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The following are three postings to a bioethics listserv on some of the
philosopical issues that arise in cases of Jehovah's Witnesses refusing
treatment.  They are by Michael Rhodes and are reproduced with his
permission.  They should not be reproduced any further without his
permission. In his posts, he responds to other posts written by physicians
and ethicists, but I have not included these.  You should not have any
difficulty in working out what ideas he is responding to.  cdp

Date:    Mon, 25 Sep 1995 18:22:05 -0600
From:    "MICHAEL R. RHODES" <MRHODES@VMS.UCC.OKSTATE.EDU>
Subject: Blood Transfusion

Robert Savis recently contributed a message from Dr. John
Mulligan concerning the standard of care regarding the practice
of obtaining court orders for blood transfusions when parents
object on religious grounds.  I would like to present to members
of this list a related philosophical issue that is often
unappreciated.  This has to do with religious assessments being
made by the medical personnel in charge of ordering blood
transfusions in such cases.  Let us assume that the 5-day-old
baby (to whom we can refer as Baby J) discussed in the
Stavis/Mulligan posting was the child of Jehovah's Witness
parents (this was not stated in the original posting, so assume
it hypothetically).  Jehovah's Witnesses object to blood
transfusions.  There has been some debate about the extent to
which their objection ought to pertain only to whole blood or
also blood derivatives (e.g. plasma).  For the most part, blood
substitutes are acceptable.  Their objections are based
primarily on Old Testament passages, particularly Lev.  17:10-14
wherein the following appears:  "I [God] will even set my face
against that soul that eateth blood [takes blood into his body],
and will CUT HIM OFF FROM AMONG HIS PEOPLE..."  The Jehovah's
Witnesses regard the receipt of blood as prohibited by God with
the punishment being that of being denied any opportunity for
resurrection.  To give Baby J a blood transfusion is, according
to his parents religious beliefs, to deny Baby J an opportunity
to enter the Kingdom of God (or to be resurrected into a
heaven-like world; though the Jehovah's Witnesses would not
accept the ordinary account of Heaven, let us use this
nonetheless since it is a concept with which most of us are
somewhat familiar).

     To an atheist, this is but another ludicrous example of
religious nonsense.  To someone who believes in a Heaven (or
heaven-like existence), getting into Heaven can be very
important.  Indeed, it would seem that there is nothing more
nefarious that I could do than to do something which would keep
you or your child from ever entering Heaven.

     Suppose that I agreed with the Jehovah's Witnesses'
religious view.  Suppose that I BELIEVED that by giving Baby J a
blood transfusion that I was cutting Baby J off from Heaven.  If
I truly believed it, and if I felt that eternal life in heaven
is of far greater importance and worth than our temporary
earthly existence, then how could I give the transfusion?  Could
you, if you TRULY BELIEVED what the Jehovah's Witnesses believe?
I dare to say that you would not do it.

     What happens, however, is that a decision is made to reject
the religious belief of the Jehovah's Witness.  Once the belief
is rejected, then clearly one is faced with the need to save
Baby J's life--to prolong Baby J's earthly existence.  The
interest in Baby J's earthly existence is judged to take
priority over the parents religious beliefs.  One adopts an
attitude of the sort: "we cannot allow the FALSE religious
beliefs of a child's parents to cost the child his life; the
parents have a right to believe whatever they want (including
this idea about blood transfusions which I judge to be FALSE),
but the poor, innocent child should not die because of these
FALSE beliefs.  The child has not developed the mental
faculties, is not competent, to even consider the Jehovah's
Witness beliefs about the consequences blood transfusions."

     So, our attitude is that of saving the child, issuing the
transfusion, despite the parents beliefs--even though, what we
are doing, according to the parents beliefs, would, if those
beliefs were TRUE, be a moral abomination of the gravest sort.
Confident in our JUDGMENT THAT THE BELIEFS ARE FALSE, we proceed
with the transfusion.

     Only after this decision is made, we worry about how to
free ourselves from legal penalty.  Ideally, we would obtain the
parents consent.  Perhaps we could persuade them by conversation
and by counselling.  This of course, would involve trying to
convince them that their belief about blood transfusion are
FALSE; otherwise, we would be trying to persuade them that they
should consent to the gravest possible moral offense against
their child.  If they cannot be persuaded, however, then we take
the next step of cutting them out of control.  We will obtain
court authority to act as guardians for the sake of keeping Baby
J alive; we will ask the court to grant us the authority to
prevent the parents' religious beliefs from costing Baby J his
life.

     After the transfusion, we might even be so bold as to
attempt to console the parents by saying, "you should be happy
that we cut your child off from heaven...not you; you shouldn't
feel guilty, you tried to save your child, but we did him in."
Even if this is not what we literally say, this is what the
parents' understanding of what transpired would be.  Sure, they
find that you took actions (seeking a court approval, and
proceeding with the transfusion) as taking the blame of off
their shoulders, but to the parents, the result is that their
child is doomed--denied an opportunity to enter heaven just for
the sake of prolonging this earthly existence.

     Well, I offer this just to stimulate thought about the
issue.  I should confess that I am personally supportive of
issuing blood transfusions to minors.  But I would be deluded if
I thought that my attitude was independent of a religious
judgment.  I believe that blood transfusions should be carried
out in the case of minors, based upon my judgment that the
Jehovah's Witnesses' are WRONG about the consequences of doing
so.  But what does this say about respecting the rights of the
Jehovah's Witnesses to not only hold certain beliefs, but to act
in accordance with those beliefs; especially when the beliefs
pertain to their children whom they care very deeply about?

