When Doctors Seek to Force Blood Transfusions
WHEN you go to a doctor, what qualities do you want him to have? Of course, you want a doctor who has good medical knowledge and skill. The more ability he has, the more he can help you.
However, what if he refused to let you have any say in what happens to your body? What if he strapped you to a table and forced some medicine or surgery on you against your will? You would probably look for another doctor next time, to say the least.
What people want, and need, is a doctor who has, not only knowledge and skill, but also understanding. This kind of doctor never loses sight of the fact that he is a public servant. He serves his patients the best he can, but does not try to rule over them. He considers their wishes. Fortunately there are many such doctors. They realize that there are always new methods—and different opinions even among experts. So, while they may recommend a treatment, they do not force it upon the patient.
However, there is another kind of doctor. He, too, is no doubt sincerely interested in his patient. But this type of doctor feels so strongly about certain treatments that he will resort to a court order to force them on a patient. Often this kind of doctor does not appreciate that newer methods have outdated his way of dealing with certain ills. And it is often this same kind of doctor who lacks true appreciation of his role as a public servant, and of his patient’s right to choose or reject certain types of treatment.
So there is this great contrast in doctors. Of the two types, which would you want if you were sick, or needed an operation?
“Toward ‘Bloodless Surgery’”
Nowhere is the contrast in doctors more evident than in the matter of blood transfusions. In what way?
In the past several years a growing number of doctors have changed their minds about giving blood transfusions. They have learned to perform all kinds of major surgery without giving blood. Yet other doctors ignore these new findings. They still persist in trying to force blood on people who do not want it.
The new developments in this field are typified by such headlines as this one in the Palo Alto, California, Times: “NEW SURGICAL TECHNIQUES ELIMINATE BLOOD TRANSFUSION NEED.” Another headline, in the Long Island, New York, Press, proclaimed: “A GROWING TREND TOWARD ‘BLOODLESS SURGERY.’” This latter publication stated:
“It used to be that the blood transfusion was a standard part of surgery. No longer. In recent years physicians have developed new methods of operating to minimize, if not totally eliminate, blood transfusions. They claim the new methods are better for the patients, too.”
Noted heart surgeon Dr. Denton A. Cooley of the Texas Heart Institute, in Houston says: “The fact is evident now that most major surgery can be done without transfusion. . . . Our goal is to see how little we can use.” And Dr. Jerome H. Kay writes the following to The Journal of the American Medical Association: “We have avoided blood transfusions as much as possible. . . . We have now done approximately 6,000 open-heart operations at the Saint Vincent’s Hospital in Los Angeles. Since we have not been using blood for the majority of patients, it is our impression that the patients do better.”
There are several reasons for this trend toward “bloodless surgery.” One is that the dangers of blood transfusions have become more widely recognized.
Newsweek of April 30, 1973, noted that blood transfusion is “a process that can produce serious complications if the new blood is contaminated or is incorrectly matched with the patient’s.” How serious? Winfield Miller says in Medical Economics: “No biologic product has a greater potential for fatal mistakes in medical practice than blood. More than one doctor has learned to his sorrow that every bottle of blood in the blood banks is a potential bottle of nitroglycerin.”
How deadly can blood transfusions be? Estimates vary. One says that each year more than 30,000 Americans get hepatitis from blood transfusions, and that of this number 3,000 are killed by the disease. Another estimate says that “180,000 Americans each year develop serum hepatitis from blood transfusions.” Still higher figures have been published in the United States Congressional Record, which says:
“The Center for Disease Control has stated that the actual rate of hepatit[i]s may be well in excess of the official figure due to the failure of many physicians to report serum hepatit[i]s cases. The center estimates that as many as 35,000 deaths and 500,000 illnesses a year may be due to the presence of serum hepatit[i]s in blood for transfusions.”
All those estimates are based on just one complication from blood transfusion—hepatitis. However, there are others, like hemolytic reactions and overload, which are mentioned in the book Complications in Surgery Management. This book then adds: “In terms of disability and loss of life . . . blood transfusions rival some of our major health problems.” The Cecil-Loeb Textbook of Medicine estimates that in the United States “at least 120,000” recognizable adverse reactions to blood transfusions can be expected annually.
In Rhodesia the Bulawayo Sunday News reported late in 1973 on another serious complication. It told of a baby girl and a baby boy who had become infected with syphilis by blood transfusions. Both had been given blood from the same pool. This African publication commented: “The children had been given fresh blood which had been subjected to the normal tests for venereal disease and pronounced clear.” How could such a thing happen? The Davis-Christopher Textbook of Surgery explains: “Early stages of syphilis are difficult to detect and donors may not be aware of their infection.”
How sensitive blood is can be seen from recent findings. In a study of 29,000 blood donors, Wisconsin researchers found an excessively high amount of carbon monoxide in the blood. Carbon monoxide is one of the most deadly poisons known. How did it get into the blood of those donors? Among the factors given were automotive exhaust fumes, the person’s work, and where he lived. The worst offenders were tobacco smokers. They had three to four times as high a level of this poison in their blood.
