skeeter1

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  19

  NOW ONLINE - PEDIATRICS AND CHILD HEALTH - DEC 2006 MAG ARTICLE ON BLOOD

  by West70 in

  1. watchtower
  2. medical

  this has most likely already been posted, but i don't have the time or will to sort through past postings to verify.

  given all the attention given to the canadian sextuplets tragedy, it won't hurt anything if this is a duplicate posting.

  at any rate, the december 2006 issue of "pediatrics and child health" magazine contains anarticle entitled, "medical emergencies in childrenof orthodox jehovah's witness families", co-authored by juliet guichon, a medical bioethicist at the university of calgary.

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  skeeter1

  Hawkaw,

  Is this lying Watchtower lawyer, Shane Brady? As in the Shane Brady that's handling the sextuplet case?

  Skeeter
• 
  19

  NOW ONLINE - PEDIATRICS AND CHILD HEALTH - DEC 2006 MAG ARTICLE ON BLOOD

  by West70 in

  1. watchtower
  2. medical

  this has most likely already been posted, but i don't have the time or will to sort through past postings to verify.

  given all the attention given to the canadian sextuplets tragedy, it won't hurt anything if this is a duplicate posting.

  at any rate, the december 2006 issue of "pediatrics and child health" magazine contains anarticle entitled, "medical emergencies in childrenof orthodox jehovah's witness families", co-authored by juliet guichon, a medical bioethicist at the university of calgary.

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  skeeter1

  Excellent article!

  Imagine that, a Watchtower Laywer lied in court! Lawyers are not supposed to lie in court, in fact it can have Bar sanctions and loss of license.

  Skeeter
• 
  19

  NOW ONLINE - PEDIATRICS AND CHILD HEALTH - DEC 2006 MAG ARTICLE ON BLOOD

  by West70 in

  1. watchtower
  2. medical

  this has most likely already been posted, but i don't have the time or will to sort through past postings to verify.

  given all the attention given to the canadian sextuplets tragedy, it won't hurt anything if this is a duplicate posting.

  at any rate, the december 2006 issue of "pediatrics and child health" magazine contains anarticle entitled, "medical emergencies in childrenof orthodox jehovah's witness families", co-authored by juliet guichon, a medical bioethicist at the university of calgary.

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  skeeter1

  Link?
• 
  44

  AWESOME! New Article on Blood and Canadian Sextuplets

  by V in

  1. watchtower
  2. medical

  ethicist says b.c.

  blood feud may save children and jehovah's witness parents.

  published: thursday, february 1, 2007 | 8:46 pm et.

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  skeeter1

  I'll try posting the part on young children again. Hopefully, it will not have the "box" on it. http://emj.bmj.com/cgi/reprint/22/12/869

  Traditionally, when children are incompetent, the power to giveor withhold consent to medical treatment on their behalf lieswith those with parental responsibility. Legally, except inan emergency, parental consent is necessary to perform any medicalprocedure on an incompetent child. While courts throughout thewestern world recognise these parental rights, they are notabsolute.4 The right to raise children is qualified by a dutyto ensure their health, safety, and wellbeing.5 Parents cannotmake decisions that may permanently harm or otherwise impairtheir healthy development:6,7

  "Parents may be free to become martyrs themselves. But it doesnot follow that they are free, in identical circumstances, tomake martyrs of their children..."8

  There is, therefore, no legal debate about the ability of parentsto refuse blood on their children’s behalf when bloodproducts are clinically indicated. Since the Watchtower Society(WTS), the JW governing body, introduced the blood ban in 1945,courts in the USA,9 the UK,10 and Australia11 have made it clearthat parents cannot refuse blood on their children’s behalf,based on three main principles: (a) the child’s interestsand those of the state outweigh parental rights to refuse medicaltreatment;12 (b) parental rights do not give parents life anddeath authority over their children;13 and (c) parents do nothave an absolute right to refuse medical treatment for theirchildren based on their religious beliefs14 if that refusalis regarded as unreasonable.
• 
  44

  AWESOME! New Article on Blood and Canadian Sextuplets

  by V in

  1. watchtower
  2. medical

  ethicist says b.c.

  blood feud may save children and jehovah's witness parents.

  published: thursday, february 1, 2007 | 8:46 pm et.

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  skeeter1

  I think you should read this. You will find it very enlightening on how & why courts in the Western world view this matter. Parents can not make martyrs of their children. Below is an abstract, but you can get the full text of the article in .pdf format at http://emj.bmj.com/cgi/reprint/22/12/869

  ORIGINAL ARTICLE

  Jehovah’s Witnesses in the emergency department: what are their rights?

