LEGAL AND ETHICAL ISSUES

Legal and Ethical Issues



Legal and Ethical Issues

Introduction

The refusal of Jehovah's Witnesses on religious grounds to take blood transfusions has been an important issue in the recent history of United States jurisprudence. The issue of compulsory blood transfusions has not been addressed by the Supreme Court, but significant litigation has occurred in the lower courts. From the viewpoint of society as a whole, one might think a resolution of this issue is not urgent, since it affects so few people. Efforts are being made to use replacement fluids when possible with Witnesses in order to avoid blood transfusions. To the Jehovah's Witness who is being urged to take a transfusion and to the medical professional faced with a difficult.

The issue of refusal of blood transfusions is a complex one. What interest should the state have in the individual? How compelling is this interest? Besides being a life-and-death issue, the blood transfusion question is complicated by the problem of religious freedom. How absolute can, or should, freedom of religion be? Free exercise of religion has been given a position of honor by the Constitution of the United States. How far can the state go in limiting this right? Even though the Supreme Court has never ruled on this question, it has been termed the "ultimate challenge to the states limitation power--the right of an adult to refuse medical treatment on the basis of religious conviction even at the risk of death."4 In the lower courts there have been numerous cases from which a legal background for future decisions is being developed (Ott, 1977, 1256). The issues at stake are the conflicting and complex individual rights versus the rights of society. How are these various rights to be weighed? Which is to be given precedence? First, there are the rights of the individual.

Ethical Challenge

Physicians face a special challenge in treating Jehovah's Witnesses. Members of this faith have deep religious convictions against accepting homologous or autologous whole blood, packed RBCs [red blood cells], WBCs [white blood cells], or platelets. Many will allow the use of (non-blood-prime) heart-lung, dialysis, or similar equipment if the extracorporeal circulation is uninterrupted. Medical personnel need not be concerned about liability, for Witnesses will take adequate legal steps to relieve liability as to their informed refusal of blood. They accept nonblood replacement fluids. Using these and other meticulous techniques, physicians are performing major surgery of all types on adult and minor Witness patients. A standard of practice for such patients has thus developed that accords with the tenet of treating the "whole person (Henling, 1985, 914).

Physicians face a growing challenge that is a major health issue. There are over half a million Jehovah's Witnesses in the United States who do not accept blood transfusions. The number of Witnesses and those associated with them is increasing. Although formerly, many physicians and hospital officials viewed refusal of a transfusion as a legal problem and sought court authorization to proceed as they believed was medically advisable, recent medical literature reveals ...