Jehovah’s Witnesses are known for refusing blood transfusions, even in dire situations due to their religious beliefs. Jehovah’s witnesses believe that it is not in God’s will to receive blood transfusions and often even refuse taking blood transfusions of their own blood (Medical Protection Society, 2014). This can be a difficult for some physicians because this significantly cuts back their treatment options for those who are Jehovah’s Witnesses.
One example of a difficult illness to treat due to the
refusal of blood transfusions is acute leukemia. An interesting article
regarding these health disparities notes that some Leukemia patients are not
provided with the proper treatment and intensive chemotherapy due to concern
that these individuals without blood transfusions would not have the proper
support to survive myeloablation (Chaer & Ballen, 2019). Myeloablation is a
form of myelosuppression in which bone marrow activity is decreased, resulting
in fewer red blood cells, thus restricting the oxygen and blood circulation in
an individual’s body (NCI Dictionary of Cancer Terms, 2021). This makes the
treatment of acute leukemia in Jehovah’s Witness patients remarkably more
complex, unique, and interesting. This also makes an interesting ethics case as
physicians must respect a patient’s autonomy meanwhile while doing what is best
to treat their patient.
Before diving further into the ethical concerns of a
case like this, another treatment option for these patients is discussed and
noted to be Hematopoietic Stem Cell Transplant. This type of stem cell
transplant has been found to be successful in Jehovah’s Witness patients. This
treatment protocol is a reduced intensity condition but with a longer treatment
time and is less likely to require blood transfusions to keep a patient healthy
(Chaer & Ballen, 2019). The treatment process, however, can pose a
challenge due to prolonged suppression in the individual. This article in particular notes this is
likely the best treatment method for these patients in combination with infusion
of CD34 cells, which are associated with greater platelet recovery (Chaer &
Ballen, 2019).
This treatment is not the first line of treatment for
leukemia though and once again brings up ethical concerns. Physicians are required
to respect an individual’s bodily autonomy and their right to choosing treatment
protocols that best fit with their belief. On the other hand, physicians also must
look out for what the best thing to do for the patient is and exercise beneficence,
taking care of all their patients equally. Understanding alternative treatment
methods is essential to a physician as they can respect their patient’s bodily
autonomy and right of treatment refusals but also provide their best care
possible for the patient. In this case, understanding these two ethical
arguments is essential in successfully treating individuals who practice the
religion.
El Chaer, F., & Ballen, K. K. (2020). Treatment of acute leukaemia in adult Jehovah's Witnesses. British journal of haematology, 190(5), 696-707.
Mps. (2014). Medical
Protection Society. Retrieved from https://www.medicalprotection.org/southafrica/casebook/casebook-may-2014/the-challenges-of-treating-jehovah's-witnesses
NCI Dictionary of
Cancer Terms. (2021). Retrieved from
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/myeloablative-chemotherapy
Again, this was a great post Danielle and definitely makes the reader think. A fair majority of us in the MSBS program want to be physicians of some kind and I think this post postulates a great point of discussion as there is a high probability that we will run into treating a Jehovah’s Witness at some point in our careers. As a physician, our job is to provide the utmost care to our patients and do everything in our power in order to help them, but at the same time we still have to offer them complete autonomy over there course of medical treatment. This definitely proposes a challenge though when it comes to balancing beneficence, non-malfeasance, and autonomy. Personally, I believe it is idiotic to reject life-saving medical treatment, but as a physician we must remain educated and culturally competent in treating patients with different ideals, values, and beliefs from our own. Throughout this semester we have discussed a fair amount of biomedical ethical principles and applied them to different course readings and discussions, but this is one that I would love to learn more about and discuss in class.
ReplyDeleteIn a paper I found online, JW’s suffering from life-threatening anemia can choice to receive erythropoietin-stimulating agents and intravenous iron in order to help stimulate and restore red blood cells and as well as Hb levels (Posluszny & Napolitano, 2014). JW’s suffering from reduced oxygen carrying capacity of their red blood cells can also receive Hb-based oxygen carriers (HBOCs), but this method of treatment is not yet FDA approved, although can be used in very critical situations (Posluszny & Napolitano, 2014). Both of these methods seem to be okay at helping JW’s with life-threatening anemia but are still not as great as undergoing a simple blood transfusion. Thus, the question of, “what do I do in this case” as a physician is still looming.
Posluszny, J. A., Jr, & Napolitano, L. M. (2014). How do we treat life-threatening anemia in a Jehovah's Witness patient?. Transfusion, 54(12), 3026–3034. https://doi.org/10.1111/trf.12888