  S Woolley

  Correspondence to:
  Dr S Woolley
  Bristol Royal Infirmary/Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK; [email protected]

  Accepted for publication
  21 February 2005

  
  

  	ABSTRACT

  
  The Jehovah’s Witnesses Society is best known to outsiders for its refusal of blood products, even when such a refusal may result in death. Since the introduction of the blood ban in 1945, Jehovah’s Witness (JW) parents have fought for their rights to refuse blood on behalf of their children, based on religious beliefs and their right to raise children as theysee fit. Adolescent JWs have also sought to refuse blood products based on their beliefs, regardless of the views of their parents.Adult JWs have fought to protect their autonomy when making both contemporaneous and advance treatment refusal. The refusal of blood products by JWs raises ethical and legal dilemmas that are not easily answered. Do an individual’s rights (namely bodily control, right to privacy, right to decide about life/death issues, right to religious freedom) outweigh society’s rights (namely the preservation of life, the prevention of suicide, the protection of innocent third parties, and the maintenanceof the ethical integrity of the medical profession)? Does the right to choose outweigh the value of human life? For doctors,conflict occurs between the desire to respect patient autonomy and the need to provide good medical care. The Watchtower Society (the JW governing body) imposes a strict code of moral standards among its members, and it is unlikely that individual JWs are making truly autonomous decisions about blood transfusions.While young children and adolescents are protected by the courts and conscious adults are afforded autonomy, dilemmas still arise in the emergency situation. This article examines the rights of young children, adolescents, and adults, focusing in the latter half on adults in the emergency situation.

  ---

  Abbreviations: JW, Jehovah’s Witnesses; WTS, Watchtower Society

  Keywords: Jehovah’s Witnesses; blood products; emergency

  The Jehovah’s Witness Society (JW), based in New York,is an international religious organisation, the followers of which believe the Bible is the true word of God.1 To many people,the Society is best known for its absolute prohibition on the acceptance of blood transfusions, based on the belief that transfused blood is a nutrient,2 and that three Biblical passages allegedly forbid transfusion.3 In the emergency department (ED), refusalby a JW to accept blood products creates ethical and legal dilemmas.This article discusses the rights of both patients and health care professionals in the context of the ED.

  
  

  	YOUNG CHILDREN

  
  Traditionally, when children are incompetent, the power to give or withhold consent to medical treatment on their behalf lies with those with parental responsibility. Legally, except in an emergency, parental consent is necessary to perform any medical procedure on an incompetent child. While courts throughout the western world recognise these parental rights, they are not absolute.4 The right to raise children is qualified by a duty to ensure their health, safety, and well being.5 Parents cannot make decisions that may permanently harm or otherwise impair their healthy development:6,7

  "Parents may be free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children..."8

  There is, therefore, no legal debate about the ability of parents to refuse blood on their children’s behalf when blood products are clinically indicated. Since the Watchtower Society (WTS), the JW governing body, introduced the blood ban in 1945,courts in the USA,9 the UK,10 and Australia11 have made it clear that parents cannot refuse blood on their children’s behalf, based on three main principles: (a) the child’s interests and those of the state outweigh parental rights to refuse medical treatment;12 (b) parental rights do not give parents life and death authority over their children;13 and (c) parents do not have an absolute right to refuse medical treatment for their children based on their religious beliefs14 if that refusal is regarded as unreasonable.

  
  

  	ADOLESCENTS

  
  The situation regarding the ability of mature minors to refuse medical treatment is not as straightforward. In Canada, despite pre-1996 court decisions15 supporting the notion of adolescent autonomy, adolescents may not refuse medical treatment.16 In the USA, three states recognise the "mature minor" concept17 but elsewhere adolescents rely on parental decision making. In England and Wales, mature minors may consent to, but may not necessarily be able to refuse, treatment. In Scotland, although not specifically referred to, the Age of Legal Capacity Act18 implies that a competent child may refuse, as well as accept, treatment.

  The debate commenced in 1985 with Gillick v West Norfolk.19The majority of the House of Lords were clear that if a child under 16 years could demonstrate sufficient understanding and intelligence to fully understand the treatment proposed they could give their consent to treatment.19 Unfortunately this case did not address the issue of treatment refusal. Subsequent cases20 may possibly be seen as undermining the ability of minors to make decisions about the refusal of medical treatment, as in each case the court has exercised its right to overrule the decisions of minors "in the best interests" of the child. In all cases concerning adolescent JWs,21 the courts have allowed transfusion, with the judges expressing concern about the child’s ability to make a fully informed decision because of their sheltered upbringing and the influence of the JW faith.

  
  

  	ADULTS

  
  Although the state has an interest in the preservation of life, that interest is not absolute. Individuals have the right to control their own person and part of that autonomy is the "right to make choices pertaining to one’s health, including the right to refuse unwanted medical treatment".22 Although this right should encompass all medical choices, including the refusal of blood products, JWs have had to defend this right in the courts.

  Although there are no UK cases concerning competent non-pregnant adult JWs, cases have appeared before the courts in the USA since 1964.23 These cases focus primarily on an individual’s rights versus state interests. Earlier cases24 placed the state’s interest before an individual’s right to refuse unwanted medical treatment and subsequent cases have used a variety of arguments to transfuse adults against their wishes.25–28 However, in 1985 the appeal court in In Re Brown29 ended the debate with a strong statement supporting an individual’s right to refuse medical treatment:

  "Rights are subject to compromise only when they collide with conflicting rights vested in others...The right of free exercise of religion protects more than mere beliefs... Religiously grounded actions or conduct are often beyond the authority of the state to control...".30

  This statement is supported by subsequent cases,31 and gives competent adult JWs the right to refuse unwanted blood products, even in the USA.

