Jehovah's Witness, 15, crushed by car dies after refusing blood transfusion because of his faith
By Fay Schlesinger
A schoolboy died after refusing a blood transfusion following a car crash because he was a Jehovah’s Witness.
Joshua McAuley, 15, suffered life-threatening injuries to his legs and abdomen after being pinned against a shop front by an out-of-control car as he went to buy sweets.
He survived the crash in Smethwick, West Midlands, and remained conscious, but lost a massive amount of blood and was airlifted to hospital for a transfusion.
But Joshua died six hours later, after he refused to consent to the operation because of his faith, church representatives said.
Under medical law, doctors are required to decide whether a child under 16 is
competent enough to consent to or refuse medical treatment without the need for parental permission or knowledge.
Sources at University Hospitals Birmingham NHS Trust suggested doctors followed this law, known as the Gillick competence test, before deciding Joshua was able to make his own decision.
It is unclear whether either of the boys’ parents were at the hospital at the time.
Last night members of his congregation described how he told doctors ‘no blood, no
blood, no blood’ after he was flown to Selly Oak Hospital, in Birmingham.
As a Jehovah’s Witness from a devout family, Joshua followed the belief that blood is sacred and transfusions are prohibited by the Bible.
Hospital staff are thought to have begged the teenager to change his mind, but he
refused.
Clive Parker, an elder at the Kingdom Hall of Jehovah’s Witnesses where Joshua and his family worshipped, said: ‘I believe he was conscious enough after the accident and he made a stand on the blood issue. He made the choice personally.’
Joshua, who was about to start his GCSEs at the local Shireland Academy, went to
buy sweets while out preaching to residents at 11.15am on Saturday, when the accident happened, friends said.
Firemen battled to free Joshua, as others trapped inside the shop feared the building would collapse.
Paramedics gave him pain relief and emergency treatment at the roadside, before
flying him to hospital. Four other pedestrians were hurt in the crash – one seriously.
The 28-year-old male driver, from Birmingham, has been bailed pending further
inquiries, West Midlands Police said.
This article was found at:
http://www.dailymail.co.uk/news/article-1279252/Jehovahs-Witness-15-dies-refusing-blood-following-crash.html
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Girl Forced Into Blood Transfusion Can't Sue
ReplyDeleteBy JEFF D. GORMAN, Courthouse News Service July 12, 2013
(CN) - It is too late for a 15-year-old Jehovah's Witness to fight the appointment of a guardian who forced her to undergo a life-saving blood transfusion, the Wisconsin Supreme Court ruled.
Sheila W., as she is named in the decision, was 15 when she was diagnosed in early 2012 with aplastic anemia, an illness in which the patient's immune system attacks the bone marrow.
She declined to undergo life-saving blood transfusions, and her parents supported her decision. They are Jehovah's Witnesses and believe that God does not allow blood transfusions.
Citing the biblical passage Acts 15: 28-29, Sheila told a Dane County judge that a transfusion would be equivalent to "rape."
When the county petitioned for temporary physical custody, the court held a hearing at the hospital and appointed a temporary guardian to decide whether to consent to the recommended transfusions.
With the guardian's consent, "an undetermined number of blood transfusions were administered to Sheila," according to the ruling.
Sheila appealed, but the order to appoint the guardian expired while the action was pending and the Court of Appeals dismissed the case as moot.
The Wisconsin Supreme Court affirmed Wednesday.
"No determination of this court will have any practical legal effect upon an existing controversy because the order being appealed has expired," the unsigned opinion states.
While all of the parties agreed on the mootness subject, Sheila wanted the state's highest court to rule on the issue of whether Wisconsin recognizes her rights as a mature minor to make medical decision and whether the appointment of the guardian violated her constitutional rights.
Despite their acknowledgement that the case "undoubtedly presents issues of public importance," the justices declined to rule on the merits of the case.
"We deem it unwise to decide such substantial social policy issues with far-reaching implications based on a single fact situation in a case that is moot," they wrote.
Justice David Prosser wrote a longer concurrent opinion.
"Permitting a minor to refuse lifesaving medical treatment comes uncomfortably close to permitting a minor to commit suicide," he wrote.
Justice Michael Gabelman wrote in dissent that the court should have ruled on the merits of the case.
"The Sheila W.s of this state may have to wait a long time before the legislators on white horses arrive," Gabelman wrote. "In the meantime, the actual problem of what to do with minors who refuse life-saving treatment will remain unresolved."
One week earlier, the court affirmed the convictions of Leilani and Dale Neumann, a "Pentecostal" couple whose daughter died as they prayed over her instead of seeking medical treatment.
http://www.courthousenews.com/2013/07/12/59336.htm
'Firm stand' on transfusions
ReplyDeleteMatt Smith, The Mercury November 12, 2011
A JEHOVAH'S Witness leader has defended the position of the religion to make its own choices on blood transfusions.
Jehovah's Witness senior elder Graeme Martin said it was a misconception that Jehovah's Witnesses suffered a greater mortality rate as a result of refusing transfusions.
"An increasing volume of medical research indicates the very opposite," Mr Martin said yesterday.
He said a growing number of people around the world were refusing blood transfusions for cultural and medical reasons.
However, he said Jehovah's Witnesses were the only group of people who made the decision on religious grounds.
Mr Martin was responding broadly to the issue after a Tasmanian Coroner Rod Chandler published his findings into the death of a Glenorchy Jehovah's Witness.
Mr Chandler found a blood transfusion would probably have saved the life of Judith Louise Allen, who died of complications after lap band surgery in July 2009.
Medical staff tried to persuade her husband to consent to the transfusion when she became critically ill after the surgery, but he insisted that her religious beliefs be respected.
The case has prompted Mr Chandler to call on the Jehovah's Witness governing body to relax the doctrine that Christians should not accept blood transfusions.
Mr Martin said he could not comment on Mrs Allen's case.
"Nevertheless, it is common knowledge that Jehovah's Witnesses continue to take a firm stand regarding blood transfusions based on the Bible's clear injunction that Christians 'abstain from blood'."
Mr Martin said evidence showed blood transfusions did not help in some situations.
"In addition to lack of evidence for benefit, there is a growing body of literature showing transfusion to be associated with harm in the short, mid and long term," he said.
http://www.themercury.com.au/article/2011/11/12/276151_most-popular-stories.html
Lawyer tells of agonising scenes as doctors forced to let a Jehovah's Witness who wanted to live, die
ReplyDeleteJeremy Laurance The Independent June25, 2012
A lawyer who advised doctors that they must let a 22-year-old Jehovah's Witness die even though he wanted to live has spoken of the agonising scenes before the young man's death.
Robert Tobin, a partner in the London law firm Kennedy’s, was called in by an unnamed NHS Trust when the man, a Jehovah’s Witness who was critically ill with sickle cell anaemia, refused a blood transfusion which could have saved his life.
Over three weeks the man gradually deteriorated as the crisis progressed, before eventually dying.
“Medical staff were understandably upset at seeing a patient deteriorate before their eyes knowing a simple procedure could have been provided that would have saved his life,” Mr Tobin said.
The man’s mother, also a Jehovah’s Witness, was at her son’s bedside, and an elder from the man’s church also attended. The trust was concerned that they were unduly influencing him but a doctor from a neighbouring trust who was called in to assess him said he had full capacity and was making the decision on his own.
Mr Tobin said: “I don’t know what his mother was thinking as she sat by and watched him die. I assume either she felt powerless or she felt bound to her own religious code of conduct which says you can’t share blood with others.
“He had full capacity, he made his decision, however irrational. His doctors were bound by that. The rules are very clear.”
Mr Tobin said that at the Trust’s request, the Jehovah’s Witness signed an advance directive - the so-called “living Will” - setting out his wishes in case he lost mental capacity in the future.
Mr Tobin highlighted the ethical discrepancy in the law which forbids the same doctors from assisting those who want to die.
He contrasted the Jehovah's Witness's case with those cases raised in the debate over assisted dying, in which patients have petitioned the courts for the right to seek help to end their lives.
Last week Tony Nicklinson who has “locked in” syndrome after suffering a massive stroke, sought a ruling exempting doctors from criminal prosecution if they assisted his suicide.
“There is a subtle distinciton between a patient’s right to life and a patient’s right to die,” Mr Tobin said.
While the law forced medical staff to stand aside and not intervene in the case of the 22 year old Jehovah’s Witness, even though the man had no intention of ending his life, they were prevented from intervening to help patients such as Tony Nicklinson die at a time of their choosing.
“But the same doctors could be faced on a another day with a patient who wants assistance to die when his condition becomes impossible to live with. In that case the doctors could face criminal prosecution if they helped him to realise his wish,” said Mr Tobin.
While the legal distinction was clear for doctors treating the Jehovah's Witness, the ethical one was not. Both patients wanted to exercise their personal autonomy but only one - the Jehovah’s Witness - was able to do so, because he needed no assistance.
Mr Tobin added: “It is tragic that his goal was not to die but to ensure that he obeyed what he regarded as his religious commands. Death only came about as a consequence of that and not, as with those wishing assistance with dying, as the primary aim."
http://www.independent.co.uk/life-style/health-and-families/health-news/lawyer-tells-of-agonising-scenes-as-doctors-forced-to-let-a-jehovahs-witness-who-wanted-to-live-die-7879674.html
Without fanfare, Jehovah’s Witnesses quietly soften position on blood transfusions
ReplyDeleteby Tom Blackwell, National Post Staff | Dec 20, 2012
For years, the Jehovah’s Witnesses’ fiercely held belief that blood transfusions are contrary to God’s will led to emotional and very public disputes, hospitals clashing with parents over whether to infuse sick children.
That long history of messy legal confrontations appears to be vanishing, however, amid changing approaches to the issue on both sides, health-care officials say.
The church’s ban on accepting blood still stands, but some major pediatric hospitals have begun officially acknowledging the parents’ unorthodox beliefs, while many Jehovah’s Witnesses are signing letters recognizing that doctors may sometimes feel obliged to transfuse, they say.
As institutions show more respect toward parents’ faith and try harder not to use blood, Witnesses often seem eager to avoid involving child-welfare authorities to facilitate transfusions, and more accepting that Canadian case law is firmly on the doctors’ side, some hospital officials say.
“They get it that we’re going to transfuse where it’s medically necessary. They’ve lost that battle; they understand that,” said Andrea Frolic, a bioethicist at McMaster Children’s Hospital in Hamilton, Ont. “But it’s kind of an affront to their community to involve child-welfare services where there aren’t concerns about neglect, there aren’t concerns about abuse. … Part of the thing was ‘Just go on and do it. Why do we need to involve CAS [Children’s Aid Services]? It makes us feel like bad parents.’ ”
Ms. Frolic made a presentation on her hospital’s two-year-old policy to the Canadian Society of Bioethics conference earlier this year and said several other children’s hospitals are following similar approaches.
They include Sick Kids in Toronto and Montreal Children’s Hospital.
To Calgary’s Lawrence Hughes, an ex-Jehovah’s Witness who fought a long court battle against the blood policy, the apparent changes are a sign that the Witnesses are fed up with the legal tussles, which he believes were unpopular with members and a strain on resources.
Mr. Hughes broke with the Witnesses, and the rest of his own family, when it tried to prevent his teenage daughter, Bethany, who died in 2002, from receiving a blood transfusion while being treated for cancer.
The turning point seemed to come in 2007, he argued. A Vancouver hospital had child-welfare officials seize some of the sextuplets born to a Jehovah’s Witness couple that year so doctors could give them blood. The church’s governing Watchtower Bible and Tract Society fought the move in a losing — and highly publicized — court battle.
