crisis.4 Thus the situation paitned by Muramoto of Witnesses
who will accept blood in secrecy is virtually nonexistent.
A good relationship between doctor and patient is mandatory for a
good outcome of the treatment. It is fine that the doctor should ask the
patient about his or her decision to refuse blood, in order to be sure
that this is the final decision on the part of the patient. However,
Muramoto’s suggestions that the signed card expressing the patient’s
decision should not be accepted, and that the doctor should try to make
the patient accept blood bacause this is what many Witnesses want but are
afraid to do, may really harm the patient. First, the signed medical
document is a legal document which should be accepted by doctors. Second,
the standpoint of the patient is an example of the principle of ‘informed
consent’, and it is not the duty of the doctor to try to change the will
of the patient.
The standpoint to abstain from blood was reached when the patient was
fit and well, but the Witness patient will defend this decision when he or
she is weak from blood loss or pain as well. But it is my experience that
there is one thing the patient wants more than anything else in such a
situation, namely, an assurance from the doctor that blood will not be
used and that the best possible treatment will be given. Such an assurance
will help the patient get mental strength which will contribute to his or
her recovery. Suggestions from a third party work against the patient
achieving this feeling of security, because the doctor unnessesarily can
become suspicious about the motives of the patient.
CONCLUSION
Bloodless surgery is standard procedure in many hospitals, and the
Witness patient in most cases does not pose a challenge for the doctor.
The realisation that infusion of blood components may be dangerous, and
the work of the hospital liaison comittees in conveying information to
doctors and assisting the Witness patient when they are called to do so,
have contributed to a cordial relationship between the Witnesses and many
doctors. Third party articles such as the one written by Muramoto, do not
represent the interests of Witnesses but rather those of the opposers, and
may harm this good relationship.
My hope is that doctors will respect the autonomy of each patient,
not by trying to breach the relationship between the patient and fellow
believers and by asking cunning questions, as Moramoto suggests. But
instead: ask the patient clear questions to make sure that the standpoint
regarding blood is his or her own. And then, assure the patient that blood
will not be given, thus giving the patient the feeling of security that he
or she is seeking.
1 Even before World War II the sanctity of blood was stressed in
connection with vaccines. One reason why vaccination was not recommended
was that a great part of those vaccines which were administered in the
1920s and 1930s was blood.
2 The blood system of a pregnant woman is separate from that of the
fetus in her womb. The fact that the mother’s major blood components do
not under normal conditions cross the placental barrier into the fetus’
blood, while some protein fractions including albumin do move naturally
into the blood system of the fetus (albumin moves less efficiantly), has
led some Christians to believe that only the major components represent
haima.
3 It should be noted that only 35 % of the erythrocyte is dry weight,
so depending of the point of view it can be said that either 95 or 33 % of
the red blood cell is hemoglobin.
4 The experience of a professor at one of the University hospitals in
Oslo was that 1 % of the Witness pateients accepted blood (personal
communication).
Rapid Response:
The conscience of the individual Jehovah's Witness as a basis for refusing blood
As a member of the hospital liaison committee in Oslo, Norway for the
last ten years the question about medical ethics and the use of blood is
very important for me. When I stand at the bed of a critically ill person
who has called for my assistance, I feel strongly the responsibility for
building on a firm Biblical foundation - life is not something with which
to play. Dr. Muramoto’s article presents several facts regarding Jehovah’s
Witnesses, but its setting has a certain twist which may harm the
relationship between the doctor and the Witness patient. Every researcher
knows the importance of seeing the subject of research from the inside,
and the fact that his informants are opposers, and that he lacks personal
experience from inside the Witness organization, can perhaps explain why
the article sends several wrong signals to doctors. There are also
several misunderstandings in the comments to Muramoto’s article in BMJ, so
allow me to present the ground on which I stand.
PROPHETS VERSUS TEACHERS AND PRESSURE VERSUS INFLUENCE
I and my fellow Witnesses believe that each person should decide
which ethical values he or she wants to follow without being pressed by
others. However, it should be stressed that in all areas of life, our
choices are very much influenced by others; this is simply unavoidable! If
we want to use the Bible as our sole ethical foundation, still we are
dependent upon knowledge accumulated by other human beings: We are
dependant upon those who wrote the autographs, that they did a faithful
job, we are dependent upon those who copied the text, and upon those who
made the modern critical editions of these text copies. Further, we are
dependent upon those who made lexical and grammatical studies of the Greek
and Hebrew text, and we are dependent upon those who translated the Bible
into our modern tongue.
