Zadok Paper S99Autumn 1999
Refusing Treatment: A physician reflects on the ethical dilemmas of treating Jehovah's Witnesses
by Sam Muramoto

The Paper: Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of 'no-blood' treatment. Many physicians, particularly so-called 'sympathetic doctors', are establishing a close relationship with this religious organisation. On the other hand, it is little known that this blood doctrine is being strongly criticised by reform-minded current and former JWs who expressed conscientious dissent to the organisation. Their arguments reveal religious practices that conflict with many physician's moral standards. They also suggest that a certain segment of 'regular' JWs may have different attitudes toward the blood doctrine. The author considers these viewpoints and argues that there is an ethical flaw in the blood doctrine, and the medical community should seriously reconsider their supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned. (A version of this paper appeared in two parts in the Journal of Medical Ethics, 1998, Vol. 24, pp. 223-230 & 295-301. It is used with the author's permission.)

The Author: Osamu (Sam) Muramoto, M.D., Ph.D., is a member of the ethics committee at Kaiser Permanente Northwest Division, and a neurologist at Northwest Permanente P.C., in Portland, Oregon, USA. E-mail: muramotosa@kpnwoa.mts.kpnw.org (The views and opinions expressed in this paper are the author's personal ones and do not reflect those of Kaiser Permanente and Pacific Northwest Permanente P.C.)

Introduction

Refusing Treatment: Jehovah's Witnesses' (hereafter "JWs") refusal of medical and surgical treatment using blood products is widely known in the medical community. They are supported by physicians who accept the challenge of 'bloodless' treatment, at least for adult cases. For example, "Surgical Red Blood Cell Transfusion Practice Policies" of the American Journal of Surgeryrecommends as "policy 1" to "accept the limitation that allogenic blood cannot be used". This policy recommends involving the local JW "Hospital Liaison Committee" appointed by the church organisation (Watch Tower Bible and Tract Society, hereafter "WTS") for assistance in making decisions. Most medical literature describes JWs' refusal of blood products as definitive, absolute and consistent. Many courts have ruled that JWs' directive not to receive blood products should be complied with even at the cost of the patient's life.

On the other hand, medical and judicial decisions rarely take into account how this blood doctrine developed or is enforced in the JW community. Certain little-known JW practices regarding blood are morally questionable and may require the medical community to reevaluate its support of the doctrine. The JW religion recently has come under strong criticism by dissidents and reformers, including a former top official (Governing Body member) who authored two books that detail WTS history, religious practices and internal conflicts, and revealed for the first time secret inner workings of this religion. The effects of the decisions and policies on the "rank and file" members of the religion are set out in the writings of other former members.

Another important development comes from easy Internet access which has enabled current and former JWs to "come out of the closet" and voice their opinions without fear of retribution. JWs have been strongly discouraged from discussing critical religious issues with outsiders, particularly with former members, and can be 'disfellowshiped' (excommunicated) for doing so. However, the medical community is generally unaware of these issues.

Thus, the following serious questions arise: Should physicians continue accommodating the JW patient's request for non-blood treatment based on the 'official' position of the WTS alone, disregarding the views of reformers and dissidents, and the resulting ethical questions? How can one avoid compromising one's own sense of ethics while aware of unethical practices that may compromise the autonomy of individual JW patients?

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Osamu (Sam) Muramoto, M.D., Ph.D., is a member of the ethics committee at Kaiser Permanente Northwest Division, and a neurologist at Northwest Permanente P.C., in Portland, Oregon, USA. E-mail: muramotosa@kpnwoa.mts.kpnw.org (The views and opinions expressed in this paper are the author's personal ones and do not reflect those of Kaiser Permanente and Pacific Northwest Permanente P.C.)