  
  

  	THE EMERGENCY SITUATION

  
  Unconscious JWs, with signed blood refusal cards, a form of advance directive, create medical, ethical, and legal dilemmas for healthcare professionals. English law is clear and unequivocal. Patients have the right to refuse medical treatment "for reasons which are rational or irrational or for no reason"32 and "even in circumstances where she is... certain to die in the absenceof treatment".33 This absolute principle is applicable to a competent patient’s anticipatory refusal of consent in the form of an "advance directive" or "living will".33 Anticipatory refusals should ideally fulfil certain criteria.34,35 and there is concern that the blood refusal cards carried by JWs may not meet these criteria.

  Since the 1970s, JWs have carried WTS distributed blood refusal cards. These cards specify that the owner will not accept blood products under any circumstances. Although theoretically, refusal is religiously motivated, the card recognises risks associated with blood,36 making it essential that treating physicians are satisfied that JWs have enough information regarding the risks and benefits of blood transfusion to make a decision to refuse it.

  In an emergency, the doctor must be satisfied that a card carrying JW has been provided with the information necessary to make an informed decision. This is unlikely, as the WTS37 provides information about the risks but not the benefits of blood. In addition to the possible lack of information there is also concern about whether an individual’s decision to carry a card is without external influence (crucial when considering autonomy).The WTS decides which products JWs may accept, distributes the"boilerplate" cards annually, and initiates the card signing process. Disfellowshipping (a form of excommunication) is the penalty for accepting blood products, and thus it is unlikely that a decision to sign a blood refusal card is without external influence.

  What, therefore, should doctors do in the emergency situation? In an emergency, treatment that is in the patient’s best interests may be given under the doctrine of necessity. However, this doctrine assumes that "under the circumstances, a reasonable person would consent, and thus the probabilities are that the patient would consent".38 This doctrine is unlikely to apply to JWs, as most, if conscious, would object to treatment.39

  Unfortunately, the two leading legal cases40 considering unconscious JWs offer conflicting advice. In Dorone,41 the Supreme Court upheld a decision to allow transfusion,42 whereas in Malette,43 the physician was found liable for battery. The standard in Dorone40 essentially precludes application of any form of advance directive. Conversely, the court in Malette43 accepted the undated, unwitnessed card at face value.44 The latter approach is not ideal; the decision was retrospective and it would be impossible to know whether the pre-printed wishes still reflected the patient’s views.

  HE v a Hospital NHS Trust45 resolved these issues. A Muslim born woman who had converted to the JW faith following her parents’ divorce required life saving medical treatment for congenital heart disease. Shortly after her conversion, she signed a blood refusal card. Her father argued that this card should not bevalid because: the girl was now engaged to a Muslim man and had consequently rejected her faith as a JW, she had not attended any JW meetings in the preceding 4 months, her advance directive predated her change in faith, and she had not mentioned the advance directive while conscious. The court accepted these arguments, adopting the approach in Dorone:41

  "There are no formal requirements for a valid advance directive...There are no formal requirements for the revocation of an advanced directive... An advance directive is inherently revocable...The burden of proof is on those who seek to establish the existence and continuing validity and applicability of an advance directive... If there is doubt, that doubt falls to be resolved in favour of the preservation of life".45

  Therefore, in the emergency situation, if doubt exists about the validity of a blood refusal card, physicians should aim to preserve life and administer the necessary blood products.

  
  

  	CONCLUSION

  
  JWs presenting to the ED continue to cause concern. However,the law regarding young children, adolescents, and adults (in the non-emergency situation) is clear: parents may not refuse blood on their children’s behalf if such a refusal isdeemed unreasonable, adolescents cannot necessarily refuse blood,and competent adults can refuse unwanted treatment.

  In an emergency, the situation is more complex, particularly as there are concerns about how informed individual JWs are about the risks/benefits of blood. Physicians should provide the necessary information for an individual to make an informed choice and where this is not possible, physicians should administer blood products in life threatening situations, if any doubt exists about the validity of a blood refusal card.

  
  

  	FOOTNOTES

  
  Competing interests: none declared

  
  

  	REFERENCES

  
  

  1. Harrison BG. Visions of glory: a history and memory of Jehovah’s Witnesses. New York: Simon and Schuster, 1978.
     
  2. Anonymous. "A patient in hospital may be fed through the mouth, through the nose or through the veins. When sugar solutions are given intravenously, it is called intravenous feeding. So the hospital’s own terminology recognizes as feeding the process of putting nutrition into one’s system via the veins. Hence the attendant administering the transfusion is feeding the patient blood through the veins, and the patient receiving it is eating through his veins. " The Watchtower 1951; July:415.
     