But this is not all. In connection with any subject which has to be
learned, there is a need for teachers to guide us through the knowledge
which is accumulated by others, and to point out important data for us.
Similarly, there is a need for guidance when we are going to work out our
ethical principles on the basis of our English translations of the Bible.
And here is one area where Muramoto errs: the responsible persons among
Jehovah’s Witnesses who organize the world-wide community are portrayed as
prophets who force their arbitrary decisions upon the individual Witness,
while they are no more than teachers, whose teaching can be checked by the
individual Witness. There can be two reasons why the individual Witness is
very receptive to what is written in the literature from the Watchtower
society and what is said in the congregation: 1) Each member is
brainwashed and does not use his or her thinking ability, or 2) what is
written and said accords with his or her Christian conscience and
viewpoints based on the Bible. As an example why I advocate 2) I will
point to an incident some years ago: At a gathering of members of many
hospital liaison comittee members a particular understanding of a side of
the blood issue was presented, and my reaction was: «This simply is not
correct, and it cannot be accepted!» Fortunately it turned out to be a
mistake. So it is possible to be sympathetic to a source which I have
experienced allways has given true information without being slaves of
men!
TO TAKE OR NOT TO TAKE BLOOD
As a linguist I am painfully aware of the fact that language is
ambiguous. One reason why teachers of the Bible are needed, is that most
people do not master lexical semantics (word meaning), particularly not as
far as Greek and Hebrew are concerned. To illustrate why I see our
standpoint regarding blood as consistent and not arbitrary, I will use an
example as to word meaning from a text where blood is also mentioned.
Acts 15:29 in the New Testament gives the law «to keep abstaining
from things sacrificed to idols and from blood (Greek haima) and from
things strangled and from fornication (Greek porneia)». A person who wants
to base his ethics on the Bible may logically ask: «What is the meaning of
the Greek word porneia which is translated by the English word
fornication? Any lexicon will show that immoral sexual practices are
involved, but this is rather vague. The word evidently involves sexual
intercourse between a married person and one who is not one’s mate, but
does it involve sex between persons who are unmarried? And does it include
homosexual acts and bestiality? The sexual drive of some persons may
influence their answers to the questions, so it is not guaranteed that we
can get a good answer just by reading definitions in lexicons.
Witnesses who knew the Biblical languages struggled with the word
porneia for a long time; it can seem strange for non-linguists, but
sometimes it is extremely difficult to pinpoint the semantic range of a
single word. The study concluded that ‘fornication’ is an immoral use of
another person’s (or an animal’s) sexual organs, and it includes all the
four areas mentioned in the last paragraph. Apart from this, there may be
‘grey’ areas, such as how unmarried persons will show affection for one
another, but such cases are a matter of the individual consciences, where
each person must bear his or her own responsibility.
Just as the ethical interest of Jehovah’s Witnesses in the law ‘to
abstain from fornication’ revolves around the question «What is included
in the concept porneia?», similarly the ethical interest in the law ‘to
abstain from blood’ revolves around the question «What is included in the
concept haima?» Thus what Muramoto calls a ‘policy change’ which allows ‘a
wider selection of acceptable blood products’ (p. 38) is hardly more than
a clarification of the important ethical question of what the Greek word
haima really includes in a situation where ever more new products are
manufactured from blood.
The Encyclopedia Britannica, Micropedia II (1974) p. 89 defines the
major blood components as «plasma, red blood cells (erythrocytes), white
blood cells (leucocytes), and platelets (thrombocytes)». I can see no
reason to exclude any of these components from the concept haima, and
therefore, from the second World War1 when blood transfusions bacame
common, Jehovah’s Witnesses have abstained from whole blood and from any
of the mentioned components. However, in the last few decades fractions
and extracts have been synthesized from the aforementioned components, and
naturally questions have arisen: Immunglobulins, coagulation factors,
albumin, stem cells, interleucines etc, are they included in the concept
blood (haima)? We cannot answer this question with certainty because
these factors did not exist as products in Biblical times, and therefore
the answer has been that the use of these components is a matter of
conscience. This does not mean that the Watchtower Society or a group of
humans has authorised the use of these components, but rather that they
have pointed out that they represent a grey area where each Christian
conscience must decide.
