Ethics of Surgical Intervention in Jehovah’s Witness Patients

Abstract

Jehovah’s Witness patients, due to their strict tenant of prohibition of receiving blood products, pose a major challenge in surgical care. Their refusal poses a major threat of death from profound anemia, should bleeding occur in these patients. Due to this increased risk, surgeons often are confronted with the ethical dilemma of whether to take on the challenge of treating these individuals. However, access to any necessary surgical interventions should not be denied to any patients solely because of their religious beliefs. The four principles of medical ethics, beneficence, autonomy, nonmaleficence, and justice, provide a moral framework in which to discuss the ethical implications for providing medical care to Jehovah’s Witness patients.

While most Jehovah’s Witness patients firmly reject actual blood products, some individuals may be lenient on blood analogues or isolated coagulants. Therefore, it is important to respect the autonomy of the patient by having a detailed and comprehensive informed consent regarding each of those agents. During informed consent, it is imperative that the patient understands the higher risk of death. After careful discussion, they need to clearly express their desire that they would rather die rather than receiving life-saving transfusions. The surgeon must look at all alternatives and weigh other treatments balancing the efficacy of the treatment versus the risk of death. Once the treatment course has been planned and the patient has been fully informed and has agreed, multidisciplinary care and preoperative planning with all necessary departments are crucial to optimizing the patient’s preparation prior to surgery. Meticulous surgical technique to minimize blood loss and having protocols in place in case massive bleeding is encountered intraoperatively are important aspects in treating for these patients. Early vigilance, recognition, and intervention in the postoperative period will minimize blood loss and safely guide these patients through recovery.