  3. The Bible. Genesis 9:4, Leviticus 17:11–14, and Acts 15:20, 29.
     
  4. Parental rights not absolute: Newmark v Williams 588 A.2d 1108 (Del. 1991), Jacobson v Massachusetts 197 US 11 (1905), Hawaii v Standard Oil Co. 405 US 251 (1972); Rejection of the Free Exercise Clause: Prince v Massachusetts (1944) 321 US 158, Walker v Superior Court 763 P, 2d 852 (1988), Commonwealth v Barnhardt 497 A. 2d 616 (Pa. Super. 1985), Craig v State 220 Md. 590 (1959), People v Pierson 176 NY 201 (1903), State v Norman 808 P. 2d 1159 (Wash. Ct. App. 1991), Funkhauser v State 763 P. 2d 695 (1988), Commonwealth v Nickson 718 A. 2d 311 (Pa. Super. Ct. 1998), In Re Custody of a Minor 379 NE. 2d 1053 (Mass. 1978), Commonwealth v Twitchell 617 NE. 2d 609 (Mass. 1993).
     
  5. CYPA 1933, sections (1) and (2)(a) but liability here is not as a parent but as a person over 16 having the ‘custody, charge or care’ of a child under 16.
     
  6. Dwyer JG. The children we abandon: religious exemption to child welfare and education laws as denials of equal protection to children of religious objectors. North Carolina L Rev 1996;74:1321.
     
  7. Queensland Law Reform Commission. Consent to medical treatment of young people. Discussion paper 34–35 1995.
     
  8. Prince v Massachusetts (1944) 321 US 158 at 170.
     
  9. People ex rel.Wallace et al. v Labrenz et al., 104 N.E.2d 769 (IL 1952), Morrison v State 252 S.W.2d 97 (MO C. of A. 1952), State v Perricone 181 A.2d 751 (NJ 1962), Hoener v Bertinato 171 A.2d 140 (NJ Juv. & Dom. Rel. C. 1961), Santos v Goldstein 227 N.Y.S.2d 450 (NY 1962), In re Clark 185 N.E.2d 128 (OH C. of Corn. P1., Div. Of Dom. Rel. 1962), Jehovah’s Witnesses v King County Hospital 278 F. Supp. 488 (W.D. Wash. 1967) aff’d 390 U.S. 598 (1968), In re Green 448 Pa. 338, 292 A.2d 387 (PA Supreme Court, 1972), In re Sampson 317 N.Y.S.2d 641 (NY Fain. C. 1970), Muhlenberg Hospital v Patterson 320 A.2d 518 (NJ Sup. C., Law D. 1974), In Interest of Ivey 318 So.2d 53 (FL D.C. of A., 1 Dist 1975), In the Matter of Tara Cabrera, a Minor 552 A.2d 1114 (Pa. Super. 1989, In the Interest of JV, a Child 516 So.2d 1133, In the Matter of Baby Girl Newton 1990 WL 54916 (Del.Ch.) (unpublished opinion), In the Matter of Elisha McCauley 565 N.E.2d 411 (Mass. 1991), Cooper v Wiley 513 N.Y.S.2d 151 (A. D. 1 Dept. 1987).
     
  10. Re O (A Minor) (Medical Treatment) [1993] 1 FCR 925, [1993] 2 FLR 149, Re S (A Minor) (Medical Treatment) [1993] 1 FLR 376, Re R (A Minor) (Blood Transfusion) [1993] 2 FCR 544.
      
  11. Birkett v Director General of Family and Community Services (Unreported decision of Supreme Court of New South Wales, 3 Feb. 1994, No. 3161 of 1991), Dalton v Skuthorpe (unreported decision of Supreme Court of New South Wales, 17 Nov. 1992, No. 5094 of 1992, Marchant v Finney (unreported decision of Supreme Court of New South Wales, 31 July 1992, No. 3599 of 1992), Director General, Department of Community Services Plaintiff and BB Defendants [1999] NSWSC 1169 (19 November 1999).
      
  12. Custody of a Minor 375 Mass. 733, 379 N.E.2d 1053 (1978).
      
  13. Prince v Massachusetts (1944) 321 US 158, Custody of a Minor 375 Mass. 733, 379 N.E.2d 1053 (1978).
      
  14. Prince v Massachusetts (1944) 321 US 158, Jacobson v Massachusetts 197 U.S. 11 (1905).
      
  15. Re L. D.K.; Children’s Aid Society of Metropolitan Toronto v K and K (1985) 48 R.F.L. (2d) 164, 23 C.R.R 337, Re Y.(A.) (1993) 111 Nfld. & P.E.I.R 91, 348 A.P.R. 91, Walker (Litigation Guardian of) v Region 2 Hospital Corp. (1994) 4 RFL (4 th ) 321, 116 DLR (4 th ) 477, 150 NBR (2d) 366, 385 APR 366.
      