“I think that did them in. They couldn’t take it any more,” said Mr. Hughes. “I’ve been contacted by people who used to be in my congregation, and they left because of this [blood ban].”
Mark Ruge, a spokesman for the Watchtower Society in Georgetown, Ont., said the church, which has branches throughout the world, has not altered its blood ban, though he said he could not account for the actions of individual families.
continued in next comment...
David Gnam, one of the Witnesses’ lawyers who has handled many of the transfusion cases, also said there has been no official change in policy, though he is aware that some hospitals have patients sign forms.
ReplyDelete“I’ve been involved in cases representing Jehovah’s Witnesses patients and occasionally it’s been in everybody’s best interests to come to some sort of agreement between the parties,” he said. “But that’s just individual hospitals, doctors and patients.”
Still, evidence suggests that the number of cases that end up before a judge has dropped significantly. The Canlii website, which catalogues many Canadian court decisions, includes nine separate child blood-transfusion rulings from 2000 to 2007, but just three in the five years since then.
The Witnesses’ conviction that agreeing to transfusions of whole blood can lead to damnation, officially adopted in 1945, stems from various Bible verses that call on followers to “abstain from” blood.
Disputes arise when parents refuse transfusions on behalf of children below the age of consent. Hospitals in the past typically approached child-welfare authorities, who asked the courts for an order giving them temporary custody so they can ensure the transfusion is administered.
Toronto’s Sick Kids now will go to “all lengths” to find alternatives to transfusing blood when Jehovah’s Witnesses voice their opposition, said Rebecca Bruni, a bioethicist at the hospital. It also asks parents to sign a letter of understanding — drafted with the help of one of the church’s hospital liaison committees — that says the institution recognizes their religious objections and will try to avoid transfusions if at all possible. The letter is not a consent form, but adds that where the child is at imminent risk of serious harm or death, medical staff will press ahead with the transfusion.
“What is beautiful about this is that it’s a symbolic way of embodying respect and dignity and when we do this, we don’t need to call Children’s Aid, which can be messy and ugly.”
McMaster Children’s Hospital has a similar letter of understanding, recognizing that providing a blood transfusion can be traumatic when “it has potentially eternal consequences,” said Ms. Frolic.
McGill Children’s Hospital in Montreal has had such a protocol for about a decade, and found that it brought about a “real, significant drop” in conflicts, said Lori Seller, a clinical ethicist at the facility.
All the ethicists stress, as well, that some Jehovah’s Witnesses do not agree with the blood ban, but are anxious that their green light to transfusion be kept confidential.
“Some families are really more concerned about other Jehovah’s Witnesses finding out they consented to the blood transfusion,” said Ms. Seller.
http://life.nationalpost.com/2012/12/20/without-fanfare-jehovahs-witnesses-quietly-soften-position-on-blood-transfusions/
Doctors win right to save Jehovah's Witness boy's life
ReplyDeleteby Vanda Carson, The Daily Telegraph Australia April 18, 2013
A TEENAGE boy has vowed to "rip out" a needle giving him a blood transfusion despite a judge ordering the lifesaving treatment against the boy's religious beliefs.
Doctors from Sydney Children's Hospital in Randwick made an urgent application to the Supreme Court to help them save the boy, a devout Jehovah's Witness, who is fighting Hodgkin's disease.
In a judgment handed down on March 28, Justice Ian Gzell immediately ordered a blood transfusion after doctors said the 17-year-old's life depended on it.
Justice Gzell noted his orders "may only extend (the boy's) life for 10 months - when he becomes an adult and may stop the treatment".
"The sanctity of life in the end is a more powerful reason for me to make the orders than is respect for the dignity of the individual," he said.
The boy, who cannot be identified, was diagnosed with Hodgkin's disease in January last year. He is a "devoted" follower of the religion and Justice Gzell found him to be "cocooned in that faith".
The boy told doctors he did not want to be given blood, even in an "emergency", and that if he was forcibly transfused while sedated it would be like being "raped".
Doctors had respected his wishes, with the teen treated with chemotherapy in order to avoid giving him transfusions. But that did not reduce the tumours in his lungs, spleen and lymph nodes.
His doctor, Professor Glenn Marshall, argued the boy needed a high dose of chemotherapy, but that would make him anaemic and he would require a transfusion.
Professor Marshall told the court that, if he continued to treat the boy's cancer with chemotherapy and he was not transfused, he had an 80 per cent chance of dying.
"The alternative is that (the boy) will die of cancer because he is receiving less than optimal treatment for it," Justice Gzell said.
Professor Marshall said the boy had a 50 per cent chance of being cured of cancer if he was given full treatment, including a transfusion.
His father has written a scripture quote which refers to abstaining from blood on a whiteboard in his hospital room. The court was told "it is a tenet of the Jehovah's Witness faith that blood products are forbidden".
The boy and his father told the court there were no "ramifications" from their church provided the transfusion was "against his will".
The boy told the court taking blood would change his relationship with God.
The judge has given the green light for doctors at the Kids Cancer Centre at Randwick (part of the Sydney Children's Hospital) to give the boy blood.
The boy was in remission from the disease for several months last year but he suffered a relapse in November.
Last year the NSW Supreme Court made similar orders for a four-year-old girl from South Australia.
http://www.dailytelegraph.com.au/news/sydney-news/doctors-win-right-to-save-jehovahs-witness-boys-life/story-e6freuzi-1226623009060
A matter of life or death
ReplyDeleteby B.C., The Economist Aug 28th 2013, BELFAST
A YOUNG man with severe learning disabilities should be given a life-saving transfusion of blood if that were to become necessary during extensive dental surgery, despite the fact that he and his mother belong to the Jehovah's Witnesses, a faith which regards transfusion as sinful. That is what Northern Ireland's Lord Chief Justice ruled in a judgment several weeks ago which has only just been made public.
Summarising the case rather sensitively, Sir Declan Morgan described the unnamed 26-year-old as a man who "enjoys a close and loving relationship with his mother" and was said by her to "enjoy attending church" and have "positive social contact" through church in an otherwise difficult life. But he could not take an informed decision about transfusion because under the established rules, such choices cannot be made if "the patient is unable to comprehend or retain" the necessary information. At least two articles of the European Convention on Human Rights were relevant, the judge noted: the second, which guarantees the right to life, and the third, which outlaws "inhuman and degrading" treatment. But legal precedents indicated that a treatment aimed at preserving life could not be considered cruel.
The verdict amounts to a victory for what many people would see as common humanity, in the face of a religious taboo which every so often has tragic consequences. In 2007 a young woman in the English town of Shrewsbury died after giving birth to twins because her principles as a Jehovah's Witness prevented her from receiving blood. But last year, a high court in Dublin ruled that a woman who suffered an ectopic pregnancy should be given a life-saving transfusion, even though she and her husband were Jehovah's Witnesses and she had (as the faith recommends) signed an "Advanced Care Directive" signalling her objection to receiving most blood products. She was heavily sedated at the time of the verdict.
The Jehovah's Witnesses propagate (in every corner of the earth) a millennarian variant of Christianity, insisting that the end of the present world era is imminent and denying the Trinity—God in three persons—which for most Christians is a core doctrine. Their objection to transfusion reflects warnings against consuming blood that occur in the New Testament book of Acts, and as well as in the books of Genesis and Leviticus in the Hebrew Scriptures. But transfusion for medical reasons did not exist in Biblical times; this is one of the many difficulties that arise when codes of ethics that were devised for life in the pre-modern desert are applied to the 21st century.
In Russia, reining in the Witnesses' objections to transfusion has taken a sinister turn, according to religious-freedom campaigners. In a practice that was condemned by the European Court of Human Rights, a prosecutor in St Petersburg told hospitals to report, with names and personal details, any cases of people refusing blood transfusions, as possible evidence for a broad investigation of the entire sect. The Witnesses are among several faith groups which have been targeted under a Russian law that outlaws religious "extremism" in the broadest of terms. The ECHR awarded damages to two Witnesses whose privacy had been violated.
Further west, a consensus is emerging that people of more-or-less sound mind can, if they so choose, put their lives at risk by refusing certain treatments; but they cannot impose that risk on dependants who for one reason or another cannot decide for themselves.
http://www.economist.com/blogs/erasmus/2013/08/jehovahs-witnesses-and-blood
Religious boy fights court for right to die
ReplyDeleteby Rachel Olding, Sydney Morning Herald September 18, 2013
He is a ''highly intelligent'' boy just 10 months shy of his 18th birthday but he does not have the right to make medical decisions for himself.
The Jehovah's Witness who was ordered to have a life-saving blood transfusion for cancer, despite threatening to rip the IV needle from his arm, is appealing against the court claiming he is mature enough to dictate his own fate.
Supreme Court Justice Ian Gzell overrode the wishes of the boy, known as X, and his parents when he ruled in April that he must undergo treatment for Hodgkin's lymphoma at the Sydney Children's Hospital.
''The sanctity of life in the end is a more powerful reason for me to make the orders than is respect for the dignity of the individual,'' Justice Gzell said. ''X is still a child, although a mature child of high intelligence.''
The boy's barrister, David Bennett, QC, argued in the NSW Court of Appeal on Tuesday that the judgment failed to take into account how mature and competent X was and how close he was to being 18.
Despite X's doctor, Professor Glenn Marshall, giving him an 80 per cent chance of dying from anaemia if he didn't have the transfusion, Mr Bennett argued a child was entitled to a degree of decision making ''reflective of their evolving maturity''.
He referred to several overseas cases of younger Jehovah's Witnesses being allowed to refuse blood, which is forbidden in the religion, because a ''sliding scale of maturity'' known as the Gillick competency test was considered.
In most cases, the young person died like 15-year-old Joshua McAuley, who refused a blood transfusion following a car crash in England's West Midlands in 2010.
''It's easy to place very great emphasis once the word death creeps into a discussion,'' Mr Bennett said.
''But … [it] is a question of relative risk rather than a question of life or death and one has to weigh that against the fact that an adult is fully entitled to make decisions to refuse life-saving medical treatment and we are dealing with someone very close to [adulthood].''
However, the Children's Hospital said the boy had a ''cocooned upbringing'' and his family had ''little exposure to challenges of their beliefs from outsiders'' so what they may have thought was best was not necessarily correct.
''The views of many 21-year-olds … are much different to their views when they were 16 or 17,'' Jeremy Kirk, SC, told the court.
On a whiteboard in his hospital room, X's father wrote a scripture reference to abstaining from blood.
The boy told Professor Marshall that being sedated for a blood transfusion would be akin to being raped. He has since had three unsuccessful cycles of chemotherapy at a lower dose.
http://www.smh.com.au/nsw/religious-boy-fights-court-for-right-to-die-20130917-2tx5u.html
Teenage Jehovah's Witness loses court bid to refuse life-saving blood transfusion
ReplyDeleteAAP ABC News Australia September 28, 2013
A Sydney teenager has lost his bid to refuse a potentially life-saving blood transfusion treatment because he is a Jehovah's Witness.
The 17-year-old cancer victim, known only as X, appealed against a NSW Supreme Court order that staff at the Sydney Children's Hospital should be allowed to give him the treatment.
He told his doctors he would rip the IV out of his arm if forced to have the transfusion, which he believes is akin to being raped.
X is suffering from Hodgkin's disease and his doctors believe he has an 80 per cent chance of dying from anaemia if he does not receive the treatment.
