More doctors honor religious objections to blood transfusions
October 09, 2012 | By Manya A. Brachear, Chicago Tribune reporter
As a Jehovah's Witness, Tracy Pickett always has enjoyed knocking on doors and introducing strangers to the tenets of her faith. But by the time she reached her mid-40s, scoliosis made every step excruciating and her spiritual mission impossible.
Walking again would require surgery that often involves tremendous blood loss and a transfusion — a medical procedure to replenish the blood supply forbidden by her church.
"Even though I love life and I don't want to die, I want good medical care without blood," said Pickett, 49, of Crown Point, Ind. "If it got to that point, I would rather lose my life than disobey my creator and take a blood transfusion."
Dr. Christopher Dewald, Pickett's orthopedic surgeon at Rush University Medical Center, nervously agreed to find alternatives and perform the surgery. Dewald said he couldn't fathom letting a patient die on his operating table, but because he respected Pickett's convictions, he invested time to explore the options.
"I explained to her that I would have a hard time letting her pass away right in front of me and that I might have a problem not giving her blood," said Dewald, a Roman Catholic. "But I was going to do everything in my power to honor her wishes."
For years, many doctors have resisted accommodating religious tenets that they believe endanger their patients. But more physicians, including Dewald, are practicing within the confines of religious restrictions, even when it might put their patients' lives at risk.
Although alternatives to transfusions have been around for years, more physicians are weighing patients' spiritual well-being and peace of mind as part of their treatment.
"In the rational realm, it doesn't necessarily make sense," said Dr. Valluvan Jeevanandam, an expert in high-risk cardiac surgery at the University of Chicago Medical Center. "But if what they believe makes them peaceful and content, I'm not going to take that away from them."
Jehovah's Witnesses cite Acts 15 in their own New World translation of the Holy Scriptures to explain their objection to blood transfusions. "Therefore my judgment is that we should not trouble those of the Gentiles who turn to God, but should write to them to abstain from the things polluted by idols, and from sexual immorality, and from what has been strangled, and from blood."
Most Christians believe that verse denounces pagan rituals such as eating and drinking blood. But Jehovah's Witnesses interpret it as a prohibition on accepting blood that has been removed and stored. They also point to four verses in Leviticus and three verses in Deuteronomy to demonstrate that any blood spilled and not eaten (referring to animal blood) should not be reused, but given back to God.
Because it can be difficult to find doctors who respect the rule, the church appoints hospital liaisons to manage a database of local physicians and make referrals.
"Each major city of the world has a hospital liaison committee to bridge the gap between the Jehovah's Witness community and medical community," said T.J. Bullock, the church's liaison in Chicago. "If physicians have questions about what we accept or don't accept or are looking for advice, we can put them in touch with other physicians."
Jeevanandam has accepted many of Bullock's referrals. He said he warns every patient that the mortality rate is higher for anyone who declines blood transfusions.
"We don't have a 100 percent success rate. We do lose people," he said. "You're telling me what ammunition to use to fix your problem. If you take blood away, that's a large portion of my arsenal. There will be potential for higher complications."
Brian Montalbano, 31, of Nashville, Tenn., found Jeevanandam several years ago when he needed a second heart transplant. His first transplant at age 9, before he was a Jehovah's Witness, had involved a transfusion that also transmitted a virus, he said.
By the time he came to Jeevanandam in his late 20s, he not only remembered that rocky recovery, but also had converted to a faith that didn't allow another transfusion. However, it did allow him to get a new heart.
Montalbano encountered more complications. Shortly after the surgery, his lungs filled with fluid. Other doctors besides Jeevanandam recommended a transfusion to boost his strength. Still, he declined, resulting in a stroke that temporarily paralyzed his left side, he said.
"I believe I was making the right decision," said Montalbano, adding that he has fully recovered. "The ultimate goal is to serve God and do his will. And I believed that if I made it through, I would be doing it faithfully. Any risks that come would be worth the reward."
Dr. Hieu Ton-That, a trauma surgeon at Loyola University Medical Center, has struggled to build a critical mass of specialized colleagues who agree to avoid transfusions regardless of the outcome. He has worked to overcome the widespread misperception that Jehovah's Witnesses wholly reject medical care.
An atheist working at a Catholic hospital, Ton-That has discovered he also must overcome a clash of values.
"Obviously, there are some values that we should share as a society: preservation of life if possible, autonomy," Ton-That said. "My job is understanding where people come from and giving them access to care that's appropriate to their value system."
Ton-That has launched a hotline for patients who want to avoid blood: 708-327-0RBC (0722), which stands for "Zero Red Blood Cells."
"Everyone comes in with a framework of values and beliefs for everything including their health issues," he said. "Caregivers come with a value system too. That's why it's hard to build this network of providers because maybe the value system around here is more predominantly 'life at all costs regardless of other values.' There has to be some ground where we can accommodate both."
Dr. Kathy Johnson Neely, chair of Northwestern Memorial Hospital's medical ethics committee and an assistant professor at Northwestern University's medical school, said preserving life is the most obvious ethical obligation of doctors. Less obvious is the tenet to never abandon a patient, no matter where that patient's illness and choices lead, she said. And that tension can create a dilemma for doctors, she said.
"I have an absolute obligation to listen to what my patient says no to and respect that and not violate their body if they say no," she said. "I also have an absolute obligation to help my patient get better. There are situations in life and in medicine when we can't fulfill one without violating another."
Dewald faced that conundrum when Pickett walked into his office earlier this year. And, he acknowledged, he never quite resolved it.
While he agreed to do the surgery, he also referred Pickett to a hematologist to increase her blood count in advance. Once in the operating room, he used a Cell Saver, or cell salvage machine that suctions, washes and filters blood so it can be recirculated instead of thrown away. Jehovah's Witnesses believe such machines act as an extension of the circulatory system, so blood doesn't leave the body.
To control any blood loss, he divided the complex procedure into two separate operations. By the time he walked into the operating room, he felt confident that both surgeries would be a success.
But Dewald said Pickett's convictions prompted him to contemplate his own Catholic beliefs.
"It helped me to be introspective about what my beliefs were in terms of facing that problem. Could I let someone die?" he said. "I would've had a hard time walking out of the operating room. A plan was not in place. I'm not sure what I would do. I never completed that sentence."
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