Here is a particular interesting thread started on the forum of the JW website "NoBlood".
Few extract of the long discussion, (each time there is a now quote box, it is an another post)
Considering how fast it was falling, and how fragile these babies were (they were several months premature, less than 2 lbs each), I don't think EPO and IV iron would have stabalized them fast enough. They were already critically anemic and falling fast.
The use of Hyperbaric chamber :
As for the hyperbaric oxygen, it would depend on the availability of a hyperbaric chamber. Plus there are risks, such as how to deal with an emergency should the child worsen (you can't just remove them and move them to an OR, you'd have to wait for the pressure to return to normal).
Is the action of the doctors legal ?
Your medical ethical citation is dated. A contemporary medical ethical view is expressed by Dr. Author Caplan of the University of Pennsylvania. He expresses that doctors today do not abide by a patient’s refusal based on respect for religion, but rather out of respect for self-determination. Children do not have self-determination, and neither are children owned by their parents as though parents have unlimited authority over them. Hence in cases where parental refusal endangers a child’s life or health, the ethical thing is to treat them according to the best standard of care available and likely to prevent mortality and/or poor health. You can view Dr. Caplan’s very well expressed commentary on medical ethics in relation to Jehovah’s Witnesses and children in the film Knocking.
The sovereign nation of Canada is standing up for self determination by protecting those premature babies. They do not yet have self determination of their own, but one day they will if they survive. The parents also cannot express self determination for anyone other than themselves. This is why someone needs to protect the right of the child to live, develop and assert their own self determination. If we undermine self determination then society will surely turn to totalitarianism. (link)
What they are talking about is a 1995 ruling by the Supreme Court which allows parents to attend a hearing when the state is requesting custody of the children for the purposes of medical treatment. The article is misquoting that ruling to give the impression that the Supreme Court allows parents to refuse treatment. The SC did no such thing. Instead they just allowed parents to argue their case before the court responsible for issuing the seizure order. It's unclear why the provincial judge did not have a hearing, and that's why the parent's appealed to the BC provincial Supreme Court.
So the court can still override parent's wishes, but in this case, there was an error in procedure that will likely allow the parents to request compensation. Had the court allowed a hearing but still seized the children for treatment, the Supreme Court would likely have upheld the provincial judge's ruling... (link)
This will be an interesting case, as the Child, Family and Community Service Act of BC allows a Director to seize a child without court order (sec 30), and authorize medical treatment, if he/she believes the child's life is in immediate danger. But the act also says the Director needs to apply to a court with the opinions of two doctors, and hold a hearing in which the parents must be allowed to attend, if the child is to be seized for medical treatments that the parents refuse (sec 29).
I'm guessing the judge interpreted this to mean that if the child's life was in immediate danger, he could skip the hearing until after the treatment (sec 29 of the act allows this as well, sec 29 does not overrule section 30...) At that point the province dropped the custody order, and so the hearing became moot (until the appeal to the BC Supreme Court that is, they are allowed to consider the custody order as still in effect when they proceed to rule).
Anyway, since the parental rights of religion are not supported already (the 1995 case), it will boil down to whether the inclusion of the "no-hearing seizure" part of the Act is considered constitutional. I suspect that Section 1 (reasonable limits prescribed by law as can be demonstrably justified) will be the judgement line for this case.(link)
Not necessarily. I notice you're from the US, so I'll point out that our "rights" are a lot more flexible than yours. Section 1 of the Charter of Rights & Freedoms basically allows reasonable restrictions of any Charter rights (the key being reasonable).
This is why even though the parents religious and parental rights were violated in that 1995 case (sec 2 & 7), the SC ruled that section 1 allowed the Child Welfare Act to override those rights. It did rule that under sec 7, the parents were required to be given a hearing first. (In that case, there was no medical emergency, so there's a loophole.)
In this case, BC's version of the Child Welfare Act allows the gov to seize & treat children IF there is a danger to the child's life, without a hearing. The judge likely ruled that refusing emergency medical treatment likely constitutes a danger to the child's life. (A hearing is required for all other medical treatment that parents refuse.)
So it's not whether the doctors acted illegally, it's whether BC's law is a reasonable restriction of rights under Section 1.