It is obvious, then, that there are many, many serious problems linked to blood transfusions. With good reason, therefore, the New York State Journal of Medicine declared: “No transfusion should ever be given if other therapy will suffice.” And this conclusion was reached several years ago before many of the new methods of “bloodless surgery” had been developed.
No Foolproof Test
Much effort has gone into trying to devise methods of detecting disease-carrying or incompatible blood. But while some improvements have been made, there is no foolproof method.
This conclusion was reached by the California Legislature and included in its Bill No. 793 of March 15, 1973. And Medical World News acknowledges: “Even if all donor blood is screened by the most sensitive tests now available . . . , many patients will still develop post-transfusion hepatitis.”
Nor is it just a matter of not being able to screen out the hepatitis factor. The famous open-heart surgeon at St. Barnabas Hospital (New York city), Dr. Charles P. Bailey, states: “Damages of incompatibility and kidney damage from transfusions, though much reduced, can never be abolished, no matter how carefully the blood is ‘matched.’”
One of the reasons for these great problems was noted by the magazine Let’s Live. In an article written by two doctors, mention is made of “the uniqueness of the relationship between a body and its own blood.” The article says:
“In his book Who Is Your Doctor and Why?, Dr. Shadman writes, ‘The blood in any person is in reality the person himself. It contains all the peculiarities of the individual from whence it comes. This includes hereditary taints, disease susceptibilities, poisons due to personal living, eating and drinking habits. . . .’
“‘Every individual has his own type of blood, and since no two are exactly alike, you cannot with impunity put another person’s blood into your veins no matter how well it is typed. Your system has to get rid of it and begins to do so immediately, and continues to do so until it has all been eliminated. . . .’
“‘A lot of propaganda is circulated about purifying the blood and only using the clean residue. It cannot be done. The bloodletting of yore has been superseded by blood transfusion. Of all the ridiculous medical practices of the past and present times, this present blood craze is the worst.’”
The article also quoted Dr. Shadman as saying: “In performing upwards of 20,000 surgical operations, I never gave a blood transfusion and never had a patient die from lack of it. I have given many transfusions of normal salt solution. It is better and safer. I have used it in cases of all degrees of exsanguination, and none died. Some were white as chalk and cold as stone, but they lived.”
Such a claim may seem exaggerated to some. Yet, note what the authoritative Davis-Christopher Textbook of Surgery states: “It has been estimated that 35 to 50 per cent of all blood transfusions are unnecessary, and only about 1 per cent are given as lifesaving procedures.”
In addition, it is not likely that the human element can be eliminated from the collection and storage of blood. Mistakes are made, and there is also carelessness, as acknowledged in Hospital Practice of January 1974.
Release from Responsibility
The damages from blood transfusions have created huge legal problems. Doctors and hospitals have been sued for large amounts of money. This became far more serious a problem when not long ago an American state supreme court ruled that hospitals can indeed be held liable for damages resulting from a blood transfusion.
As a result, many patients that are to be given blood transfusions have to sign a release form. By signing this form the patient agrees to release the hospital and its personnel from any responsibility if there is damage from the blood. One such hospital form reads:
“I fully understand that the transfusion or administration of blood or blood derivatives to me may result in VIRAL HEPATITIS or other untoward reactions resulting in possible serious illness and complications, hospitalization, need for further medical care and treatment, temporary or permanent disability, as well as other possible adverse effects upon my health and well-being, (including death).”
In this form, a space is provided for parents or guardians to sign when the patient is a minor.
Is It Consistent?
It is certainly consistent with the patient’s rights to inform him of the dangers of blood transfusions. That is, if the patient wants blood. By signing the form he agrees to take blood at his own risk.
But what if he does NOT want blood? How consistent is it for doctors and hospitals to want forms signed freeing them from liability for giving blood, and yet in other cases want court orders so they can force blood on unwilling patients?
Also, the same inconsistency is shown when dealing with patients who are minors, children. On the one hand, parents or guardians are asked to sign forms freeing doctors and hospitals from responsibility if damage occurs to the child from a blood transfusion. Yet, on the other hand, parents or guardians have been ignored when they sign, or want to sign, forms freeing doctors and hospitals from liability for NOT giving the child a blood transfusion.
There can be only one consistent and reasonable view. That is to take into account the patient’s right to refuse a particular type of medical treatment. Especially is this right precious when that treatment is admittedly dangerous, even death dealing.
On this point, Dr. Arthur Kelly, former secretary of the Canadian Medical Association, said: “No doctor can be positive that a person will die if he doesn’t get a transfusion or live if he does. It is perhaps better that the odd person die rather than the fundamental right of refusing medical treatment become impaired.”
A More Important Reason
As is well known, Jehovah’s witnesses will not take blood transfusions. True, they recognize the dangers. But they principally object on religious grounds, and for them this is a far more important reason.
God’s Word, the Holy Bible, specifically commands true Christians to “abstain from things polluted by idols and from fornication and from what is strangled and from blood.” (Acts 15:20, 29) It says they should “keep themselves . . . from blood.”—Acts 21:25.