  16. H (T) v Children’s Aid Society of Metropolitan Toronto (1996) 138 DLR (4 th ) 144 (sub nom. Children’s Aid Society of Metropolitan Toronto v TH) 9 OTC 274, 37 CRR (2d) 270, U (C.)(Next Friend of) v Alberta (Director of Child Welfare). 2000 ABQB 626, [2001] 3 WWR 575, 273 AR 106, 87 Alta LR (3d) 144, 3 WWR 575, [2000] AJ No. 1067, Alberta (Director of Child Welfare) v H (B) 2002 ABPC 39, [2002] 11 WWR 752, 6 Alta LR (4 th ) 34, 31 RFL (5 th ) 16.
      
  17. In re EG 549 N.E.2d 322 at 328 (Ill. 1989), Belcher v Charleston Area Med. Ctr., 422 S.E.2d 827 (W. Va. 1992) and W. VA. CODE 16-30C-6 (1998); Cardwell v Bechtol 724 S.W.2d 739 (Tenn. 1987).
      
  18. Age of Legal Capacity (Scotland) Act 1991.
      
  19. Gillick v West Norfolk and Wisbech AHA [1985] 3 All ER 402.
      
  20. Re R (A Minor)(Wardship: Consent to Medical Treatment) [1992] Fam. 11, Re W (A Minor)(Medical Treatment: Court’s Jurisdiction) [1993] Fam, 64, Re S (A Minor)(Wardship: Medical Treatment) [1994] 2 FLR 1065, Re E (A Minor)(Wardship: Medical Treatment) [1993] 1 FLR 386, Re L (Medical Treatment: Gillick Competence) [1999] 2 FCR 524, [1998] 2 FLR 810.
      
  21. Re E (A Minor)(Wardship: Medical Treatment) [1993] 1 FLR 386, Re S (A Minor)(Wardship: Medical Treatment) [1994] 2 FLR 1065, Re L (Medical Treatment: Gillick Competence) [1999] 2 FCR 524, [1998] 2 FLR 810.
      
  22. Annotation. Religion as a Factor in Child Custody and Visitation Cases 22 ALR 4th 971 (1983).
      
  23. Erickson v Dilgard 252 N.Y.S.2d 705 (NY 1962).
      
  24. Application of President and Dir of Georgetown College, 331 F. 2d 1000 (D.C.Cir.1964), cert. Denied 377 U.S. 978 (1964), Raleigh Fitkin-Paul Morgan Memorial Hospital v Anderson 201 A.2d 537 (NJ 1964).
      
  25. Powell v Columbian Presbyterian Medical Center 267 N.Y.S.2d 450 (NY 1965).
      
  26. John F. Kennedy Memorial Hospital v Heston 279 A.2d 670 (NJ 1971).
      
  27. In re Estate of Dorone 517 Pa. 3, 534 A.2d 452 (1987), Werth v Taylor 475 N.W.2d 426 (Mich. App. 1991), In the Matter of Alice Hughes 611 A.2d 1148 (N.J.Super.A.D. 1992).
      
  28. In re Conroy 98 NJ 321, 486 A.2d 1209 (1985).
      
  29. In re Brown 478 So.2d 1033 (MS 1985).
      
  30. In re Brown 478 So.2d 1037 (MS 1985).
      
  31. Public Health Trust v Wons 500 So. 2d 679 Public Health Trust v Wons aff’d 541 So. 2d 96 (Fla. 1989), In re Duran 769 A.2d 497 (Sup. Ct. Penn 2001).
      
  32. Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital [1985] AC 871, 904F.
      
  33. In Re T (Adult: Refusal of Treatment) [1993] Fam 95 at 121H (per Lord Justice Staughton).
      
  34. Culver, CM. Advance Directives. Psychology, public policy and law 1998;4:676–87.[CrossRef]
      
  35. The Voluntary Euthanasia Society. Living wills. www.ves.org.uk/Deb-LivWill.html.
      
  36. Watchtower Bible and Tract Society of Pennsylvania. Jehovah’s Witness blood refusal card. New York: Watchtower Bible and Tract Society of New York, Inc, 1998.
      
  37. Watchtower Bible and Tract Society of Pennsylvania. How can blood save your life?. New York: Watchtower Bible and Tract Society of New York, Inc, 1990.
      
  38. Ridley DT. Honoring Jehovah’s Witnesses’ advance directives in emergencies: a response to Drs Migden and Braen. Acad Emerg Med 1998;5:824–35 quoting Prosser and Keeton on the Law of Torts Section 18, at 117 (5th ed, 1984),.[Abstract]
      
  39. Ridley DT. Honoring Jehovah’s Witnesses’ advance directives in emergencies: a response to Drs. Migden and Braen. Acad Emerg Med. 1998;5: 824–35, quoting President’s Commission for the Study of Ethical Problems in Medicine, Making Healthc Decis 1982;93.
      