2 things will be argued before the court. 1) Were the children's lives in danger? (alternative treatments may play a part in arguing one way or the other) 2) If yes, is the BC Child, Family and Community Service Act Sec 29 & 30 a reasonable restriction of parental rights under Sec. 1 of the Charter? (link)
After the transfusions were completed, why WOULD the state keep custody?
From the info I found earlier, the state wouldn't be able to hold the kids longer than needed for the treatment, assuming it was emergency treatment. After that, barring any further danger to the children, the state would be *required* to hand the children back until a hearing could be convened... (link)
Are the JW the only responsible for "bloodless therapy" ?
Though the religious position taken by most Jehovah witnesses about blood transfusion has significantly influenced the medical community in relation to treatment options, it is not the only driving force.
Medical science is constantly striving for improved therapies. As medical science recognizes complications and hazards associated with a particular treatment this community of dedicated scientists is compelled to find newer and better medicines, technologies, procedures or methods of delivery. This is a non-religious force affecting blood based therapy.
National interest compels governments to improve military efficiency. A major cause of mortality in wartime is hemorrhage on the battlefield due to trauma. This is another non-religious force affecting blood based therapy. This force also represents an economical incentive for research and development of alternative therapy.
It is somewhat surprising to see the high profile this case is attaining in Canada. In the UK such cases are not so much publicized because the Jehovah witness hospital services tends to encourage parents to see things according to law. Since the court will always rule in favor of child protection then Jehovah witness patients tend not to force religious preference over a doctor acting to save a child’s life or health. Parents will ask doctors to avoid transfusion, but they do not usually demand the doctor withhold despite imminent death. If they do, then application is made to the court and guardianship is assigned.
Transfusion in the womb of the mother ?
My wife brought up an interesting point. In the womb, the blood of the mother & children co-mingles due to the fact that the capilaries for the womb, and the capilaries for the placenta, are so fine that blood cells can pass in & out at will. So the child essentially spends 9 months getting a slow transfusion from the mother and vice versa (this is why R-factor problems occur, since the mother's immune system reacts to the presence of the child's blood cells).
So would a transfusion from the mother be out of the question?
An answer:
The blood of expecting mothers and fetuses does not commingle as freely as you suggest. Were it to mix this freely it would cause all sorts of life threatening medical complications.
Another precision:
I realise it doesn't completely co-mingle (it would certainly cause a LOT of complications if it did), but it does enough that I would argue that there was already a transfusion from mother to child and vice versa, even if only an extremely minor one. Otherwise the Rh(D)-factor complications would not happen (the babies blood needs to come into contact with the mother's blood in order for the immune system response to occur), although this is much more likely to be due to a placental bleed rather than an actual co-mingling.
Still, the fact that a minor transfusion can occur without the mother even knowing about it...
The USA jurisprudence concerning JW's child and the death of JW refusing blood products:
In the United States the courts take a very similar approach as in Canada in that they will always act in the best interest of the child. If a doctor believes parents are refusing life saving treatment they too can petition courts for custody in order to render life or health saving therapy. Earlier I mentioned Dr. Caplan. He practices in the United States, and he will tell you doctors have a duty to render life saving therapy to a child regardless of parental refusals. From what I read, in the United States there have been many cases where courts took custody of children because of parental refusal of life saving medical treatment.
When alternate therapy is unlikely to prevent death and transfusion is likely to prevent death then refusing transfusion is tantamount to homicide. Many Jehovah witnesses have suffered preventable death as a result of refusing various blood product therapies. It is not uncommon. If alternate therapies were just as viable then these deaths would not have occurred.
Are the JW protected from all the danger of the blood ?
In your comments you seem to neglect the serious blood borne pathogen exposure to members of your faith. These too accept a wide range of blood products, and these carry risks too. In some cases the risk is higher than transfusion of whole blood. This is because products such as cryoprecipitate are produced from plasma pooled from many donors.
I am editing this reply to remind everyone that I too am an advocate of bloodless medicine.
The Rainbow's bloodless program and the necessity of a blood transfusion for a child in emergency:
Rainbow’s bloodless program administrators and doctors realize the limitations of bloodless therapy as well as its medical and social responsibility to children in a situation as is discussed here.