In March, Justice Ian Gzell ordered the hospital be allowed to carry out the treatment on the boy, who immediately appealed against the decision.
While noting he was highly intelligent, a "mature minor" and devoted to his faith, the judge also found the boy had been "cocooned in that faith" for his entire life.
"The sanctity of life in the end is a more powerful reason for me to make the orders than is respect for the dignity of the individual," Justice Gzell said at the time.
In a judgment handed down in the Court of Appeal today, the three appeal judges agreed.
"There is no reason why a different result should be achieved because the [boy] is now five months closer to his 18th birthday," the judgment said.
"The interest of the state is in keeping him alive until that time, after which he will be free to make his own decisions as to medical treatment."
The boy turns 18 on January 18 next year, when he will then be able to exercise his right as an adult to refuse further treatment.
http://www.abc.net.au/news/2013-09-27/jehovahs-witness-loses-bid-to-refuse-blood/4985476
This is How Jehovah’s Witness Elders Are Taught to Minister to People with Suicidal Thoughts
ReplyDeleteBy Hemant Mehta, Friendly Atheist February 15, 2014
Suppose you’re religious and your husband dies. And you’re depressed, even a year later. The depression is so bad, in fact, that you’re thinking about committing suicide (by “turning the car on in the garage and just going to sleep inside”) so you can be reunited with him in the afterlife.
So you ask some elders at your church for guidance.
They don’t suggest seeking out professional help.
Instead, they first meet in private to find just the right Bible verses to preach at you. Then they visit your home to tell you how you’re just like Job and how you ought to be an “integrity keeper.” Then they tell you to treat your thoughts of suicide much like you treat thoughts of immorality: by rejecting them entirely (as if it’s just that easy). Then they tell you to repeat the words, “I am an integrity keeper” and memorize some Bible verses to cope with your grief. (“Please find Jeremiah Chapter 29, Verses 11 and 12… will you agree to memorize those two verses?”)
This is what Jehovah’s Witness elders are actually taught to do according to a just-leaked video from the “Watchtower-approved” Kingdom Ministry School. It was sent to blogger John Cedars at JWsurvey, who has posted the video (and a couple of other ones) online:
http://vimeo.com/86598529
Even after watching that emotionless, almost cruel exchange, it’s the last few seconds that may be the most disturbing:
Armed with this outrageous pseudo-psychiatry, Mary excuses herself from the conversation to get some cookies for the elders. The older elder seemingly takes this as a sign that they have done their jobs well and mouths “thank you Jehovah” heavenward as the other elder looks on.
Jehovah’s Witnesses don’t get as bad a rap as other Christian denominations, but these videos, including one about how to properly disfellowship a church member, show just how harmful and petty JW leaders can be.
Jehovah’s Witnesses don’t get as bad a rap as other Christian denominations, but these videos, including one about how to properly disfellowship a church member, show just how harmful and petty JW leaders can be.
http://jwsurvey.org/cedars-blog/doubts-over-organizational-solidarity-as-disturbing-video-on-handling-suicide-is-leaked
http://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_congregational_discipline#Disfellowshipping
If you’re not outraged after watching those videos, there’s something wrong with you.
http://www.patheos.com/blogs/friendlyatheist/2014/02/15/this-is-how-jehovahs-witness-elders-are-taught-to-minister-to-people-with-suicidal-thoughts/
Baby to undergo blood transfusions despite objection of Jehovah's Witnesses parents
ReplyDeleteHigh Court judge agrees to proceedure despite his parents' objections on religious grounds
The Telegraph UK March 3, 2014
A High Court judge has given permission for a baby boy to undergo blood transfusions during an operation notwithstanding his parents' objections on religious grounds.
Mr Justice Keehan had been told by a specialist that the baby - whose parents are Jehovah's Witnesses - had complex heart disease and no ''long-term prospect of survival'' if he did not have cardiac surgery.
The baby's parents had agreed to surgery but said they could not consent to their son - who is a few weeks old - receiving blood.
But Mr Justice Keehan concluded that receiving blood was in the little boy's best interests - notwithstanding his parents' ''understandable objections''.
The judge did not identify the little boy but said doctors at the Birmingham Children's Hospital had applied for an order that surgery could proceed with blood transfusions.
Detail emerged in a written ruling following a hearing in the Family Division of the High Court in London.
''Their objection is on the basis of their religious beliefs as Jehovah's Witnesses and they cannot consent to (their son) receiving blood products during or subsequent to the surgery. I entirely understand and sympathise with the stance of these parents,'' said Mr Justice Keehan.
''Standing back and looking at (the baby's) welfare best interests, I am in no doubt whatsoever that it is in his best interests to undergo the surgery that is proposed.''
He added: ''On the basis that that is my view, it is inevitable that he must receive blood transfusions during the course of or subsequent to the surgery.
''Accordingly, I am again of the view, notwithstanding the parents' understandable objections on religious grounds, that it is in (his) welfare best interests to receive blood products both during the surgery and, if necessary, subsequent to it.''
http://www.telegraph.co.uk/health/10673078/Baby-to-undergo-blood-transfusions-despite-objection-of-Jehovahs-Witnesses-parents.html
Judge rules seriously ill boy 13 can be treated against mothers beliefs
ReplyDeleteTeenager can be treated with blood products against the belief of his Jehovah's Witness mother
By Agencies, The Telegraph UK July 30, 2014
A seriously ill teenager can be treated with blood products even though his mother is unable to consent because of her religious beliefs, a High Court judge has ruled.
Mr Justice Cobb said the 13-year-old boy's mother was a Jehovah's Witness and was not ''happy''.
But the judge gave medics permission to administer ''plasma exchange treatment'' after concluding that without it the youngster's prospects of recovery were slight.
Detail of the case has emerged in a written ruling by Mr Justice Cobb following a hearing in the Family Division of the High Court.
The judge had been asked to make a decision by specialists treating the boy. He did not identify anyone involved.
''This treatment is ... controversial in this case because the mother is a Jehovah's Witness and finds herself unable, by virtue of her religious principles, to consent to this treatment,'' said Mr Justice Cobb.
"Without this treatment, the prospects for (the boy) of recovering very much from where he currently lies is slight.
''In my judgment, and taking account of the risks advised, and the views of his mother, I am nonetheless clearly of the view that it is in (his) best interests that he should receive this treatment and should receive it immediately in order to give him the best possible prospects of recovery.''
The judge said the youngster had been "a fit and healthy boy" last month but had been struck down by a disease which affected his central nervous system.
He said the teenager faced "potentially catastrophic ill health".
Specialists considered plasma exchange treatment as a "gold standard".
He said medics had told the youngster about the possibility of the treatment and he had given a "thumbs up".
The judge said the situation was urgent.
Jehovah's Witnesses say their attitude to blood stems from Biblical teaching.
"Both the Old and New Testaments clearly command us to abstain from blood," says the religion's website http://www.jw.org.
"God views blood as representing life. So we avoid taking blood not only in obedience to God but also out of respect for him as the Giver of life."
The website highlights a number of Biblical references, including passages in Genesis, Leviticus, Deuteronomy and Acts.
http://www.telegraph.co.uk/news/uknews/law-and-order/11001580/Judge-rules-seriously-ill-boy-13-can-be-treated-against-mothers-beliefs.html
Medicine Without Blood
ReplyDeleteHow Jehovah’s Witnesses Are Changing Medicine
BY AMANDA SCHAFFER, THE NEW YORKER AUGUST 12, 2015
This is the first in a three-part series, “Medicine Without Blood,” about the ways that Jehovah’s Witnesses have changed how doctors think about blood transfusion. Read the second and third installments, “Should Anyone Be Given A Blood Transfusion?” and “The Ethics of Bloodless Medicine.”
In the Book of Acts, the apostle Paul urges congregants to abstain “from things sacrificed to idols, from blood, from what is strangled, and from sexual immorality.” Jehovah’s Witnesses, apparently alone among Christian groups, believe this verse, along with others, prohibits them from accepting blood transfusions, no matter how dire the circumstance. As Joan Ortiz, a Witness in her sixties, recently told me, it’s as much a sin to take a blood transfusion as to have an extramarital affair. In this interpretation of Scripture, those who comply will prosper and enjoy good health. Those who don’t can be cut off from their people and denied resurrection. “Everything about us is carried in our blood,” said Ortiz. “Our personality, our sicknesses, all the good things about us. It’s who we are. It’s our soul.” It should not be mixed, even if life depends on it.
Though Witnesses accept virtually all other medical interventions, the stricture against transfusion can affect their care. Patients may need donor blood when they lose their own blood rapidly, as a result of a car crash or surgery, or when they develop severe anemia—for instance, during cancer treatment. In the past several decades, specialty programs in “bloodless medicine” that cater to Jehovah’s Witnesses have grown up at dozens of hospitals.
Surprisingly, doctors’ experience in these programs has often led them to order blood far less frequently for other patients, as well. Some bloodless medicine experts have also helped lead a national movement calling for more sparing use of transfusion. Donor blood comes with risks for all patients, including the potential for immune reactions and infections. And clinical trials have shown that, for a broad range of conditions, restrictive transfusion practices do not lead to worse outcomes than liberal ones. In recent years, the American Medical Association has listed transfusion as among the most overused therapies in medicine.
An institution that has pioneered work in bloodless medicine is Englewood Hospital and Medical Center, in New Jersey. Englewood has long drawn patients from around the country and the world to its specialty program, and it is where, in early March, I met up with Joan Ortiz. By eight o’clock in the morning, she had been prepped for surgery and was waiting anxiously in a gleaming O.R, as staff members disentangled tubing, hung bags of fluid, and prepared to remove a large tumor from her abdomen and spine. A blue and white surgical gown was draped over her small frame. Her dyed-black hair, gathered earlier that morning into a youthful side ponytail, was now loose around her shoulders. Ortiz lives in Florida, but she was born in the Bronx to a Jewish mother and Christian father and she spent much of her life on Long Island. At the age of seventeen she married her first husband, and at age eighteen she began to think seriously about religion. When Jehovah’s Witnesses knocked on her door one day and offered to study the Bible with her, she was receptive to their outreach. As the conversation progressed, she found their textual knowledge compelling, along with the promise that the righteous would live for eternity on Earth. “I never wanted to live up in heaven,” she said. “I didn’t want wings.” Eventually, she was baptized as a Jehovah’s Witness, and then she and members of her new community persuaded the rest of her family to join the religion, too.
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Ortiz had never before been in an operating room. She had, in fact, “never had anything worse than a cold or the flu.” But in January, she had begun to feel a slight pressure in her side, as though she had to go to the bathroom. Over the next few days, the pain intensified and she began to hobble. After consulting with doctors and receiving a CT scan, she was diagnosed with a spinal and retroperitoneal schwannoma, a tumor that arose from a nerve in the spine and ballooned outward into her abdomen. Biopsies showed that it was not malignant, but it had grown unchecked, probably for years, and wrapped itself around nervous tissue, blood vessels, and bone.
ReplyDeleteIn hindsight, Ortiz said she thinks this type of tumor runs in her family. Decades earlier, her mother, who was living at her house, had felt dizzy and lightheaded and hurried to the bathroom. A few minutes later, what looked like “this big huge thing the size of a football dropped out of her and splashed in the toilet and blood shot up everywhere.” Her mother hadn’t known about a tumor, but when it broke loose, “I could just hear the blood running out of her, ‘glug, glug, glug.’ ” She was wrapped in thick black rubber and rushed to the hospital by ambulance, but died shortly thereafter. “She knew there was nothing she could do,” Ortiz said. “She was faithful and loyal. So she said a prayer and went to sleep.”