This prohibition on blood was recorded in the Christian Greek Scriptures. But it was not new even then. The same law was given by God thousands of years earlier, and is recorded in the Hebrew Scriptures. Nor was such law given just to the ancient nation of Israel. It was given to mankind centuries before that nation came into existence and it applies to all mankind.—See Genesis 9:4; Leviticus 17:11, 12, 14; Deuteronomy 12:23 as examples.
Many people ridiculed such commands when blood transfusions first became popular. But now some of these same people are having second thoughts. They see that what seemed like a “cure-all” at first has now turned into a nightmare. So, after all these years, the latest findings of modern medicine have shown the wisdom in the divine prohibition against taking blood.
Still Trying to Force Blood Transfusions
One would think that surely now, at this late date, and in view of the latest information and new techniques, doctors and hospitals would not force blood transfusions on people. But they do.
For example, late in 1973 a young pregnant woman, Connie Reavis, refused her doctor’s recommendation to take blood. The doctor and hospital in Portland, Oregon, took the matter to court. Circuit Court Judge Berkeley Lent approved the petition to force blood. Mrs. Reavis refused to comply with the order. She contacted doctors in Seattle who agreed not to use blood. At the University of Washington Hospital they performed a successful cesarean section and delivered an eleven-pound eleven-ounce baby girl. No blood was used.
In another instance, Curtis Dunn and his wife Patsy, Jehovah’s witnesses, found how misleading signed forms can be. Expecting her third child, they signed a form releasing the doctors and the hospital from any liability for her not taking blood.
After the child was born it developed anemia. Physicians of a Houston, Texas, hospital took the infant away from the parents by a court order and gave it a blood transfusion. The action was taken suddenly. No allowance was made for a hearing of the matter first. But what had happened to the form they signed?
Closer scrutiny of the release form was revealing. The form stated only that it would release the physicians and the hospital from any responsibility for the parents’ decision. It did not say the parents’ decision would be honored under all circumstances. So such forms may be relatively valueless. They can be deceptive, lulling trusting patients into a false sense of security.
Interestingly, a doctor who analyzed the case later said: “This anemia in all probability was due to the prolonged use of the umbilical venous infusion catheter which had been inserted [for the infusion of fluids or blood] when the child was seven hours old.”
Not “Life or Death”
Many times doctors have told Jehovah’s witnesses faced with major surgery that they must have a blood transfusion or they would die. However, over and over again that has not proved to be the case. Many have been allowed to take alternate treatment and have done very well. And in doing so they were freed from the dangers that arise from blood transfusions.
For example, the parents of a one-day-old baby in Kentucky were told that the baby had to have a blood transfusion. Doctors in a hospital in Fort Thomas said it would otherwise die from Rh incompatibility. When physicians sought a court order to give a blood transfusion, the father, William Bergeron, contacted another doctor. He took his baby out of that hospital and transferred it to one in Houston, Texas. There doctors successfully treated the child with fluorescent phototherapy and dismissed it in three days.
The experience of Aaron Lee Washburn, sixteen years old, was similar. He had been in a vehicle accident and suffered multiple fractures of the head and other areas. At a medical center in Dallas his parents clearly stated their rejection of blood transfusions. At first this was respected. But three days later the surgeon who was to operate sought a court order to force a blood transfusion. He told the judge that surgery could not be done without it. But then other surgeons were given the case. They respected the parents’ stand on blood and proceeded to operate. The entire operative period lasted seven and a half hours. No blood was used. The operation was a success and was widely acknowledged in press reports.
The experiences that Jehovah’s witnesses have had regarding blood transfusions reveal several lessons. One of the more positive ones is reported on by the Associated Press:
“The need to develop surgical techniques which did not require blood transfusions was stimulated in part by limitations on usual forms of surgery imposed by the faith of Jehovah’s Witnesses, whose religion opposes transfusion of donor blood.”
Yes, many of the new procedures and trends in “bloodless surgery” have come about because of doctors looking for better ways to operate on Jehovah’s witnesses. Some of these new techniques have been so successful that a growing number of doctors now use them on all their patients.
Another lesson learned is that while there are now more doctors who respect the patient’s right to refuse blood, this is by no means a universal trend. Many doctors do not show such respect, and will resort to court orders trying to force blood on unwilling patients.
A painful lesson learned is that a signed form is no assurance that the patient’s refusal of blood will be respected. It is not enough to sign a statement freeing medical personnel from responsibility if anything should go wrong because of the patient’s not having taken blood. Such forms must include a guarantee by the medical personnel involved not to give blood under any circumstances. At the same time, such forms can express the willingness to take alternative treatment approved by the patient.
Nevertheless, while Jehovah’s witnesses still experience many difficulties, there have been major “breakthroughs.” They have seen many in the medical profession acknowledge that blood transfusions can damage and kill. They have seen more authorities speak out against the practice. And they have come to know more and more doctors who honor their right to refuse blood. For such understanding doctors, these patients are very grateful.