There has been a steady development of the use of blood from vaccines
to the transfusion of whole blood, and to the extraction and synthesizing
of components from blood which occur at present. Because the witnesses all
the time have been continually faced with new products and new uses, a
continual study of the blood issue has been necessary. In the course of
the study several roads have been explored, such as which components of
blood can be said to be nutrients, the role played by particular blood
components in the body2, and whether we can differentiate between
erythrocytes and hemoglobin when 95 % of the dry weIght of an erythrocyte
is hemoglobin3. The answer to such questions may influence some person’s
choice of using or not using a particular component, but the fundamental
position has all the time been the same: What clearly is blood (haima) we
do not accept! So the conclusion of the study which was published in The
Watchtower June 2000 June 15:29-31 is in my view logical and consistent;
everything except the major blood components is a matter of conscience.
A THIRD PARTY CAN HARM THE RELATIONSHIP BETWEEN THE DOCTORS AND THE
WITNESS PATIENT
To abstain from blood is deeply rooted in Jehovah’s Witnesses; so
deeply that even many persons who no longer are Witnesses stick to it in
situations of crisis. Because of this and because of actual experience, my
estimate is that less than 1 % of the Witnesses would accept blood in a
situation of crisis.4 Thus the situation paitned by Muramoto of Witnesses
who will accept blood in secrecy is virtually nonexistent.
A good relationship between doctor and patient is mandatory for a
good outcome of the treatment. It is fine that the doctor should ask the
patient about his or her decision to refuse blood, in order to be sure
that this is the final decision on the part of the patient. However,
Muramoto’s suggestions that the signed card expressing the patient’s
decision should not be accepted, and that the doctor should try to make
the patient accept blood bacause this is what many Witnesses want but are
afraid to do, may really harm the patient. First, the signed medical
document is a legal document which should be accepted by doctors. Second,
the standpoint of the patient is an example of the principle of ‘informed
consent’, and it is not the duty of the doctor to try to change the will
of the patient.
The standpoint to abstain from blood was reached when the patient was
fit and well, but the Witness patient will defend this decision when he or
she is weak from blood loss or pain as well. But it is my experience that
there is one thing the patient wants more than anything else in such a
situation, namely, an assurance from the doctor that blood will not be
used and that the best possible treatment will be given. Such an assurance
will help the patient get mental strength which will contribute to his or
her recovery. Suggestions from a third party work against the patient
achieving this feeling of security, because the doctor unnessesarily can
become suspicious about the motives of the patient.
CONCLUSION
Bloodless surgery is standard procedure in many hospitals, and the
Witness patient in most cases does not pose a challenge for the doctor.
The realisation that infusion of blood components may be dangerous, and
the work of the hospital liaison comittees in conveying information to
doctors and assisting the Witness patient when they are called to do so,
have contributed to a cordial relationship between the Witnesses and many
doctors. Third party articles such as the one written by Muramoto, do not
represent the interests of Witnesses but rather those of the opposers, and
may harm this good relationship.
My hope is that doctors will respect the autonomy of each patient,
not by trying to breach the relationship between the patient and fellow
believers and by asking cunning questions, as Moramoto suggests. But
instead: ask the patient clear questions to make sure that the standpoint
regarding blood is his or her own. And then, assure the patient that blood
will not be given, thus giving the patient the feeling of security that he
or she is seeking.
1 Even before World War II the sanctity of blood was stressed in
connection with vaccines. One reason why vaccination was not recommended
was that a great part of those vaccines which were administered in the
1920s and 1930s was blood.
2 The blood system of a pregnant woman is separate from that of the
fetus in her womb. The fact that the mother’s major blood components do
not under normal conditions cross the placental barrier into the fetus’
blood, while some protein fractions including albumin do move naturally
into the blood system of the fetus (albumin moves less efficiantly), has
led some Christians to believe that only the major components represent
haima.
3 It should be noted that only 35 % of the erythrocyte is dry weight,
so depending of the point of view it can be said that either 95 or 33 % of
the red blood cell is hemoglobin.
4 The experience of a professor at one of the University hospitals in
Oslo was that 1 % of the Witness pateients accepted blood (personal
communication).
Competing interests: No competing interests