When Ortiz received the schwannoma diagnosis, she was committed to avoiding her mother’s fate, but said that, like her mother, she would never consider a transfusion. She signed herself in to a hospital in Florida that she believed would be sensitive to her beliefs. The doctors there, however, said that surgery would involve too much blood loss and could not be performed safely without transfusion. At a second hospital, also in Florida, Ortiz was once again turned away. “We have to use blood,” she said a doctor told her, “and if you’re not going to take it we can’t do anything here.” Finally, she reached out to Englewood, which, since the nineteen-nineties, has developed a reputation for performing complex neurological, vascular, and orthopedic surgeries, many of which can involve substantial blood loss, without the use of transfusion. Abe Steinberger, a neurosurgeon who has been treating Witnesses for twenty years, agreed to work with Ortiz. “We’ll just have to be meticulous in the dissection of the tumor and make sure we stop the bleeding before it starts,” Steinberger told her, with brisk confidence. Ortiz decided to travel north.
Still, bloodless medicine requires more than surgical skill, as Steinberger himself also stressed. It rests on a myriad of small precautions and coördinated, blood-saving techniques that begin well in advance of surgery. When Ortiz had pre-operative testing done in Florida, on the advice of a nurse who was familiar with Witnesses, she insisted that the phlebotomist use pediatric tubes and draw the minimum amount possible.
In the O.R. at Englewood, Ortiz lay on her stomach, on a large cushion designed to prevent the compressing of veins, as a young anesthesiologist named Margit Kaufman cheerfully and confidently double-checked the tubes around her. Kaufman first rotated through Englewood in 2012, while completing a fellowship in critical-care medicine. The hospital’s culture of respect for patients’ wishes, borne of its work with Jehovah’s Witnesses, drew her in—as did the skills its doctors had cultivated in caring for these patients. The hospital now minimizes the use of transfusion even in those who do not object to the practice, and who, at other institutions, would be likely to receive blood. Kaufman said that it was almost a year before she transfused a single operating-room patient at Englewood, a stark contrast to her experience during training, where she provided the procedure multiple times per month.
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On Kaufman’s signal, a nurse anesthetist began to draw blood from Ortiz. It was startling, at first, to see rich, maroon liquid flow out of her body and enter the long thin plastic tubes through which it would travel to a collection bag on the floor. But the plan was to keep this blood in reserve, until the end of the operation (or a moment of crisis) when it could be re-infused. In the meantime, a pale fluid, called hetastarch, flowed into Ortiz’s body, diluting her circulation so that when she bled she would lose fewer red cells. Kaufman had promised never to detach the tubing connecting Ortiz’s body to the blood; it would remain part of a supplementary circuit—in her view, never actually “leaving.” (Many Jehovah’s Witnesses object to transfusions of their own blood if it has been stored externally for a prolonged period.)
ReplyDeleteWhen Steinberger made an incision in Ortiz’s back and began to work down to her spine, suctioned blood also flowed into a small device on the floor, called a cell-salvage machine. The blood passed first through a filter, which trapped bits of fat and bone, then entered the reservoir, where a centrifuge spun it to separate out the red blood cells. These were then washed with saline and filtered again, so that they could be returned to the body later on. Typically, the team salvages every possible red cell, even suctioning blood from bits of gauze used at the surgical site, Kaufman told me. “In most O.R.s, they throw all that away.”
Of course, not every case goes according to plan. One older Jehovah’s Witness who underwent surgery at Englewood had severe anemia and died in the I.C.U. when his organs failed, a situation that transfusion might well have averted. “That was very difficult,” said Kaufman, who was directly involved in the case but declined to share other details. “But we had to remind ourselves we were respecting his wishes. Patients have the right to determine their care.” In another case, when Steinberger was operating on a young woman from Louisiana who had a large brain tumor, she began to hemorrhage, and he decided to stop the surgery. He and his colleagues closed her up and waited several weeks, during which time she was treated to build up her red cell count. Then she returned to the O.R. and Steinberger completed the surgery.
By early afternoon, he had disconnected the tumor from Ortiz’s spine, and a second team arrived to work on the portion in her abdomen. “Now if they yank on it, I’m not worried we’ll have a horrendous disaster,” in which her spinal cord would be damaged and might become paralyzed, he said. Operating-room staff turned Ortiz onto her side, and the incoming surgeons positioned themselves on opposite sides of the table and then made a fresh incision. Leaning in, with headlamps nearly touching, they cut through muscle and exposed the bulk of the tumor: a luminous white orb tinged with blood. Eventually, they disentangled it from a phalanx of blood vessels. Lyall Gorenstein, a thoracic surgeon who had been at Englewood for around a year, headed into the doctors’ lounge, visibly relieved. He had performed four or five surgeries on Jehovah’s Witnesses but this had been one of the largest. “It’s very stressful as a surgeon, dealing with a tumor that has the potential for massive bleeding and knowing you don’t have the option of transfusion,” he told me. “It’s like being a trapeze artist with no safety net.”
A few hours later, when Ortiz awoke, she could sit up by herself in a chair. The next day, she was able to stand and take a few steps. The doctors told her she would need to “walk, walk, walk,” which, she joked, is what Jehovah’s Witnesses like to do anyway, going door to door and talking about their faith.
http://www.newyorker.com/news/news-desk/how-jehovahs-witnesses-are-changing-medicine
Should Anyone Be Given a Blood Transfusion?
ReplyDeleteBY AMANDA SCHAFFER, THE NEW YORKER AUGUST 13, 2015
This is the second part in a three-part series, “Medicine Without Blood,” about the ways that Jehovah’s Witnesses have changed the way that doctors think about blood transfusion. Read the first and third installments, “How Jehovah’s Witnesses Are Changing Medicine” and “The Ethics of Bloodless Medicine.”
The United States’ full embrace of blood transfusion began during the Second World War, when large-scale blood donation and mobilization became part of the war effort. “Your blood, as a gift, is unlike money, unlike time or work,” one radio broadcast, titled “Women at War,” announced. It was a gift “to an American soldier or sailor, who may live to save all that you count precious in the world.” One Marine Corps correspondent described the arrival of blood at a medical station in the Pacific: “the wine-colored bottles were held aloft above the prone bodies [of wounded men] and the stuff was doing its miraculous work.” It was the “most precious cargo on this island of agony.” Japanese troops had nowhere near the same access to blood, which only heightened its symbolic power. The Germans, too, were hampered by a refusal to collect from non-Aryans, a policy that “eventually frustrated even their own physicians,” according to the journalist Douglas Starr, whose book “Blood: An Epic History of Medicine and Commerce” details this history.
After the war, donated blood became an integral part of Western medicine. Advances in care, including open-heart surgery, artificial kidney replacements, and trauma work “consumed huge amounts of blood,” Starr writes. Doctors also transfused patients to top off their hemoglobin levels following procedures like tonsillectomies, appendectomies, and even childbirth. Yet, in the thrall of wartime transfusion, blood had never been treated like an experimental drug and subjected to rigorous, randomized clinical trials assessing risk and benefit. Its power was intuitive. Doctors observed that patients with anemia seemed to feel better following transfusion. “The patients looked rosy and felt full of energy,” one older doctor told me. No one was thinking yet about adverse effects.
This made it difficult for Jehovah’s Witnesses who developed anemia or needed major surgery. The religion’s governing body had decided that passages in the Bible, which instruct adherents not to consume blood, meant that they should avoid transfusion. The mixing of blood seemed to them a form of existential contamination. Yet most Witnesses still wished to receive medical care. And “in some doctors’ minds, there was confusion,” Zenon Bodnaruk, of Hospital Information Services at the Jehovah’s Witnesses’ world headquarters, in Brooklyn, told me. Some doctors believed that the religious objection to blood transfusion was tantamount to a refusal of care. One frequent scenario involved patients with heart disease who needed coronary-artery bypass grafts or cardiac-valve-replacement surgeries, both of which involved substantial blood loss and were nearly always accompanied by transfusion. Jehovah’s Witnesses were repeatedly turned away by cardiac surgeons or “asked to reconsider their religious position on blood,” Bodnaruk said.
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Still, a small number of doctors were willing to accommodate requests for bloodless treatment. In the late nineteen-seventies, Watch Tower leaders decided to cultivate relationships with these physicians. In the late eighties, the governing body approved a large-scale effort to help Witnesses find sympathetic care, according to Bodnaruk. In the early nineties, one of the institutions that Witnesses contacted was Englewood Hospital and Medical Center, in New Jersey, which welcomed them. Aryeh Shander, a voluble, grandfatherly man who was then the chief of anesthesiology at Englewood, became an important advocate for their cause. His empathy for religious minorities was strong, he said, because his mother was a Holocaust survivor and had impressed on him the importance of “always looking out for human rights.” At the same time, he had developed an academic interest in blood transfusion, which he believed, based mainly on intuition, was overused in surgery. There wasn’t any real evidence yet to prove him right or wrong.
ReplyDeleteFrom the beginning, the bloodless program at Englewood enjoyed anecdotal success. In small observational studies, the witnesses’ surgical outcomes seemed to match those of other patients undergoing the same procedures. By the late nineteen-nineties, Shander and his team were committed to applying the lessons of bloodless medicine to non-Witness patients. Englewood was not alone in this experience. Numerous bloodless-medicine programs had sprung up around the same time in the United States, thanks to the Jehovah’s Witnesses’ advocacy.
Meanwhile, the prevailing attitudes toward blood had grown more fraught, in the U.S. and elsewhere. Since the late nineteen-sixties, when patients with hemophilia began to use clot-promoting proteins that were derived from large pools of donor blood, they had been vulnerable to infection, especially hepatitis. In the early eighties, however, with the emergence of AIDS, risks soared. Before the development of an H.I.V. screening test for donors, in 1985, almost half of all hemophiliacs became infected with the virus.
Lawrence Tim Goodnough, who is now the director of the transfusion service at Stanford Medical Center, was a fellow in hematology oncology just as the H.I.V. epidemic began. His experience with hemophiliacs, in particular, inspired in him a lifelong interest in reducing patients’ exposure to blood. “I was not coming primarily from a Jehovah’s Witness point of view,” he said. But as bloodless-medicine programs developed, in the late nineteen-eighties and nineties, he found that the clinicians running them made natural bedfellows. Their experience was “key to showing how often you can get patients through complex hospitalizations, surgical and medical, without blood transfusions.”
In 1999, the first strong evidence to validate this perspective emerged. In arandomized controlled trial published in the New England Journal of Medicine, Canadian researchers found that more restrictive blood-transfusion practices could often be just as good for patients—or better. Interestingly, the lead researcher, a critical-care specialist named Paul Hébert, had expected to demonstrate just the opposite. He and his colleagues enrolled more than eight hundred critically ill patients in intensive-care units. These patients were not actively losing blood, but they suffered from anemia, a problem in which the blood lacks sufficient hemoglobin and struggles to transport oxygen through the body. Hébert and his team randomly assigned them to receive red-blood-cell transfusions either on a liberal or restrictive basis. After thirty days, the two groups had equivalent mortality. Among patients who were younger than fifty-five or who had less severe conditions, the probability of death was actually lower for those treated under the more restrictive guidelines.