  40. In re Estate of Darrell Dorone 534 A.2d 452 (Pa. 1987), Malette v Shulman 72 O.R.2d 417 (Ont. Ct. App. 1990).
      
  41. In re Estate of Darrell Dorone 534 A.2d 452 (Pa. 1987).
      
  42. In re Estate of Darrell Dorone 534 A.2d 452 (Pa. 1987.; "The emergency exception applies when immediate treatment is required to preserve life or prevent...serious impairment...but consent cannot be obtained from a patient...and there is no indication that the treatment would be refused were the patient...able to make his or her wishes known. ".
      
  43. Malette v Shulman 72 O.R. 2d 417: "the doctor could administer blood transfusions without incurring liability...if he had no reason to believe that the patient, if she had the opportunity to consent, would decline..., If he knows that the patient has refused to consent to the proposed procedure, he is not empowered to overrule the patient’s decision by substituting his decision for hers even though he, and most others, may think hers a foolish or unreasonable decision". (Ont. Ct. App. 1990).
      
  44. Malette v Shulman 72 O.R.2d 417 (Ont. Ct. App. 1990) at 431.
      
  45. HE v A Hospital NHS Trust [2003] EWHC 1017 (Fam), [2003] 2 FLR 408, [2003] Fam Law 733.

  
  

  Related Article

  Primary Survey

  Geoff Hughes
  Emerg. Med. J. 2005 22: 837. [Extract][Full Text]

  edited to remove text boxes overlapping main text of article ~ Scully
• 
  44

  AWESOME! New Article on Blood and Canadian Sextuplets

  by V in

  1. watchtower
  2. medical

  ethicist says b.c.

  blood feud may save children and jehovah's witness parents.

  published: thursday, february 1, 2007 | 8:46 pm et.

  1. 
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• 

  skeeter1

  No Apologies,

  It is well documented, and I have posted, that babies born at 25 weeks gestation have a 50-80% chance of survival with the right medical care. It is also well documented and I have posted, that these medical odds almost always includes MANDATORY blood transfusions. Why? These babies must be tested every few hours to determine if they are in jeapardy, if kidneys are failing, if blood sugar is too high, etc. etc. etc. Only a small amount of blood is taken for these tests, but these babies do not have the vast volumes of blood that we have. Further, a transfusion for these babies is a small syringe-full, not bags.

  These little ones do not "make" blood yet. Becuase their organs are developing, they are not the best candidates for erythropoiten (EPO) treatment (kidneys are not yet functional, and epo. depends on mature kidneys to kick start the blood production in the bones). Further, a drop in oxygen to the developing organs means the organs will not develop properly. We're talking brain damage, kidney failure, liver failure, etc. etc. etc. Plus, these little ones do not have functioning lungs. Lungs do not mature until the 33-35th week of pregnancy! Lungs = oxygen delivery = good organs. Without blood transfusions, the chance of death or severe disability is very high. It will really drop the 50-80% chance of survival.

  Let's look at the blood policy. Has it changed through the years? Yes. At one time, no blood products were allowed. Imagine if these kids were born then. Recombatant, human erythropoitien (if available) would not have been allowed in the 1950s, as it was a blood product since it contains a small amount of albumin. http://www.cim.sld.cu/productos/productos_ing.asp?var=11 . Today, the Watchtower Society is pushing this human epo, hemoglobin, albumin, immunoglobins, etc...all of which they call "blood fractions." No where in the Bible does it say that we can have blood fractions. It's like saying, don't eat the fruit of that tree in the garden's center, but it's ok to eat apple sauce, apple juice, apple cider, apple pie made from that fruit. If the individual blood fractions were added together, they would equal a whole unit of blood if added together. The Watchtower Society no longer believes that one should abstain from blood, so I do not see what the big deal is over giving these babies a syringe of blood.

  The Watchtower 2000; June 15:29-31
  See also Watchtower Advance Directive, page 11, 1.3(b)
  
  

  Watchtower policy permits the transfusion of cow's blood? True or False - see answer Watchtower Society approves Hemopure for Jehovah's Witnesses In a truly remarkable development, the Watchtower Society has ruled that a new oxygen carrying solution made from cow's blood can be used by (JWs) Jehovah's Witnesses. This despite the Watchtower Society's purported biblical ban on the storage/use of animal blood. Nonetheless, members may not pre deposit their own blood or even use certain tiny human blood products like platelets that are frequently required during chemotherapy. Internal Opposition to WTS Policy Mounts Some Jehovah's Witnesses believe that a blood transfusion is a liquid tissue or organ transplant, not a meal, and hence does not violate the biblical admonition to "abstain from [eating] blood." The Watchtower Society attempts to deny these members, many of them born to JW parents, a free choice in their medical care by means of controls and sanctions - namely enforced shunning by JW family members and friends. They have been persecuted for their conscientious beliefs by their own religious organization which presents itself as a champion of human rights. AJWRB members in the United States, Netherlands, and United Kingdom have been disfellowshipped for questioning the Watchtower's irrational blood policy.

