Bioethics and Bloodless Surgery
RECENT years have seen unprecedented progress in the field of medicine. However, while solving medical problems, some advances have created ethical ones.
Doctors have to ponder such dilemmas as: Should aggressive medical treatment sometimes be abandoned so that a patient can die with dignity? Should a doctor overrule a patient’s decision if he feels it is in the patient’s best interests? How should health care be rationed when expensive treatment is not available for everyone?
Such complex issues have brought into focus the medical discipline called bioethics. This speciality aims to help doctors and scientists to deal with the ethical implications of biological research and medical advances. Since many of the most difficult decisions arise in hospitals, many hospitals have established bioethical committees. Usually the committee members—including doctors and lawyers—attend seminars on bioethics, where ethical problems in medicine are analyzed.
Some questions frequently raised in such seminars are: To what extent should doctors respect the beliefs of Jehovah’s Witnesses who, primarily for religious reasons, refuse to accept blood transfusions? Should a doctor transfuse a patient against the patient’s will if that seems medically “advisable”? Would it be ethical to do so without the patient’s knowledge, as if ‘what the patient doesn’t know won’t hurt him’?
To handle such issues appropriately, doctors need an objective understanding of the Witnesses’ viewpoint. On their part, Jehovah’s Witnesses are eager to explain their position to doctors, realizing that mutual understanding can serve to avoid confrontation.
A Meeting of Minds
Professor Diego Gracia, a prominent Spanish authority in bioethics, wanted his class to have such a dialogue. “It is only right that you [Jehovah’s Witnesses] be given an opportunity to express your concerns . . . in view of the difficulties you have had in connection with blood transfusions,” the professor said.
Thus, on June 5, 1996, three representatives of Jehovah’s Witnesses were invited to the Complutense University in Madrid, Spain, to explain their viewpoint. Some 40 doctors and other professionals were present.
After the Witnesses made a brief presentation, the session was opened to questions. All present concurred that an adult patient should have the right to refuse a particular medical treatment. The class also believed that a transfusion should never be administered without the patient’s informed consent. Yet some aspects of the Witnesses’ stand concerned them.
One question concerned money. Sometimes bloodless surgery involves special equipment, such as laser surgery, as well as costly drugs, such as erythropoietin, used to stimulate red blood cell production. One doctor wondered if by refusing a less expensive option (homologous blood), the Witnesses might be expecting public-health services to give them special privileges.
While recognizing that money is necessarily a factor that doctors have to consider, a Witness representative referred to published studies that analyze the hidden costs of homologous blood transfusions. These include the cost of treating transfusion-related complications, as well as the loss of income resulting from such complications. He quoted a comprehensive study from the United States that indicated that the average unit of blood, although initially costing only $250, actually generated expenses of over $1,300—more than five times the original sum. Hence, he pointed out, when all factors are taken into account, bloodless surgery is cost-effective. Furthermore, much of the so-called extra cost of bloodless surgery is equipment that is reusable.
Another question on the minds of several doctors related to group pressure. What would happen, they wondered, if a Witness wavered and accepted a blood transfusion? Would he be ostracized by the Witness community?
The response would depend on the actual situation, for disobeying God’s law certainly is a serious matter, something for the congregation’s elders to examine. The Witnesses would want to help any person who has undergone the traumatic experience of life-threatening surgery and who has accepted a transfusion. Doubtless such a Witness would feel very bad and be concerned about his relationship with God. Such a person may need help and understanding. Since the backbone of Christianity is love, the elders would want, as in all judicial cases, to temper firmness with mercy.—Matthew 9:12, 13; John 7:24.
“Won’t you be reassessing your ethical stand before long?” asked a professor in bioethics, who was visiting from the United States. “Other religions have done that in recent years.”
The stand of the Witnesses respecting the sanctity of blood is a doctrinal belief rather than an ethical viewpoint subject to periodic review, he was told. The clear Biblical command leaves no room for compromise. (Acts 15:28, 29) Violating such a divine law would be as unacceptable to a Witness as condoning idolatry or fornication.
Jehovah’s Witnesses appreciate very much the willingness of doctors—like the ones present at the bioethics seminar in Madrid—to respect their decision to seek alternative treatment that accords with their Bible-based convictions. Doubtless, bioethics will play an important role in improving doctor-patient relationships and fostering greater respect for the wishes of the patient.
As a famous Spanish physician is reported to have said, doctors must always remember that they “work with imperfect instruments and fallible means.” They therefore need the “conviction that love should always extend to where knowledge cannot reach.”