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At first, Hébert said he did not believe the results. But over the years, his work has been recognized as “one of the landmark papers in transfusion medicine,” according to Courtney Hopkins, the Chief Medical Officer of the American Red Cross’s eastern division. Numerous other randomized controlled trials have confirmed his core finding, as well. Researchers have compared restrictive and liberal transfusion strategies in critically ill children. They’ve also studied adults with septic shock, gastrointestinal bleeding, and traumatic brain injury, and those undergoing high-risk hip surgery. These papers have either found no difference between the two groups or have found better outcomes in those receiving less blood. (One exception has been patients with acute coronary events, such as heart attacks, for whom the evidence is mixed and may support more liberal transfusion, Hébert said.) Most physicians conducting this research have not worked in programs for Jehovah’s Witnesses. But the Witness community has taken note. So too have leaders of bloodless-medicine programs, many of whom are passionate advocates for reducing transfusion whenever possible. (The Society for the Advancement of Blood Management, the first national organization dedicated to this goal—founded by Shander, Goodnough, and others—has played a key role in disseminating best practices regarding patients’ blood.)
ReplyDeleteHospital administrators have also zeroed in on the emerging evidence, because it allows them to cut costs associated with transfusion. “Maybe it was the great recession or maybe the winds of health reform,” Goodnough said, but since around 2009, an increasing number of hospitals have established programs dedicated to using blood more conservatively. From 2008 to 2011, the last year for which national data are available, transfusion in the U.S. decreased by more than eleven per cent—and, according to the American Red Cross, that trend has continued. Even blood bankers have joined the chorus; their major professional organization in the U.S, the American Association of Blood Banks, now sponsors workshops that teach techniques like boosting red blood cells before surgery, avoiding unnecessary blood draws and recycling blood cells to patients during procedures. “I’m teaching providers to use less of the product we sell,” Dr. Hopkins of the Red Cross said, “but that’s because we want to do what’s best for patients.”
From a medical standpoint, restricting transfusion may be helpful for a range of reasons. When red blood cells are stored, they become more rigid and undergo chemical changes that make them less efficient at carrying oxygen. (And, when doctors know that they won’t be able to transfuse, they may work harder to build up blood-cell counts and avoid squandering cells.) The extent to which transfusion may cause further, low-grade risks is hard to assess, since subtle harms—as well as subtle gains—can easily go unrecognized in patients who are already critically ill. For reasons that are not entirely clear, donor blood can suppress recipients’ immune systems, or it can trigger overactive immune responses, thanks to the waste products the cells secrete. A bag of blood that’s been sitting in storage is “like a dirty fish tank you haven’t cleaned in a month,” Patricia Ford, a hematologist at Pennsylvania Hospital, told me. And of course, while the risk of H.I.V. infection is now extremely low in the developed world, proponents worry about new pathogens.
This isn’t to say that transfusion is useless—just that it’s not nearly as useful as people used to believe. “I firmly believe that transfusions save lives,” Hébert said. “I transfuse in my practice all the time, just a little less than I used to.”
http://www.newyorker.com/news/news-desk/should-anyone-be-given-a-blood-transfusion
The Ethics of Bloodless Medicine
ReplyDeleteBY AMANDA SCHAFFER, THE NEW YORKER AUGUST 14, 2015
This is the third in a three-part series, “Medicine Without Blood,” about the ways that Jehovah’s Witnesses have changed the way doctors think about blood transfusion. Read Parts One and Two: “How Jehovah’s Witnesses Are Changing Medicine” and “Should Anyone Be Given a Blood Transfusion.”
Pennsylvania Hospital, in downtown Philadelphia, was Colonial America’s first hospital, founded in 1751 by Benjamin Franklin and the physician Thomas Bond. For much of its history, the hospital’s staff treated conditions from pneumonia to gangrene and headaches with aggressive bloodletting, a practice that may have originated in ancient Egypt, and that persisted for millennia, despite the scarcity of evidence that it cured patients of disease. Benjamin Rush, who was a co-signer of the Declaration of Independence and practiced at Penn Hospital in the late eighteenth and early nineteenth centuries, was known by colleagues as the Prince of Bleeders. His enthusiasm arose from the belief that “all disease arose from excitation of blood vessels, which copious bleeding would relieve,” according to the author Douglas Starr. “If the patient fainted, so much the better, for it meant that the harsh measures were taking effect.” During the yellow-fever outbreak of 1793 in Philadelphia, Rush reportedly treated more than a hundred patients a day with bloodletting; years later, the provost of the University of Pennsylvania recalled that “his house was filled with the poor whose blood, from want of a sufficient number of bowls, was often allowed to flow upon the ground.”
Widespread blood transfusion, by contrast, is less than a century old. Yet it, too, was popularly adopted without rigorous testing of when, exactly, it benefitted patients. Just as early practitioners accepted the virtues of draining blood away, most mid-twentieth-century doctors took it on faith that infusing more was better. On a warm Saturday in April, however, more than a hundred Jehovah’s Witnesses gathered in the auditorium at Penn Hospital to learn about a program in bloodless medicine, in which patients choose to forego transfusion under all circumstances, and instead receive, in the course of their care, a range of treatments designed to build up their own red-blood-cell counts and painstakingly conserve as much of their blood as possible.
Jehovah’s Witnesses object to transfusion because they believe that scriptural passages forbid it. But the attendant reasoning—that an individual’s singular qualities, life and soul, are carried in blood—does not fall so far outside of the mainstream imagination. When we get hurt as kids, the first thing we notice is whether it’s bleeding. Blood rushing down an arm or a leg is a badge of honor. But blood also gives us away, revealing embarrassment when it rushes to the face, or lust when it rushes elsewhere. If we are sick or pregnant or dying, the proof is in our blood, more often than in our sweat or tears or spit. If we don’t know what’s wrong with us, we expect our blood to provide an answer. Blood symbolizes murder, birth, passion, danger, and conquest, as when hunters drink from a slain animal. Martian blood is never red like ours. Vampires can’t survive without sucking the lifeblood from people. In movies, when a drop of blood trickles from a wounded hero’s nose we know he is about to keel over. Blood is how we learn what our bodies can and cannot take.
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Patricia Ford has led the bloodless-medicine program at Penn since 1998. She is a hematologist and an oncologist with a round face, sandy hair, and a neighborly smile. Before an attentive crowd of Witnesses, she took the stage wearing a white coat with a stethoscope around her neck. She was on call that weekend, and her pockets bulged with notes on pink index cards about the patients upstairs. From early in her career, when she did volunteer work with Jehovah’s Witnesses, Ford began to notice that anemic patients who might otherwise have been given donor blood seemed to do “just fine” without it. About a decade ago, when she and her colleagues matched bloodless and other patients treated at the hospital by diagnosis, they found similar rates of survival, with the bloodless patients leaving the hospital, on average, a day sooner. (Ford’s data did not include trauma victims, because Pennsylvania Hospital does not have a trauma center.) Still, Ford soon became convinced that non-Witness patients received donor blood more often than necessary. She began to apply techniques she’d honed on Witnesses, and the number of transfusions she ordered dropped almost ninety per cent.
ReplyDeleteFord is perhaps best known for the work she does performing stem-cell transplants without transfusion. These interventions, which we used to call bone-marrow transplants, have long been given to patients with advanced forms of blood cancer—but always, traditionally, with donor blood. That’s because patients first undergo high-dose chemotherapy, which leaves them unable to produce blood cells of their own for several weeks. On stage, Ford told the audience about the first Jehovah’s Witness to approach her, early in her career, in need of this treatment: a thirty-year-old man with relapsing lymphoma. A stem-cell transplant was his only chance of a cure; without it, she believed he would die in a matter of months. “I didn’t know if anyone could survive the procedure” without a transfusion, Ford told the audience. The patient, however, was committed to moving forward without one, and, remarkably, he seemed to do well. He was in and out of the hospital in two weeks. “No complications, full recovery,” Ford said.
Word spread in the Witness community, and a few months later a twenty-one-year-old woman with Hodgkin’s lymphoma came to Ford in need of the same procedure. This time around, however, she died, “definitely of profound anemia,” Ford said. Blood transfusion might have helped. At first, Ford and her colleagues decided to stop offering stem-cell transplants bloodlessly. But then the young woman’s parents came into the hospital and urged them to reconsider. They believed that future patients could still benefit from this work, and appreciated that their daughter, who would have refused any transfusion even if she knew it would save her life, had at least been given a chance.
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Ford was persuaded. She believed that she could do better with experience, and she has. She now boosts patients’ red-blood-cell counts aggressively in advance of transplant, using drugs called erythropoiesis-stimulating agents. To date, Ford has performed more than a hundred and thirty stem-cell transplants on Jehovah’s Witnesses and, in early April, she published a summary of her results, showing a mortality rate of six per cent. This is still higher than the national mortality rate for this procedure, which she cited as between one and 3.5 per cent. (For her non-Witness patients, some of whom she treats with transfusion and some not, depending on the specifics of the case, her over-all mortality rate is on par with the national figures.) She has had no deaths in either Witness or non-Witness patients for stem-cell transplants since 2010. Still, those who refuse to allow for transfusion under any circumstances may pay a price, even in Ford’s hands.
ReplyDeleteThis raises a dilemma that she quickly acknowledges. In general, it would be unethical to offer substandard care to a particular group. That possibility seemed especially unsettling, since the vast majority of those listening to Ford’s speech, who represented prospective patients or former ones, were African-American. Yet Ford has cared for patients in accordance with their wishes: if treatment were not given without transfusion, most Jehovah’s Witnesses would opt out, she said. “Adult patients have the right to accept and decline the things that we, as physicians, offer, and we need to respect that.” Aryeh Shander, of Englewood, offered a more clinical comparison: “If a patient is allergic to antibiotics, you don’t sit around saying, If only we could give her penicillin. You get on with it and hope some good will come.”
The situation is more complicated when it comes to minors. In Ian McEwan’s novel “The Children Act,” a judge must decide whether to insist upon transfusion for a seventeen-year-old Jehovah’s Witness who has leukemia and who cannot receive two critical drugs without also accepting donor blood, according to his doctors. The judge visits the frail boy in the hospital, where he is writing poetry and learning to play violin. He is mature and articulate in his refusal of blood. Yet the judge concludes that he has experienced only an “uninterrupted monochrome” view of life, and that his welfare would be better served by not dying. (As the boy receives his transfusion, his parents, who have testified to their acceptance of religious dogma, weep openly, and he realizes they are weeping with joy.) Bloodless-medicine leaders at Penn Hospital and Englewood said that they had never faced a situation in which a Witness child needed a life-saving transfusion against the wishes of the parents. But if such a case arose, they would be obligated to get a court order, according to Pennsylvania and New Jersey state law.
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Watchtower leaders still talk about a case from the nineteen-seventies, in which a hospital in Canada collided with a witness family. In that case, a baby was born with severe jaundice resulting from a condition that causes the destruction of red blood cells. The treatment at the time was to exchange the child’s blood through transfusion. The parents, however, refused; they wanted to try light therapy, which was then experimental, though it has since become the standard of care. When it became clear that the doctors were going to get a court order to require transfusion, the parents, according to lore, smuggled the newborn out of the hospital and drove to another institution, where light therapy was available. Apparently, after the child was exposed to sunlight for several hours in the parents’ convertible, by the time the family reached the second hospital the jaundice had substantially subsided.