  Watchtower policy permits the use of some but not all of these blood components. True or False - see answer Percentage of total weight of blood At one time Jehovah's Witnesses (JWs) prohibited the use of every blood component shown here. The Watchtower has gradually permitted each component to be used, first globulin, then the clotting factors, plasma proteins and finally hemoglobin in June of 2000. The Watchtower still insists that JWs “abstain from blood”. Since permitted blood components total 100% many have asked, "What is actually forbidden?". Permitted blood components are processed from donated, stored blood. JWs benefit from the blood components donated by others but they are forbidden from donating to the blood supply. Is such a policy ethical and in accordance with well established Christian principles?

  Since the blood policy has changed, what would you do if this was the 1950's? Let these children die for a policy that would change over & over again in the 1960's, 1970's, 1980's, 1990's, and 2000's? These children would have died for a cause that changed. Since blood is allowed, albeit in parts, why let these babies die?

  In the JW faith, we say that children can not be baptised until they are mature. We looked down on other religions whose parents baptised their children while infants. Why? These children were "too young" to make the personal decision to dedicate their lives to Jehovah. Yet, you are willing to let these children DIE for Jehovah?

  As for your abortion argument, I personally think abortion is wrong. But, the US courts do not. The US courts look at the "point of viabilty" argument. If the fetus has a hope of survival outside the womb, abortion can not be performed unless it is medically necessary (meaning the mom would suffer dire consequences). Thus, abortions are not generally performed on 23+ weeks gestation. Where the fetus would not survive outside the womb, abortion can be performed.

  Skeeter
• 
  61

  IF YOU TALK TO THE MEDIA ON BLOOD, FOCUS/GET THIS POINT IN

  by skeeter1 in

  1. watchtower
  2. medical

  i've read alot of stories on the sextuplets, and it's great to have the media reporting 'bad' light on the no-blood policy & jws in general.

  but, we need to ramp it up.

  the media is missing the big story - the fraction lie.

  1. 
  2. 
  3. 
• 

  skeeter1

  Gary,

  Finally, here's another JW who ACTUALLY accepted Polyheme. http://www.google.com/search?q=jehovah%27s+witness+and+polyheme&hl=en&rls=GWYA,GWYA:2005-06,GWYA:en&start=30&sa=N

  I've got to get ready for my superbowl party. Go Colts.

  : Transfusion. 2002 Nov;42(11):1422-7. Links

  Comment in:

  Transfusion. 2003 Feb;43(2):280-7.

  Polymerized human Hb use in acute chest syndrome: a case report.

  • Lanzkron S ,
  • Moliterno AR ,
  • Norris EJ ,
  • Gould SA ,
  • Segal J ,
  • Nuermberger EL ,
  • Ness PM .

  Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. [email protected]

  BACKGROUND: Acute chest syndrome (ACS) is a complication of sickle cell disease that can cause significant morbidity. Transfusion therapy has been shown to significantly increase oxygenation in patients with ACS and RBC exchange is considered the standard of care in patients at high risk of respiratory failure. CASE REPORT: A patient with ACS and several high-risk features, including thrombocytopenia, profound anemia, bilateral pulmonary infiltrates, staphylococcal sepsis, and pulmonary embolism is presented. The patient refused transfusion on religious grounds and received 12 units of human polymerized Hb solution (poly SFH-P injection, PolyHeme, Northfield Laboratories) over the course of 13 days. The patient's respiratory status improved and she was discharged home without receiving RBC transfusions. CONCLUSION: This is the first reported case that describes the use of PolyHeme in a patient with sickle cell disease, ACS, and sepsis. This therapy is thought to have been lifesaving for this patient.

  PMID: 12421214 [PubMed - indexed for MEDLINE]
• 
  61

  IF YOU TALK TO THE MEDIA ON BLOOD, FOCUS/GET THIS POINT IN

  by skeeter1 in

  1. watchtower
  2. medical

  i've read alot of stories on the sextuplets, and it's great to have the media reporting 'bad' light on the no-blood policy & jws in general.

  but, we need to ramp it up.

  the media is missing the big story - the fraction lie.

  1. 
  2. 
  3. 
• 

  skeeter1

  Gary,

  Here's another MEDICAL article on ACTUAL JWs getting ACTUAL hemoglobin (Polyheme). http://www.blackwell-synergy.com/links/doi/10.1111/j.0958-7578.2004.00502.x/abs/

  Transfusion Medicine

  Volume 14 Issue 3 Page 241 - June 2004

  To cite this article: C. C. Cothren, E. E. Moore, J. S. Long, J. B. Haenel, J. L. Johnson, D. J. Ciesla (2004)
  Large volume polymerized haemoglobin solution in a Jehovah's Witness following abruptio placentae
  Transfusion Medicine 14 (3), 241–246.
  doi:10.1111/j.0958-7578.2004.00502.x

  Prev ArticleNext Article Full Article

  Case Report

  Large volume polymerized haemoglobin solution in a Jehovah's Witness following abruptio placentae