Rainbow’s policy addressing children states,
F. The physician participants will agree that in urgent and/or emergent medical care situations when the treating physician deems the use of blood products and/or blood transfusion necessary, to prevent death or serious bodily harm to a child, the treating physician will discuss this with the parent. If the parent still refuses, the physician will report the parent's refusal to the local child welfare authorities. Physicians are required to do so by law. However, every attempt to notify the parents will be made if any such report is contemplated.
G. If, in the rare occasion during the course of treatment an emergency suddenly arises which allows no time to report the matter to child authorities, the medical team will still do its best to honor your refusal and treat your child without blood, using all alternatives available and/or appropriate. However, if the treating physicians deem blood is immediately necessary to prevent death or serious bodily harm to the minor, the law permits them to administer blood without your consent.
Could the alternative of blood transfusion avoid the need of transfusion in all case ?
I 've already covered in this thread a situation where bloodless alternatives do not adequately provide enough of a solution. From what I've read, no-blood alternatives have one major flaw working against them. Time.
If you have time, no-blood solutions are definitely the way to go. Drugs/supplements, self-donation, diet, etc are all excellent treatments.
But when you have no time to build up a reserve of blood to transfuse yourself with, when your condition is deteriorating so rapidly that encouraging the body to produce more blood won't work fast enough (or perhaps your body is currently unable to produce enough of it's own blood), what then?
And please stop using that blood letting analogy. Blood letting was based on the flawed assumtion that they could just bleed out the disease. Perhaps if you were comparing to the old blood-transfusion assumption that blood was blood, before Rh(D) factors, blood-types, and blood-born diseases were known about, you'd have a valid comparison. Nowadays they know a lot more about how blood interacts with blood, they know about proteins, prions, genotypes/phenotypes, and how they all affect the interaction. (Citing a risk of blood-born illness is easily comparable to the risk of catching any number of transmissible diseases while at the hospital...)
Without such knowledge, no-blood solutions would never have been developed. But as I said, until they come up with a synthetic blood that replicates *all* the features of real blood (and not just most of them), there will still be situations (as I said above, mostly when time is of the essence) in which a transfusion does more good than a no-blood alternative.
Until the time when blood transfusion is supplanted as an essential treatment for some patient presentations it is not a question of getting past an idea. The idea that some patient presentations require blood transfusion to prevent mortality and/or protect health is established medical science. One day medical science may reach beyond this. But so far it has not. Respected and well educated doctors among the bloodless advocates understand this and advise patients accordingly. (link)
Are the hemoglobin-based products ready ?
I'd like some more info on these products if you can find them pls. As well as whether they've been approved by organizations like the FDA and the Cdn equivalent. Doctors usually avoid un-approved treatments unless there's no other medical alternative.
edit: I've found 3 products that act as you describe. Hemopure, Oxygent and PolyHeme, all of which are described as "oxygen therapeutics" aka fluids that behave like hemoglobin.
Hemopure is still in clinical trials inside the US, although due to FDA concerns, human trials were suspended, they are back to animal testing. The US Navy is partnering with Biopure to address the health concerns the FDA had. It has been approved by South Africa since 2001.
Oxygent has not been approved by the FDA (there are lingering concerns about the health effects of perfluorochemicals... namely that they cause cancer in lab rats)
PolyHeme uses treated human hemoglobin, and is clinical trials (although there are concerns about it's health effects, but they could be statistical anomalies)
Now it is important to make a stop. I have copied and pasted only answers of some doctors (one is clearly an advocate of bloodless medecine) to questions or comments from classical JW on this board (of Rank and File, if you want)
Now, note the intervention of Jan B. Wade, founder of the site NoBlood and of SABM, and a JW doctor: (Bold are mine)
There are times when only a transfusion of RBC's given immediately will save a life. There are times when only a transfusion of platelets given immediately will save a life.
From a medical point of view transfusions of blood components are not always good and they are not always bad. In the 1990's the balance of risk vs. benefit weighed heavily toward the risk side. Physician's really were using blood as a pre-ordered item on their treatment algorithm. Today due to the dedicated work of professionals like Shander, Spence, Goodnough, Hannon, Estioko, Spahn, Ford and Speiss physician's are more often questioning and challenging blood transfusion as a theraputic option. The rule "question every unit" is becoming more common.