ReplyDeleteIn other cases, however, the outcome is less miraculous, and the ethical handwringing persists. The story of a twenty-eight-year-old patient, who was admitted to an Australian hospital in 2008, has reverberated throughout the Witness and bloodless-medicine communities. The patient suffered from advanced leukemia, like the boy in McEwan’s novel. She was also seven months pregnant. In keeping with her faith, she refused transfusion, although she was severely anemic and had low platelet counts. The staff debated whether to deliver the fetus by C-section, but believed the mother would bleed to death during the procedure without donor blood (and might otherwise have a chance of survival). Eventually, the fetus died in utero. The mother proceeded with a stillbirth, then had a stroke, went into multi-organ failure, and died, as well.
In a letter to the Internal Medicine Journal, her physicians grappled with these two “ ‘avoidable’ deaths.” “Not administering blood products in this case undoubtedly contributed to the death of mother and fetus,” they wrote. Although “competent adults may refuse any form of medical intervention—even where that intervention is lifesaving,” the case raises thorny questions about what happens when the wishes of a pregnant woman interfere with the well-being of her fetus. As the woman’s doctors told the Sydney Morning Herald, the case was profoundly unsettling because they “rarely see people die or make a decision that will hasten death.”
Yet the right to die on their own terms has meaning for Jehovah’s Witnesses—as does each story of medical success. Joan Ortiz, who is now at home in Florida, after her bloodless surgery to remove a tumor from her abdomen and spine, said that her experience “is building others’ faith” in her congregation. For a time, she walked slowly, afraid that her stitches would pop. She wore flats instead of heels and struggled with a swollen stomach. But now she’s back to a full exercise regime and, later this summer, she hopes to present her story to thousands of listeners in a religious assembly.
When asked about the Australian case, she said, “Oh, honey, please don’t be sad for her. The two of them will be resurrected, and she’ll get to see her new baby, and neither one of them will have that leukemia.”
“This sister has more of a hope to live in the new world than I do,” she added. “Because I still live here and I could make mistakes.”
http://www.newyorker.com/news/news-desk/the-ethics-of-bloodless-medicine
When A 14 Year Old Chooses To Die Because Of Religion Can Anyone Stop Him?
ReplyDeleteBy ISOLDE RAFTERY • KUOW 94.9 FM | Seattle News & Information NOVEMBER 4, 2015
The first time I interviewed Dennis Lindberg, he was alone on a weekday evening. He had just turned 12, and he had set out Saltine crackers on a paper towel and poured me a glass of tap water.
He sat up straight on the couch and folded his hands in his lap. “What questions may I answer?” he asked. He was polite, tall for his age, with light blue eyes and acne scattered across his nose.
I was a reporter in Mount Vernon, Washington, and I was interviewing Dennis because he had written a moving essay that his teacher had shared with me. For two hours, I asked him painful questions about the first nine years of his life, which he had spent with his parents. They lived in Idaho, were often homeless and were addicted to meth. Dennis wrote of finding needles in the toilet.
At the end of the interview, he jumped from the couch and led me to an alcove in his bedroom where he kept letters from his parents. That intimate moment showed how much he missed his parents despite their flaws.
After that story was published in the Skagit Valley Herald in 2005, Dennis asked me to write about him again in five years. He wanted readers to know he had turned out OK.
A decade later, I am late to that promise, and the story that follows is not what Dennis had in mind.
No Blood: Nov. 28, 2007
Walking into the Skagit County courthouse on a rainy November morning in 2007, Judge John Meyer realized his case had hit the news.
TV vans idled outside and middle school students huddled inside, many in tears. These were friends of Dennis, a 14-year-old so committed to being a Jehovah’s Witness that he refused blood that could save his life.
Dennis had been diagnosed with cancer three weeks earlier. He had a 75 percent chance of living – but only if he accepted blood transfusions to get healthy enough to undergo chemotherapy.
When Dennis said he wouldn’t take blood, doctors and lawyers at Seattle Children’s Hospital agreed he could refuse transfusions, even though it meant he would die.
Meyer, a lanky man in his 60s, had been assigned the case the day before. As far as he could tell, this had never happened before in Washington state.
Doctors in Washington state must respect young teens’ medical decisions – but only if they believe they are mature enough to understand the consequences. It’s a judicial doctrine that has been in place since 1967 and that has expanded to allow trans teens to take hormones and girls to get abortions without telling their parents.
But does it mean teens can also choose to die? Dennis’s case highlighted how little guidance accompanies the mature minor doctrine in Washington state – there is no protocol for determining if a teenager is mature.
Nor does the doctrine demand that hospitals seek outside input, which means doctors decide if a minor is mature. In similar cases in other states, doctors have dodged this dilemma by saying the child wasn’t mature enough or by punting cases to the courts.
Seattle Children’s ultimately did call the state at the eleventh hour when a hospital administrator got involved.
That put Meyer in a tough situation; it meant he alone would decide Dennis’s fate. At the time he said the mantle of his black cloak had never felt so heavy.
Funny And Confident
Dennis wasn’t born a Jehovah’s Witness.
He spent the first years of his life zigzagging the country with his parents. As a toddler, he wandered the halls of the motels they lived in, knocking on doors, looking for company. At 4, he ran around an apartment complex with older kids, lighting fires and jumping off Dumpsters.
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The summer before fourth grade, a neighbor called his aunt Dianna Mincin in Mount Vernon and issued an ultimatum: If she didn’t pick up her nephew, she would call the state’s child protective services. Mincin wasn’t surprised; she had taken care of her nephew before. That day, Mincin got in her car and headed for Idaho.
ReplyDeleteDennis adapted well to his new life in Mount Vernon, a farm city an hour north of Seattle. Mincin taught him to brush his teeth and encouraged him as he learned to read. She immersed him in the Jehovah’s Witness faith, connected him with mentors and brought him to the nearby Kingdom Hall. On Saturday mornings, Dennis donned a suit and tie and proselytized in the area.
At school, he started a friendship club for new kids. He was popular and considered the best football player in his class. He could be found biking and skateboarding in the evenings, chatting with retirees in the neighborhood.
In the sixth-grade musical, Dennis was Baloo, the bear from “The Jungle Book.” In one scene, he shimmied around the stage in a coconut-shell bra. He was funny and confident. He stole the show.
When Dennis asked if he could call Mincin “mom,” she gently said no. He had a mother, she said. When he asked to be baptized as a Jehovah’s Witness, she resisted. He was so needy, she told me later, so eager to please. She worried that he was seeking social, not spiritual, acceptance.
In seventh grade, Dennis convinced Mincin that he was ready.
And so, at 13, Dennis was baptized. The same day, he signed what Witnesses call a “blood card,” saying he would refuse blood. Around this time, Mincin became his legal guardian. His parents said they believed it was a temporary arrangement so that Dennis could cross the nearby border to Canada for a religious convention.
Six months later, Dennis found himself out of breath playing football. His doctor ordered tests and within a day sent him and Mincin to Seattle Children’s Hospital.
Mincin, in school to be a nurse, feared the worst when she saw the results of his blood tests. Before climbing into the family’s beige SUV, she photocopied Dennis's blood card. She had used her own card that summer after losing blood during hip surgery. She was recovering slowly and using a cane to walk.
At the hospital, tests revealed that Dennis had acute lymphoblastic leukemia, a type of bone marrow cancer. When told he would need a series of blood transfusions, Dennis fell silent.
Mincin spoke instead. Dennis would refuse blood, she said. A hospital social worker wrote that “the family was open and wonderful to work with.”
“It was a lot for me as a single mother to have to confront,” Mincin told me later. “I had two daughters who were looking at me and how I was handling the situation. Their spiritual lives were at stake.”
Jehovah’s Witnesses became adamant about refusing blood around 1945, when blood banks were established in Chicago and San Francisco.
Elders at the Watch Tower Society in Brooklyn pointed to Genesis 9:4, which condemns cannibalism, and Leviticus 17:10, which says, “I will set my face against that soul who eats blood and will cut him off from among his people.”
Not that it’s been uniform. Some Witnesses say they would take fractions of blood but not whole blood or specific parts – plasma, platelets, red blood cells or white blood cells. Others accept organ transplants.
Doctors hear mixed messages as well. One pediatrician told me, “Their worst nightmare is that you’ll take them at their word, and you won’t transfuse their baby.”
Mincin assumed Children’s would ignore their wishes. So she was surprised when a hospital social worker told her that Dennis, having just turned 14, could be considered mature enough to make his own decisions.
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Years later, Mincin recalled what went through her mind: “I knew I was helping him to actually die. It was awful. But the other option was more horrifying. To abandon Dennis in his strong conviction to uphold Bible principles as we understand them and allow transfusions to be forced upon him, would have killed him in so many other ways.”
ReplyDeleteMincin had been a fighter her whole life, often picking up the pieces for her family. She saw the sad irony of her current situation: She had rescued her nephew, and here she was, now fighting for him to be allowed to die.
Then again, she told me, 14-year-old girls in Washington state can have an abortion without parental consent. Teens may volunteer themselves for medical experiments, check themselves into psychiatric wards and, if they’re parents themselves, make decisions for their babies.
So why couldn’t Dennis refuse blood?
In Washington state, even young teens can be considered mature. The policy at Children’s – one of the biggest and most cutting edge children’s hospitals in the nation – is to respect “the wishes of patients and families regarding medical care whenever clinically appropriate.”
A few years after Dennis died, I reached out to Dr. Douglas Diekema, a senior ethicist at Seattle Children’s.
Although Diekema wasn’t involved in Dennis’s care, he said he believed Dennis was too young to make such a grave decision. Brain research shows that most of our decision-making is driven by the emotional side of our brains. In teenagers, that’s even more pronounced, because teen decision-making relies more on mid-brain structures, or the socio-emotional part of the brain, than adult decision-making.
Diekema had a 14-year-old daughter and he knew that social life might trump physical life for teenagers. He also knew of teens who refused chemotherapy because they didn’t want to go bald – they would rather die than wear a wig.
“If you allow the adolescent to establish that they are a very mature person and they’ve listened to everything we’ve said, and they understood that they may die, you’ve missed the fact that the main factor that’s driving this decision is that they’re going to lose their hair,” he said.
Given Dennis’s rough start in life, Diekema said he wondered if Dennis was refusing blood to maintain his relationship with his aunt and his standing in a church community that provided him social support and nurture.
“He may not feel as obligated to make that same decision when he’s 30,” Diekema said.
'Dianna, Don't Do This' (Week 1)
Soon after Dennis was admitted to the hospital, friends at their Kingdom Hall started a blog on Caringbridge, a site for patients and their families. Mincin, always open about her family, embraced the blog.
The Caringbridge site inspired nearly a thousand comments, many from supportive Jehovah’s Witnesses. It also had another effect, one Mincin had not predicted: It gave Dennis’s parents and grandmother from Florida a better view into Dennis’s hospital room.
Dennis’s parents were still struggling to get on their feet. They had spoken with Dennis several times since he was admitted to the hospital, but Mincin had asked them not to talk about his treatment. She said it would aggravate his enlarged heart.
Olga Lindberg, Mincin’s mother, ran a cleaning business in St. Petersburg, Florida. For her, the Caringbridge site was terrifying.
“Dianna, don’t do this,” Lindberg said she shrieked into the phone. She had a thick, German accent.
“Little Dennis is your brother’s only son. If you let him die, you die along with him, because I will no longer have a daughter.”
Until then Lindberg, a Baptist, had tolerated her daughter’s adopted faith. Now she thought of her daughter as a murderer.
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One afternoon, Lindberg said, she called the oncology ward to speak with Dennis. The nurse who answered the phone told her that Jehovah’s Witnesses sat with Dennis day and night. The nurse said she had heard a Witness tell Dennis that accepting blood would make him unclean.