     If we are willing to cut out the Jehovah's Witnesses from
the influences of medical decision making, then perhaps we
should consider doing so for all religions.  It would be
philosophically naive and downright arrogant to maintain that we
should cut out all religions OTHER THAN MY OWN.  Is the
Jehovah's Witness cut out because it is a minority religion, and
can therefore be regarded as a "weird" or "bizarre" religion
that should not be taken seriously in the context of medical
decision-making?  Or is this just one illustration of why the
sentiments of Bertrand Russell as expressed in his "Why I am Not
A Christian" should be adopted by the medical professions?

     *I should mention that one widely cited work on this issue
is: Ruth Macklin's "Consent, Coercion, and Conflicts of Rights"
which appeared (I believe originally) in Perspectives in Biology
and Medicine in the late 1970's.

--Mike Rhodes
_______________________________
Michael R. Rhodes, Ph.D.
Department of Philosophy
203 Hanner Building
OSU
Stillwater OK 74078-5064

e-mail: mrhodes@vms.ucc.okstate.edu
________________________________

Date: Wed, 27 Sep 1995 16:31:47 -0600
From: "MICHAEL R. RHODES" <MRHODES@VMS.UCC.OKSTATE.EDU> Subject: Jehovah's
Witnesses (Klepper/Resply)

In response to my posting regarding Jehovah's Witnesses refusal of blood
transfusions, Howard Klepper raises a claim that certainly takes the sting
out of the issue. If he is correct, if the majority of Jehovah's Witnesses
would not construe a "forced" transfusion as an unpardonable sin (by the
recipient) punishable by being "cut off" from the possibility of
ressurection, then this does, as he suggests, open the door for "forced"
transfusions. It would remain the case, however, that the one who orders
the "forced" transfusion must reject the Jehovah's Witnesses religious
views on transfusions, since surely no physician would want to victimize a
child (by the analogy which Howard Klepper states: no physician would want
to rape a child), even granting that the child, as a victim, would not be
punished by God. While I have evry reason to trust Howard Klepper in
claiming that this IS the majority view among Witnesses, I would like to
have some evidence or reference to this, if only to rely upon Howard's
excellent point in thye future, backed by evidence. Does Howard, or anyone
on the list, know of a reliable source for this information? My
conversations with Witnesses have been contrary to this claim, but I am
willing to accept that I have spoken with those holding the minority
opinion. The genral problem I sketched out remians in full force for those
of this minority opinion, however. And perhaps the first question that
needs to be asked in such cases is whether the Witnesses hold the minority
or what Klepper refers to as the majority, view on the issue. --Mike Rhodes
 

Date: Sat, 30 Sep 1995 16:00:08 -0600
From: "MICHAEL R. RHODES" <MRHODES@VMS.UCC.OKSTATE.EDU> Subject: Witnesses
& Blood summary (Rhodes/3)

Last week, in response to a survey posted by Robert Stavis, I posted a
message which raised some philosophical/ethical issues pertaining to the
refusal by Jehovahs Witness parents to consent to their child's receipt of
a blood transfusion. I did so with the hope of stimulating discussion and I
have not been disappointed. I am grateful to those have carried on the
discussion by means of either direct correspondence to me or on the
BIOMED-L server.

In my original posting, I conveyed that the standard view of Jehovah's
Witnesses is that the receipt of blood is regarded as resulting in being
denied the possibility of ressurection, even when the transfusion if forced
upon the recipient. Howard Klepper suggested that I was not necessarily in
keeping with the view of the majority of Witnesses in this respect. He
commented that the majority view, among Witnesses, is that the receipt of
blood is pardonable if it is forced upon the recipient; hence he suggested
that I was actually presenting a minority view. In subsequent postings,
Glen Graber and Russell McIntyre have offered support that my account is
the majority account--most Witnesses do not regard forced transfusion as
pardonable by God. Klepper raises an important point, however--namely, that
it is unlikely that we can accurately measure what is in fact the majority
view because of the reluctance of Witnesses to reveal the pardonable nature
of forced transfusions by virtue of the fact that this might be regarded as
an invitation for forced transfusions.

Other issues pertaining to the nature of Witnesses' beliefs with respect to
blood transfusions were raised. Greg Pence's posting presented the stategy
being explored in Alabama in which bloodless surgery and using the
patient's own blood are considered. McIntyre's posting noted that only a
closed loop by-pass procedure would be acceptable and that even using the
patient's own blood would otherwise be unpardonable since upon leaving the
body the blood is defiled. This too hangs on what is an accurate account of
Witnesses' religious beliefs.

I am curious as to whether the interested members of this list agree with
my assertion that the decision to issue (or to order) a blood transfusion
to a child of Jehovah's Witness parents who refuse to consent, and who
explicitly affirm their belief that the transfusion is unpardonable
(regardless of whether this is a minority or majority view among
Witnesses), involves a preliminary religious judgment on the part of the
person who issues (orders) the transfusion. Or am I mistaken? Is Nasato
Takahawshi correct in maintaining that it does not involve a religious
judgment. My claim is that one would not order the transfusion if one
believed that the parents beliefs about transfusions were true. In brief,
the moral permissibility of such a forced transfusion is contingent upon a
rejection of the religious belief. Further, is it not the case that
attempts to convince the parents to offer their consent to the transfusion
will ultimately involve trying to convince the parents to modify, suspend,
or reject their religious beliefs about transfusions?

If we reject the parents' right to deny their child a blood transfusion, we
are, in such a case, rejecting a very important religious belief of theirs.
To this extent, it is not, I submit, merely a matter of providing treatment
in accordance with what is regarded as standard medical care, contra
Takahawshi.

-- Mike Rhodes
**********************************
Michael R. Rhodes, Ph.D.
Department of Philosophy
203 Hanner Building
OSU
Stillwater OK 74078-5064
email: mrhodes@vms.ucc.okstate.edu