To take the side of zero tolerance in the blood transfusion debate offers zero possibility of winning the point. The debate should not be No Blood vs. Blood. It should be When Blood vs. When Alternatives. The protagonists in this thread are as far as can be discerned from a glance at their username profiles NOT qualified to debate the When vs. When. The news articles I have reviewed do not provide clinical values time-lines or co-morbidities. Blood count was mentioned but that isn't enough to determine efficacy of treatment decisions. Even if the chart were opened medical opinion on treatment opinions would vary. To portray the physicians working for the interests of the infants as "bad" is shortsighted, naive and not at all fair. To portray the family or their religion as unconcerned with the life and safety of their children would be equally unfair and simplistic. Having spent many years working in hospitals I am certain both sides agonize over their course of action.
At the bottom of this debate and what should not be discussed on this website is the issue of belief and faith as they influence clinical choice and how far health care providers should go to accomodate these in their patient population.
As usual JulieM has nailed the ethical and legal issues. However, is man and his body of laws in harmony or out of harmony with God and his laws? Should man's body of representatives ever allow citizens to impress their choices however sacred on children who are incapable of informed decision? These questions at the root of the case in discussion are necessarily left to another forum.
So, i have cited in great extent in this post JulieM and Wade felicitate her; now who are the "The protagonists in this thread are as far as can be discerned from a glance at their username profiles NOT qualified to debate the When vs. When": perhapsthe standard JW !!!
Also the "trigger" criteria for state intervention is NOT necessarily when blood products provide the best or most familiar standard of care. The exact laws vary between nations and provinces. However Dr. Nicolas Jabbour describes the criteria as "when there are NO nonblood alternative treatments available" (emphasis mine, Transfusion-Free Medicine and Surgery, p. 14).
This is obviously not a black-and-white area. Treatments vary in efficacy, as does the expertise level, tools/techniques and proficiency at different medical centers.
E.g, Nicolas Jabbour at USC has done many bloodless live donor liver transplants. That doesn't mean such expertise is available everywhere. Duke University Medical Center is expert at hyperbaric medicine, and uses it in their bloodless program. Such expertise isn't available everywhere. Just because we read of such successes doesn't mean that's the general standard of care available everywhere. But -- it is available.
Thus we see a complication: what if expert (albeit non-mainstream) alternative treatment is available at a different location, and the doctors have successfully treated similar cases and are willing to take the patient? Suddenly it's not so black and white. Rather than state intervention to avoid certain death, the state is intervening based on the lack of expertise in the current facility or unwillingness to transfer the patient.
I have no idea if that happened with the Canadian sextuplets, but the fact is most situations can be successfully treated -- somewhere -- without blood, given sufficient tools and expertise.
That raises the issue of patient transport and related complications and decision factors. It's not always advisable to transfer the patient, although it's often possible. There are many variables -- distance, time, surface vs aerial transport, patient condition, etc.
The confusion in these cases often stems from a black-and-white view of what is a grey area, sometimes exacerbated by premature overly aggressive legal action. It's one thing if a minor child comes in the ER from a car wreck, bleeding profusely with a hemoglobin of 2 g/dl. It's another thing if the patient has a hemoglobin of 8-9 g/dl which is gradually declining.
While the law generally requires rendering lifesaving treatment to minor children regardless of the parent's wishes, the exact definition of what constitutes "lifesaving" treatment and threshold for legal intervention is fuzzy. In a slowly deteriorating, non-time-critical situation, transferring the patient to an expert specialized facility may avoid legal problems. Identifying and acting on these cases early avoids the patient degrading to a condition where transport is more risky.
Potential patients and parents should also understand there's a difference between a cooperative doctor vs a structured, formal bloodless program. In an elective situation best results are often obtained at a facility with a formal bloodless program. Even in some trauma situations the option may exist early on to transfer to such a facility. Once the situation medically deteriorates, transport is more difficult, although not necessarily impossible. In his book "No Man's Blood", Dr. Ron Lapin related an example of aerial transport and successful operation on a female adult patient with a hemoglobin level of 2.0 g/dl.
Where transport is impossible, expert medical consultation about nonblood treatment options can be made available via teleconference or video conference.
Answer:
Transporting a patient is not objected to by hospitals, doctors or social service authorities unless transportation presents an unacceptable risk or the intended treatment at the receiving facility is viewed as experimental. (link)
Bye
Charles