ReplyDelete“Mrs. Lindberg,” the nurse said, “I’m telling you this because I’m a grandmother, and what they’re doing to your grandson is unforgivable.”
Ethics Report: Nov. 9
Three days after Dennis arrived at the hospital, a Children’s medical ethicist came to his room. It is Children’s practice to call in a medical ethicist in complicated cases.
Dr. David Woodrum, also a veteran pediatrician, met with Dennis alone and told him that he would be given blood if a synthetic alternative failed. Dennis, serious and polite, said blood would compromise his faith.
In his report, Woodrum wrote that Dennis was mature but that he seemed flexible. When a doctor said she would give blood if alternatives failed, Woodrum wrote, “Dennis and family did not voice refusal but instead stayed silent.”
“Up until a certain point, people had the idea he could be convinced to accept a blood transfusion,” Woodrum told me later. “This was a horrible experience for the clinical team.”
During his tenure at Seattle Children’s and the University of Washington, Woodrum had numerous patients whose parents said they would refuse blood for their children. But those had been babies, protected by the courts because they don’t have a voice; teenagers are different. Short of restraining Dennis, there was little doctors and nurses could do if he refused blood, he said.
Diekema agreed that he wouldn’t restrain a teen. But he said he would have pushed harder than his colleagues.
“I would have brought the blood into his room, and I would have hung it, and I would have hooked it up,” Diekema said he told the care team after Dennis died.
“If he had allowed me to do that, I would have just done it,” he said. “I would have told him that I’m sorry, and I would have apologized to him, and I would have told him that, ‘I know this disrespects what you want, but I can’t let you die.’ And if he had accepted that, I would have done it.”
Bearing Witness
Mincin worried that Dennis’s sweet demeanor was giving doctors the impression that he wasn’t steadfast. Even some Witnesses seemed soft on refusing blood.
She had noticed a man from their congregation, one of Dennis’s mentors, coaching Dennis on how to graciously accept a blood transfusion, should it come to that.
Another elder told her to prepare for Dennis to be transfused. Visualize Dennis receiving blood, he said, the bag of blood hanging by his bed, the line going into his arm.
The thought made her nauseous.
“(Elders) told me to comfort Dennis and that there was nothing the hospital could do because he was a minor,” Mincin told me by email. “I had to prove to them, because Dennis wanted me to, that he was a mature minor.”
She said she decided to read Dennis a Bible passage on fierce resistance.
She said that when she finished, he turned to her and said, “I understand, Aunt Dianna.” His hands had grown cold, his breath turned short, but he said he would fight a transfusion with all his remaining strength.
Growing Weaker (Week 2)
Two weeks after Dennis was admitted, Dr. Douglas Hawkins took over as Dennis’s doctor. Hawkins, then in his mid-40s, is currently the associate division chief of hematology/oncology at Children’s.
His patient was gaunt, and his heart had weakened from anemia. The synthetic blood had failed. Dr. Hawkins insisted that Dennis needed a packed red blood cell transfusion within two days.
Hawkins told Dennis that he was in a difficult position. He wanted to honor his patient’s wish but said that he would die without a transfusion. Hawkins said he would confer with Children’s in-house lawyers later that day.
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Mincin believed the hospital would force a transfusion. But the next morning, Hawkins delivered the news to Dennis: Dennis could make his own medical decisions.
ReplyDeleteDennis cried and said he felt respected. He said he wanted to spend his remaining time at Children’s as a hospice patient.
That day, Mincin started a blog entry with one word: “Victory!”
But the next day, the day before Thanksgiving, a Children’s administrator directed the hospital social worker to call the Department of Social and Health Services, the state agency in charge of child welfare.
“Administration asked social worker to make a CPS referral to cover all bases and to cover the aunt,” a state caseworker wrote.
At the same time, Hawkins, unaware the state had been called, met with five senior oncologists to discuss Dennis’s case. The doctors unanimously agreed that Dennis had the right to die. They believed that if a 14-year-old could so clearly express his position, then he deserved to have that position respected.
“We owe respect to a 14-year-old,” Hawkins would later tell Judge Meyer.
“In the past I have favored parents, and I’ve always regretted it,” Hawkins told the judge. “I believe we give parents rights because they speak for their child, but at some point that right transfers – we all agree that happens at 18, I guess – but it seems that we owe them some respect before 18.”
If the judge ordered a blood transfusion, Hawkins said, he would want “specific instructions about what to do.”
“Dennis has said if we were to compel a blood transfusion, he would do everything possible to fight us,” Hawkins said.
“Right now I don’t think he’s conscious enough to do that. He doesn’t have enough energy to do that. But as we gave him blood, he would recover and regain strength, and you would have to tell me – would you want me to put him in restraints or to sedate him? I would have to do this repeatedly. That for me is very difficult to do with a 14-year-old.”
Week 3: Thanksgiving
Hawkins would not speak with me for this story.
His notes are clinical but also heartbreaking as the doctor summarizes his conversations with Dennis, urging him to change his mind, while documenting the boy’s physical decline.
Woodrum, the ethicist, summed up those notes in medical terms: “Day after day after day, the hematocrit” – volume of red blood cells – “would go from 14 to 13 to 10." It got to 5.4. Normal for a teen boy is 45.
On Thanksgiving Day, Hawkins tried again.
He asked everyone to leave Dennis’s room. It was the first and only time he would speak with Dennis alone.
“I wanted to make sure that there was no one in the room who could potentially be influencing him,” Hawkins testified. “We talked for about 15 minutes alone. I told him that without blood transfusions he would die.
“He said, ‘I understand that. I do not want to be treated if the requirement is that I would have to take a blood transfusion.’”
Dennis wore boxer shorts, a white T-shirt and socks – gifts from Witnesses in his first week at the hospital. His skin had yellowed from anemia, and he could barely sit or use his bedpan.
His hand tingled and his nostrils felt dry. His heart swelled. They could turn this around, Hawkins said. Dennis still had a 70-percent chance of survival with treatment.
Heart-shaped balloons were tied to Dennis’s bed, drooping for want of helium. Mincin had bought them, believing they might inspire Dennis to produce red blood cells.
That afternoon, about 30 Witnesses from congregations in the Pacific Northwest visited Dennis. When they left, Mincin read him passages about strong characters from the Bible.
Like Jesus, Mincin said. Jesus was willing to sacrifice his life for his beliefs.
'I Should Follow My Faith'
Lindberg kept calling.
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Not Mincin anymore – her daughter wasn’t taking her calls – but to anyone else who might be able to give her a voice.
ReplyDeleteShe remembered Teresa Vaughn, Dennis’s fifth- and sixth-grade teacher. Vaughn had been reading the Caringbridge site and was also worried. Dennis was one of her favorite students.
Lindberg spoke with Vaughn, who said she would visit Dennis and report back. On the Saturday after Thanksgiving, Vaughn drove down to the hospital.
When she walked into the hospital room, Dennis was curled in a fetal position on his bed. Anxiety had kept him awake the two previous nights, and the nurses had given him drugs to sleep.
Ten Witnesses were in the room. Vaughn asked them to leave.
“Do you know these people?” she asked Dennis. He shook his head, no. They were there to support him, he said.
She looked around the curtain and saw the head of the Mount Vernon Kingdom Hall seated quietly on the other side. Vaughn glared at him. “Could you give us some privacy?” she said.
Alone with his teacher, Dennis said that if he were to die, he might be among the 144,000 believers and nonbelievers chosen to spend eternity in heaven with Jehovah. He believed that only the meek and those who followed God’s direction would endure, and he thought he stood a good chance.
“Dennis, you are a child,” Vaughn recalled telling him. “You do have an old soul, and 10 years from now, you can be pissed at me, but you have a lot more living to do.” She lowered her voice and nodded toward the Witnesses outside his room. “If they told you to take a blood transfusion, would you?”
Vaughn thought Dennis looked confident, almost smug.
“I know that you and a lot of other people want me to have the treatment,” he said, “but more people think I should follow my faith.”
A Witness entered to say Dennis needed rest. On her way out, Vaughn pulled Mincin aside in the hallway. “You can’t let him die,” she said.
“It’s not up to me,” Vaughn recalled Mincin saying. “This is Dennis’s decision.”
On the drive home, Vaughn cried. She was baffled the hospital hadn’t intervened. She wondered if Mincin would stand to watch one of her daughters die. It was a thought others had shared privately – would a mother defend her child’s right to die?
Big Dennis And Rachel
Olga Lindberg called her son, “Big Dennis” Lindberg, and Dennis’s mother, Rachel Wherry, in Idaho. Get to Seattle now, she said. Olga Lindberg believed that doctors might force treatment if they knew Dennis’s biological parents opposed his decision.
Wherry was short and raven-haired – Dennis had described her to me years before as fragile – and his father was a lumbering man whose voice was so gravelly it was sometimes hard to understand him. When I knew Dennis, he often showed me his father’s photo, which he kept in a worn leather wallet.
Big Dennis Lindberg started randomly calling agencies in Washington for guidance. The next morning, he got through to DSHS, and within hours, he and Rachel were on a plane to Seattle. The state paid the bill.
By then, high-level administrators at the Department of Social and Health Services had made up their minds to go to court.
They wanted to find out whether Mincin was Dennis’s legal guardian. They also appeared concerned that Dennis hadn’t received a psychological evaluation. “Psychology had declined as they do not have the tools for such an assessment,” a state caseworker wrote.
The state resolved to ask a judge to order blood transfusions and assess Dennis’s case when he was healthy enough to testify.
'Everyone Is Torn'
It was the Tuesday after Thanksgiving, and Judge Meyer was working against time at the Skagit County courthouse.
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Hawkins speaking by phone from the hospital, told the judge that Dennis would likely die that night or the next day.
ReplyDelete“Everyone is torn by this case because we all want Dennis to live,” Hawkins told Meyer. “If you polled nurses and physicians in training, some of them might feel that we should compel a blood transfusion.
“We can’t perform medical care by consensus or democracy,” Hawkins continued. “In the way that we design medical care, the decision rests with the attending physician. That, in this case, is me.”
Dennis’s court-appointed attorney, Jacob D’Annunzio, was in disbelief.
“They knew three weeks ago this would be a potential outcome,” D’Annunzio said at the hearing. “It’s at the Eleventh Hour that the hospital administration says, ‘We don’t want to be liable, so let’s call a judge.’ The decision was already made – by doctors and by Dennis.”
The Eleventh Hour
On Wednesday morning, Meyer stepped into his small courtroom.
Dennis’s parents stood before him. Vaughn was several rows behind them. Mincin called into the courtroom from the hospital.
The judge started slowly, pausing between words with the cadence of a minister. Dennis, Meyer said, would not be able to resist the first transfusion.
“However, over a period of time, as more transfusions were given, and as Dennis got stronger, he would start fighting,” he said, paraphrasing Dennis’s doctor. “At that point, we would have to put him in restraints, and we would have to probably sedate him.”
The judge noted that he was the father of two and grandfather of four. This was not the ruling he would want for them, he said.
Vaughn wanted to scream. That was precisely the problem, she thought. No one was treating Dennis as their own.
The courtroom grew silent as the judge concluded, “It is time to do what Dennis has decided, to place this in God’s hands.
“The motion to require an unconsented blood transfusion is denied.”
For a brief moment, the courtroom was quiet. Then Dennis’s mom started to wail. It was a cry so piercing that it could be heard outside the courthouse.
At the hospital, Mincin hung up the phone. She walked into Dennis’s room and stood by his bed.
