Jehovah Witnesses & Blood Transfusion

Jehovah's Witnesses refuse blood transfusions, including autologous transfusions in which a person has their own blood stored to be used later in a medical procedure, (though some Witnesses will accept autologous procedures such as dialysis or cell salvage in which their blood is not stored) and the use of packed RBCs (red blood cells), WBCs (white blood cells), plasma or platelets.

Accepting a blood transfusion willingly and without regret is seen as a sin. The Witness concerned would no longer be regarded as one of Jehovah's Witnesses.

This refusal to accept blood makes some operations more dangerous and causes some doctors considerable anxiety. Witnesses are willing to absolve doctors of responsibility by signing forms with appropriate wording such as:

As a member of the religious body of Jehovah's Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery. I am aware that the planned and needed procedure thus has a higher risk due to bleeding complications. After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components.

Doctors generally feel that respect for the patient's autonomy requires that this wish should be obeyed. They have sound legal reasons for this too, as to administer blood in the face of refusal by a patient may be unlawful and could lead to criminal and/or civil proceedings.

Many Jehovah's Witnesses carry a signed and witnessed advance directive card absolutely refusing blood and releasing doctors from any liability arising from this refusal.

Cell-free blood products, containing haemoglobin but not red blood cells have recently become available and may be acceptable for some Jehovah's Witnesses.

How do you approach a Jehovah’s Witness patient who needs a transfusion?

• Avoid coercion and deception that can deny patient’s autonomy and can result in charges of battery
• While evaluating the need for transfusion in a Jehovah’s Witness, consider the following:
• Determine whether the patient still believes in Jehovah’s Witness teachings
• The decision is totally on the individual himself/herself
• A Jehovah’s Witness family cannot force their religious views upon the patients
• Check if patients have changed their mind to undergo transfusion in the absence of a church or a family member
• Thus the discussion should take place in private
• If the patient does change his or her mind the doctor need to assess if this change might be a consequence of illness impairing the patient’s capacity to decide
• If patient lacks decision making capacity look to see if the patient has completed an advance directive that can guide the decision-makers
• Most Jehovah’s Witness carry advance directive cards that explicitly document the individual’s refusal of blood transfusion under any circumstances
• As a member of the religious body of Jehovah's Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery. I am aware that the planned and needed procedure thus has a higher risk due to bleeding complications. After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components.
• Make sure that the patient is basing their decisions on specific facts
• The watchtower lists all unacceptable blood and blood products, and non-blood alternatives that could be used as a substitute for blood
• Treatment even if deemed by physicians to be life saving, may not be performed on competent patients without their consent
• Transfusing minors
• Lifesaving transfusions can be given to minors against parental wishes
• In such cases proceed by acknowledging the parent’s wishes and informing the parents of the doctor’s responsibility to notify the child welfare authorities (agencies are obligated to provide administrative consent for the treatment) and to transfuse the child in an emergency as required by law
• Consultation with legal counsel is advisable in such cases