Discussions for Module 4: Blood Transfusions and the Jehovah's Witnesses Patient

Questions are answered by module author: John Doyle MD Ph.D. FRCPC

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Comment:

the topic is very interesting -- here in saudi arabia v hardly find any jv patients--but knowing about the subject is always good for our knowledge.

Feb. 18, 2007 at 02:37, S.

 

Question:

We have taken care of a few children whose parents are of JW faith and have managed to accomodate the parents wish that their child not receive blood products. Thus far we have explained the law to them (most of them are aware of the judgement) and they will sign an unmodified consent and trust to Jehovah ( and no, I am not being sarcastic) The interesting dilemmas arise because there is no age of consent in Ontario (Canada?) and thus competent individuals (of any age) can refuse treatment and are sometimes in conflict with either their parents or health care professionals or both. What do others think about redo Aortic valve surgery in a 15yr old 75kg individual who has been quoted 20% mortality without the use of blood products but thus far has not consented to their use? There is a very good article in a recent BMJ about JW and confidentiality and transfusion.

Nov. 17, 2005 at 17:32, H.H.

Dr. Doyle replies:

Redo aortic valve surgery in a 15yr old 75kg individual is risky enough without the complexity of adding the restriction of not allowing blood products. Such a restrictions would likely add enormously to the overall perioperative risk. The estimate of 20% mortality in such a setting appears to be a reasonable guess (and it is only a guess), but would naturally depend on detailed specifics such as the preoperative hemoglobin concentration, possible co-morbid conditions, the skill and experience of the surgical team, and so on.

At age 15 the child is likely to be a "mature minor" and may well have the wisdom and mental capacity to understand the enormous risks involved. However, the definitive wishes of the child can only really be established by interviewing the child alone, without the parents or other religious authority figures being present to influence the discourse. One fear I would have is that the child might have underestimated the risks, expecting that - despite everything - Jehovah will protect him from harm. Experience tells us that Jehovah does not always do this.

 

Question:

I'm curious how the community centres which do pediatric cases deal with this issue when caring for children of JW parents.

Nov. 10, 2005 at 12:56, H.F.

Dr. Doyle replies:

Although I write from the USA and usually do not do pediatric cases, I believe that the principles involved in such circumstance are substantially similar in both the USA and Canada. Specifically, I would emphasise the importance of explaining risks, benefits and alternatives in full to the parents and (to the extent that it is practical and possible) to the child.

It is occassionally necessary that a child be made a ward of the court in order to administer clinically necessary blood transfusions. In fact, the Supreme Court of Canada has ruled that this specific intervention is a legitimate limitation on religious freedom. Such circumstances are unusual, but are best tackled with assistance from hospital legal counsel.

 

Question:

Please identify a "bloodless centre" in Toronto. Are there such places locally with a high volume of JWs cared for there?

Nov. 10, 2005 at 12:51, P.A.

Dr. Doyle replies:

I am unaware of any institution in Toronto (or, indeed, in Canada) that has been formally designated a "bloodless surgery centre" in the same sense as the term is used in the USA. In fact, there are some individuals who argue that the term "bloodless surgery centre" is misleading, since such centers are really centers with a special expertise in blood surgical conservation, and they will still administer blood products when clinically necessary in patients who are not Witnesses. Here is a comment on the matter from Canadian Blood Services (www.bloodservices.ca):

In recent years, great advances have been made in limiting the need for donated blood. The term "bloodless surgery" is a bit of a misnomer, however, it refers to a combination of measures that reduces or eliminates the need for homologous blood. These include surgical techniques that reduce blood loss, machines that recycle the patient's own blood during surgery, drugs that reduce the need for transfusions, and the use of autologous donations.

That being said, some Canadian centers have a special interest in perioperative blood conservation even if they do not market themselves as a "bloodless surgery centre". More information can be obtained by contacting "Physicians and Nurses for Blood Conservation" using the information provided below.

P.O. Box 217
6-2400 Dundas St. West
Mississauga, Ontario, L5K 2R8
Telephone 905 608 1647
Email admin@pnbc.ca

 


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