“You won,” she said. “Nobody is going to come. Nobody is going to do anything.”
She thought Dennis couldn’t hear her. But he opened his eyes and a tear spilled out.
“I knew he understood what I was saying,” Mincin said.
Seven hours later, at 6 p.m., on Nov. 28, Dennis died.
Life After Dennis
Within hours, Mincin signed a form to donate Dennis’s blue eyes. She spoke with someone at a funeral home about having him cremated. At Dennis’s request, she and her daughters would climb Sauk Mountain to scatter his ashes.
Olga Lindberg flew in from Florida. She organized a memorial service for her grandson. She did not invite Mincin. One hundred fifty people came, many of them students wearing pink in honor of Dennis’s favorite color. Dennis’s mother was puffy-faced from crying. She sang “Amazing Grace.”
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Mincin held a service in a private location with Jehovah’s Witnesses standing at entrances with guest lists.
ReplyDeleteWhen Olga Lindberg returned to St. Petersburg, she staked a handmade sign in the lawn outside her condo: “No Jehovah’s Witnesses allowed on my property or I put a restraining order on you.”
In 2010, three years after his son’s death, Big Dennis Lindberg died of liver failure. Olga Lindberg later told me that his doctors said he spent his last days screaming his son’s name. After Big Dennis Lindberg died, Wherry moved to Phoenix, Arizona, to live with her father.
I last saw Mincin in Mount Vernon in 2011. We had emailed and talked by phone for months. In one email she told me that she had had trouble breathing after Dennis died and would sometimes hyperventilate.
I asked her how Dennis’s death affected her faith, and she said it was strengthened initially.
“Now that the years are passing, I feel like everybody has forgotten the courageous stand he took,” she said.
“Intellectually, I know that is not true. But, somehow, I want his name written down somewhere in our literature. I want him remembered. It's as though life goes by and he never existed. Not to me, but to others. It's hard to move on.”
Her daughters had grown up and left home. “The loneliness is almost unbearable sometimes,” she wrote in an email.
Mincin has since left Washington state and is now a pediatric nurse.
It’s true that Dennis’s death didn’t have much impact on how a case like his would be handled.
His refusal of blood has not been mentioned in Jehovah’s Witness literature. His death did not prompt a formal review of the mature minor doctrine at Seattle Children’s, according to Diekema, although the doctors discussed the case at length among themselves.
Nor were laws enacted to make sure this wouldn’t happen again, although Dennis’s sixth-grade girlfriend Morgan Curry tried. She persuaded her local representative to propose a bill she believed would have helped Dennis.
Morgan, then 15, testified in Olympia.
“HB1759 requires doctors and hospitals to immediately notify CPS when a minor’s refusal of medical care creates a substantial risk of death,” she said, reading from a statement. “It requires CPS to investigate promptly, and it requires a guardian ad litem to be appointed.”
The bill didn’t pass.
As for me, I’ve spent years unraveling the events that lead to Dennis’s death.
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I petitioned the court to unseal Dennis’s records, but my request was rejected. I ended up getting the records through Mincin, who gave me the right to view them. She also gave me a more complete set of Dennis’s medical records.
ReplyDeleteWhen I asked Children’s if another teen would be allowed to refuse life-saving care, the hospital emailed its policy:
Seattle Children’s respects the wishes of patients and families regarding medical care whenever clinically appropriate. However, when factors, including a patient’s religious beliefs, lead to the denial of necessary medical care, Seattle Children’s priority is to operate in the best interest of the child.
In an emergency situation, Seattle Children’s policy is to provide medically necessary emergency medical and surgical treatment to minors, unless there is a court order directing the contrary. In non-emergent cases where the medical team, patient and legal guardian(s) have time to develop a care plan, the patient’s medical team consults with a wide range of experts, which can include Seattle Children’s Ethics Committee, Seattle Children’s legal team and Child Protective Services.
For patients who are Jehovah’s Witnesses, physicians also collaborate with patients and their families to review any reasonably available non-blood medical alternatives, however, alternative treatments are not always available. If the recommended treatment is deemed medically necessary for the child’s welfare, Child Protective Services can present the case in court, where the final decision on treatment is made.
Diekema, the ethicist, told me he hoped there wouldn’t be another case like this one.
“A life was extinguished,” he told me when we met at the Starbucks at Children’s. For him that was the bottom line: A kid died when he didn’t have to.
Diekema quoted a U.S. Supreme Court decision from 1944, a case that involved Jehovah’s Witness children: “Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children.”
I read the full decision late in my reporting. What struck me was the dissent by Justice Frank Murphy, an Irish Catholic who wrote of the trials Jehovah’s Witnesses have faced throughout history.
“Theirs is a militant and unpopular faith, pursued with a fanatical zeal,” Murphy wrote. “They have suffered brutal beatings; their property has been destroyed; they have been harassed at every turn by the resurrection and enforcement of little used ordinances and statutes.
“Religious freedom is too sacred a right to be restricted or prohibited in any degree without convincing proof that a legitimate interest of the state is in grave danger.”
Ultimately, those close to Dennis, both those who let him choose to die and those who fought for him to live, remain haunted. They become angry when they talk about him. Some cry, others have nightmares. Sometimes I think Dennis may be the only one in all of this who has found peace.
http://kuow.org/post/when-14-year-old-chooses-die-because-religion-can-anyone-stop-him
Jury Awards $100K to Family of Jehovahs Witness Who Died After Refusing Blood Transfusion
ReplyDeleteby Greg Land, Daily Report February 19, 2016
A Fulton County jury awarded just over $100,000 to the family of a woman who died after refusing to receive blood transfusions because of her beliefs as a Jehovah's Witness.
The verdict came after three weeks of trial and two days of deliberation.
An attorney for the plaintiffs had argued that the Atlanta Medical Center—which offers a bloodless medicine and surgery program for patients who wish to avoid "bank" blood or blood products—could have saved Miriam Anderson's life had it acted sooner in response to her bleeding 10 days after delivering a baby.
But, said Kenneth Connor of Augusta, jurors couldn't get around the fact that Anderson had refused to accept a blood transfusion despite knowing that her life was in peril.
"There was no question that she realized she was in dire straits," said Connor. But Anderson, he said, was faced with a "Hobson's choice: put her soul at risk or put her life at risk. And she was unwilling to forfeit her religious beliefs."
The hospital, he said, touts its bloodless medicine program but failed to provide the care Anderson needed to prevent her from having to make that choice.
Connor, whose team included Connor & Connor colleagues C. Caleb Connor and Camille Godwin and Atlanta solo Tracee Benzo, said he was gratified that the jury found for his client on one of 10 claims: negligent misrepresentation against the Atlanta Medical Center
Connor said the plaintiffs' team is considering its options regarding any post-trial motions regarding the verdict.
The Atlanta Medical Center was represented by Kevin Race, Brian Mathis and C. Elizabeth Stell of Insley & Race.
"We extend our deepest sympathies to the Anderson family," said Race in an emailed statement. "However, we strongly support the actions of the staff and physicians at Atlanta Medical Center who fought to save Ms. Anderson's life while also respecting her and her family's deeply held religious beliefs."
Weathington Firm partners Paul Weathington and Tracy Baker represented a co-defendant, emergency room doctor Mark Waterman, who was cleared of any liability.
"We think the jury got this right," said Baker. "This was a tough, unusual case, and the jury was very smart and attentive."
According to the attorneys and trial documents, Anderson, 27, gave birth to her second child in July 2011 in a normal, vaginal delivery at the Atlanta Medical Center and was discharged. Ten days later, she was experiencing vaginal bleeding and called 911.
Emergency medical technicians responding wanted to take her to the hospital, but she declined. Later that day, Anderson again called 911 and was taken to the Atlanta Medical Center emergency room.
According to the defense portion of the pretrial order, Waterman examined her in the ER, determined she was experiencing "moderate at worst" bleeding and ordered intravenous fluids and an ultrasound test.
The ultrasound revealed that Anderson's uterus contained "retained products of conception": placental and other tissue following a delivery or termination of a pregnancy. In consultation with an obstetrician, Waterman admitted Anderson for a dilation and curettage to remove the tissue. Prior to the surgery, Anderson signed a Blood Product Consent Form upon which she "refused whole blood, major blood fractions, and all minor blood fractions except for albumin."
During the surgery, the defense account said that Anderson lost 2,500 cubic centimeters—or 2.6 quarts—of blood. (The average adult human body contains a little over 5½ quarts of blood, according to MedicineNet.com.)
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Connor said the plaintiffs contended that Anderson had been bleeding heavily before she underwent surgery, and that much of her blood loss could have been by prevented by taking her to surgery immediately.
ReplyDelete"She was clearly bleeding in the emergency room; they commented about their inability to do an intravaginal exam because of her bleeding," said Connor. "The problem was that the records did not show how much she was losing; part of our complaint was that they weren't documenting that."
Anderson was taken to the intensive care unit, where she died the day after the surgery.
In 2013, Anderson's two children, through their fathers, and the executor of her estate, sued Tenet Healthsystem GB, Atlanta Medical Center's parent, and Waterman for medical malpractice. The suit also accused the hospital of ordinary negligence, negligence per se, negligent misrepresentation, fraud and punitive damages. A claim for violation of Georgia's Fair Business Practice Act was later added against the hospital, as was a punitive damage claim against Waterman.
Shortly before the trial began, a mediation at Henning Mediation and Arbitration Service before Thomas Tobin failed to resolve the suit, Connor said.
Trial began Jan. 25 before Superior Court Judge Kimberly Esmond Adams. Connor said jury selection was complicated by the negative reactions some potential panelists expressed toward Anderson's faith.
"There was really a striking amount of ill will expressed about Jehovah's Witnesses," said Connor. "That was a surprising finding, in terms of the breadth and depth of those feelings."
Connor said his team called three key experts to bolster their case: Aryeh Shander, the director of Englewood Hospital's
Institute for Patient Blood Management and Bloodless Medicine in New Jersey; Arnold Friedman, the chairman of Mount Sinai Beth
Israel Hospital's OB/GYN department in New York; and Debbie Travers, a nursing professor at the University of North Carolina who authored a book on how to triage a patient.
Baker said Waterman's team only called one expert: Sheryl Heron, a professor of emergency medicine at Emory University School of Medicine and an ER doctor at Grady Memorial Hospital.
"The plaintiffs did not have any emergency experts, so her testimony was key for our case," said Baker.
A key witness for the hospital was Krystal Ridings, a registered nurse at Northside Hospital, Baker said.
During closing arguments on Feb. 10, Connor said, he did not ask for any specific account of money damages.
The jury deliberated until the afternoon of Feb. 12, when it returned defense verdicts on all claims against both defendants except for the negligent misrepresentation claim against the hospital, and awarded $101,261 in damages.
Both Connor and Baker were highly complimentary of opposing counsel and of Adams' handling of the expert-heavy case. They agreed that jurors laid most of the responsibility for Anderson's death on her decision to turn down a transfusion.
"At the end of the day, the jury obviously felt that she bore the responsibility for her own death," said Connor.
A website for Jehovah's Witnesses, jw.org, says members of the faith do not accept blood transfusions because, "Both the Old and New Testaments clearly command us to abstain from blood. (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29)."
The site addresses "common misconceptions" about Jehovah's Witnesses and medical treatment.
http://www.dailyreportonline.com/id=1202750028414/Jury-Awards-100K-to-Family-of-Jehovahs-Witness-Who-Died-After-Refusing-Blood-Transfusion?slreturn=20160119133437