329 Care of the Child Refusing Blood Products

Background: Jehovah’s Witnesses and Prohibitions on Transfusion of Blood The Watch Tower Bible and Tract Society web site (http://www.watchtower.org/e/statistics/worldwide_report. htm accessed January 29, 2011) indicates that in 2009, there were over 7.3 million Jehovah’s Witnesses in 236 countries worldwide. The greatest number of these (over 1.1 million) live in the USA, with numbers in excess of 100,000 being found in other countries in North America (Canada, Mexico), South America (Argentina, Brazil, Columbia, Peru), Eurasia (France, Germany, Great Britain, Poland, Russia, Spain), the Far East (Japan, Philippines), and Africa (Congo, Nigeria, Zambia). Thus, it is likely that the medical practitioner treating children almost anywhere in theworldwill come into contact with a Jehovah’sWitness family. Jehovah’s Witnesses believe that the Bible prohibits ingesting blood and do not accept transfusion of whole blood or any of its four primary components – red cells, platelets, plasma, or white cells. This prohibition applies even in clinical contexts where such refusal may result in serious harm or death. The transfusion prohibition also extends to predonation and storage of a patient’s own blood for later transfusion back to the patient. However, it is worth noting that Jehovah’s Witnesses are not one of the religious groups who shun medical care generally, and that acceptability of sophisticated medical interventions where their own blood is kept in contact with the body (cardiopulmonary bypass, dialysis), as well as receipt of organ transplants, are considered ‘‘matters of conscience’’ to be decided by each individual Witness. Other ‘‘matters of conscience’’ to Witnesses are intraoperative blood salvage where the blood is kept in contact with the body (‘‘Cell Saver’’ type devices, perioperative hemodilution) and a range of ‘‘minor fractions’’ of blood (discussed in greater detail below). While most countries legally permit refusal of medical interventions by adults, the desire of Jehovah’s Witness parents and guardians to extend refusal of blood therapy to their minor children often results in legal and ethical tensions between the family and healthcare providers treating the child, as those providers are