Bioethics of the refusal of blood by Jehovah's Witnesses: Part 3. A proposal for a don't-ask-don't-tell policy.
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Of growing concern over Jehovah's Witnesses' (JWs) refusal of blood is the intrusion of the religious organisation into its members' personal decision making about medical care. The organisation currently may apply severe religious sanctions to JWs who opt for certain forms of blood-based treatment. While the doctrine may be maintained as the unchangeable "law of God", the autonomy of individual JW patients could still be protected by the organisation modifying its current policy so that it strictly adheres to the right of privacy regarding personal medical information. The author proposes that the controlling religious organisation adopt a "don't-ask-don't-tell" policy, which assures JWs that they would neither be asked nor compelled to reveal personal medical information, either to one another or to the church organisation. This would relieve patients of the fear of breach of medical confidentiality and ensure a truly autonomous decision on blood-based treatments without fear of organisational control or sanction. (+info)
Jehovah's Witnesses' refusal of blood: obedience to scripture and religious conscience.
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Jehovah's Witnesses are students of the Bible. They refuse transfusions out of obedience to the scriptural directive to abstain and keep from blood. Dr Muramoto disagrees with the Witnesses' religious beliefs in this regard. Despite this basic disagreement over the meaning of Biblical texts, Muramoto flouts the religious basis for the Witnesses' position. His proposed policy change about accepting transfusions in private not only conflicts with the Witnesses' fundamental beliefs but it promotes hypocrisy. In addition, Muramoto's arguments about pressure to conform and coerced disclosure of private information misrepresent the beliefs and practices of Jehovah's Witnesses and ignore the element of individual conscience. In short, Muramoto resorts to distortion and uncorroborated assertions in his effort to portray a matter of religious faith as a matter of medical ethical debate. (+info)
Why some Jehovah's Witnesses accept blood and conscientiously reject official Watchtower Society blood policy.
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In their responses to Dr Osamu Muramoto (hereafter Muramoto) Watchtower Society (hereafter WTS) spokesmen David Malyon and Donald Ridley (hereafter Malyon and Ridley), deny many of the criticisms levelled against the WTS by Muramoto. In this paper I argue as a Jehovah's Witness (hereafter JW) and on behalf of the members of AJWRB that there is no biblical basis for the WTS's partial ban on blood and that this dissenting theological view should be made clear to all JW patients who reject blood on religious grounds. Such patients should be guaranteed confidentiality should they accept whole blood or components that are banned by the WTS. I argue against Malyon's and Ridley's claim that WTS policy allows freedom of conscience to individual JWs and that it is non-coercive and non-punitive in dealing with conscientious dissent and I challenge the notion that there is monolithic support of the WTS blood policy among those who identify themselves as JWs and carry the WTS "advance directive". (+info)
Medical confidentiality and the protection of Jehovah's Witnesses' autonomous refusal of blood.
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Mr Ridley of the Watch Tower Society (WTS), the controlling religious organisation of Jehovah's Witnesses (JWs), mischaracterises the issue of freedom and confidentiality in JWs' refusal of blood by confusing inconsistent organisational policies with actual Biblical proscriptions. Besides exaggeration and distortion of my writings, Ridley failed to present substantive evidence to support his assertion that no pressure exists to conform to organisational policy nor systematic monitoring which compromises medical confidentiality. In this refutation, I present proof from the WTS's literature, supported by personal testimonies of JWs, that the WTS enforces its policy of blood refusal by coercive pressure to conform and through systematic violation of medical confidentiality. Ridley's lack of candour in dealing with the plea of dissident JWs for freedom to make personal and conscientious decisions regarding blood indicates that a serious breach of ethics in the medical care of JWs continues. The medical community should be seriously concerned. (+info)
Reoperation in a Jehovah's Witness 22 years after aortic allograft reconstruction of the right ventricular outflow tract.
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We report the case of a 29-year-old male Jehovah's Witness who presented with hemolysis and right heart failure as a consequence of extreme calcification of an aortic valve-containing allograft and Dacron prosthesis that had been placed 22 years earlier to repair tetralogy of Fallot. Reoperation had been denied by several other centers, because of the patient's refusal to undergo blood transfusion. For 2 weeks preoperatively, we raised the patient's hemoglobin level by treating him with recombinant erythropoietin, oral iron, and folic acid. At surgery, under normothermic cardiopulmonary bypass, we replaced the aortic allograft in the right ventricular outflow tract with a cryopreserved pulmonary allograft, also containing a valve. The postoperative course was uneventful, and the patient was released from the hospital on the 13th postoperative day in excellent condition. (+info)
Methods and principles in biomedical ethics.
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The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the "standard" Jehovah's Witness case that having autonomously chosen the authority of his religious institution, a Jehovah's Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author's view of the child of a Jehovah's Witness scenario is that it is morally required-not merely permitted-to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (+info)
Applying the four principles.
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Gillon is correct that the four principles provide a sound and useful way of analysing moral dilemmas. As he observes, the approach using these principles does not provide a unique solution to dilemmas. This can be illustrated by alternatives to Gillon's own analysis of the four case scenarios. In the first scenario, a different set of factual assumptions could yield a different conclusion about what is required by the principle of beneficence. In the second scenario, although Gillon's conclusion is correct, what is open to question is his claim that what society regards as the child's best interest determines what really is in the child's best interest. The third scenario shows how it may be reasonable for the principle of beneficence to take precedence over autonomy in certain circumstances, yet like the first scenario, the ethical conclusion relies on a set of empirical assumptions and predictions of what is likely to occur. The fourth scenario illustrates how one can draw different conclusions based on the importance given to the precautionary principle. (+info)
Juggling law, ethics, and intuition: practical answers to awkward questions.
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The eclectic problem solving methodology used by the British Medical Association (BMA) is described in this paper. It has grown from the daily need to respond to doctors' practical queries and incorporates reference to law, traditional professional codes, and established BMA policies-all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah's Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the BMA's approach. The author's overall conclusion is that although the BMA resorts to a lengthier list of things to consider, the solutions that emerge are often likely to coincide with the four principles approach. (+info)