  • C. C. Cothren * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA 1 1 C. Clay Cothren, MD, Department of Surgery, Denver Health Medical Center, 777 Bannock Street, MC 0206, CO 80204, Denver, CO, USA. Tel.: +1 303 436 6558; fax: +1 303 436 6572; e-mail: [email protected] ,
  • E. E. Moore * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA ,
  • J. S. Long * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA ,
  • J. B. Haenel * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA ,
  • J. L. Johnson * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA and
  • D. J. Ciesla * *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA

  • *The Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, CO, USA

  1 C. Clay Cothren, MD, Department of Surgery, Denver Health Medical Center, 777 Bannock Street, MC 0206, CO 80204, Denver, CO, USA. Tel.: +1 303 436 6558; fax: +1 303 436 6572; e-mail: [email protected]

  Abstract

  Summary. Severe anaemia, with haemoglobin (Hb) levels =3 g dL Carson et al., 2002 ; Practice guidelines for blood component therapy. 1996 ; Consensus Conference. 1988 ; Hebert et al., 1999 ), few would argue the risks associated with Hb levels less than 5 g dL We describe a Jehovah's Witness patient who exemplifies the marked physiologic derangements of severe anaemia and subsequent clinical resolution with large volume polymerized human Hb transfusion. The Hb-based oxygen carrier, PolyHeme®, provided adequate oxygen transport, acting as a bridge until endogenous production could compensate for red cell loss. Practicing physicians need to be aware of current therapeutic options for use in these complicated patients.
• 
  61

  IF YOU TALK TO THE MEDIA ON BLOOD, FOCUS/GET THIS POINT IN

  by skeeter1 in

  1. watchtower
  2. medical

  i've read alot of stories on the sextuplets, and it's great to have the media reporting 'bad' light on the no-blood policy & jws in general.

  but, we need to ramp it up.

  the media is missing the big story - the fraction lie.

  1. 
  2. 
  3. 
• 

  skeeter1

  Gary,

  Here's another medical article on Jehovah's Witnesses ACTUALLY using ACTUAL hemoglobin. http://content.nejm.org/cgi/content/extract/347/9/696-a

  Combined Blood Substitute and Erythropoietin Therapy in a Severely Injured Jehovah's Witness

  	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

  Full Text PDF PDA Full Text Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article Find Similar Articles PubMed Citation

  To the Editor: We disagree strongly with the conclusions ofCothren et al. (April 4 issue) 1 about the benefits of the polymerizedhemoglobin-based oxygen carrier PolyHeme in critically ill patientswith anemia who refuse transfusions. Hemoglobin-based oxygencarriers are administered in such patients to increase oxygendelivery to the tissues, in order to maintain or restore oxygenuptake. Yet no data on tissue oxygen balance before and afterthe administration of the product are presented. Such productsmay not be associated with increased oxygen delivery when theycause vasoconstriction in the peripheral circulation and decreasecardiac output. 2 , . . . [Full Text of this Article]

  Related Letters:

  Blood Substitute and Erythropoietin Therapy in a Severely Injured Jehovah's Witness
  Cothren C., Moore E. E., Offner P. J., Haenel J. B., Johnson J. L.
  Extract | Full Text | PDF
  N Engl J Med 2002; 346:1097-1098, Apr 4, 2002. Correspondence
• 
  61

  IF YOU TALK TO THE MEDIA ON BLOOD, FOCUS/GET THIS POINT IN

  by skeeter1 in

  1. watchtower
  2. medical

  i've read alot of stories on the sextuplets, and it's great to have the media reporting 'bad' light on the no-blood policy & jws in general.

  but, we need to ramp it up.

  the media is missing the big story - the fraction lie.

  1. 
  2. 
  3. 
• 

  skeeter1

  Gary,

  Here's another medical article on Jehovah's Witnesses ACTUALLY using ACTUAL hemoglobin. http://content.nejm.org/cgi/content/extract/347/9/696-a

  Combined Blood Substitute and Erythropoietin Therapy in a Severely Injured Jehovah's Witness

  	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

  Full Text PDF PDA Full Text Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article Find Similar Articles PubMed Citation

  To the Editor: We disagree strongly with the conclusions ofCothren et al. (April 4 issue) 1 about the benefits of the polymerizedhemoglobin-based oxygen carrier PolyHeme in critically ill patientswith anemia who refuse transfusions. Hemoglobin-based oxygencarriers are administered in such patients to increase oxygendelivery to the tissues, in order to maintain or restore oxygenuptake. Yet no data on tissue oxygen balance before and afterthe administration of the product are presented. Such productsmay not be associated with increased oxygen delivery when theycause vasoconstriction in the peripheral circulation and decreasecardiac output. 2 , . . . [Full Text of this Article]

  Related Letters:

  Blood Substitute and Erythropoietin Therapy in a Severely Injured Jehovah's Witness
  Cothren C., Moore E. E., Offner P. J., Haenel J. B., Johnson J. L.
  Extract | Full Text | PDF
  N Engl J Med 2002; 346:1097-1098, Apr 4, 2002. Correspondence