When obtaining knowledgeable consent from a Jehovah’s Witness for remedies involving blood merchandise, incongruent, inconsistent and uninformed conduct may be noticed. This article supplies background on why this inhabitants might refuse remedy and suggests methods to strategy the patient that may optimize outcomes. A licensed psychotherapist and former Jehovah’s Witness weighs in on beliefs, inside turmoil and out of doors pressures skilled by those refusing blood remedy.
Caring for a Jehovah’s Witness patient, who refuses to allow a blood transfusion presents ethical challenges for medical professionals. Nevertheless, understanding the refusal of remedy from the affected person’s point of view can present a window of opportunity to succeed in those who initially refuse remedy.
You might meet a affected person who outwardly appears to stubbornly refuse blood merchandise in any respect costs. But in all probability, the individual is experiencing a values battle (acutely aware or unconscious), which causes appreciable emotional turmoil.
Background and Beliefs
The Jehovah’s Witness father or mother group, referred to as Watchtower or JW.org, propagates material citing Bible verses to justify their coverage that sacredness of blood ought to affect medical remedy. On the similar time, the organization controls members’ access to medical information, including benefits of blood transfusion therapy and limitations of options. The organization’s insurance policies on blood products shift once in a while. Remarkably, many Jehovah’s Witnesses are oblivious to current coverage shifts that permit administration of 100% of blood in fractionated type, and without religious consequence.
It may be safely assumed that any Jehovah’s Witness (JW) patient, who refuses to simply accept a blood transfusion, has been subjected to a steady routine of calculated indoctrination over a period of years. Most born-and-raised members have assimilated these beliefs, policies and expectations because the organizing rules of their lives.
If a physician’s dominant organizing principle is to preserve life and reduce suffering, a JW devotee’s dominant organizing life principle is strict obedience to God and His group (JW.org), which calls for loyalty, even to the demise. Appreciable thought-control has been imposed to arrive at this place.
Declining blood, and martyring themselves, they are taught, assures God’s favor and blessing. JWs consider that even if they die, they are keep alive in God’s memory and will probably be resurrected to life on a paradise earth quickly after the approaching holocaust they call Armageddon.
JWs expertise info management by way of isolation from alternate, balancing views. They’re dissuaded from associating with non-believers, or viewing materials which will contradict JW dogma. As a result of their friendships and family are restricted to those who are working towards JWs, defying this authority might end in a complete loss of their social help network, turning into disapproved, and finally being shunned.
They know that if their church turns into aware they accepted a blood transfusion (often as a result of posting “support persons” on location at the hospital), they’ll both experience a bodily demise by refusing life-saving remedy or a social dying in the event that they accept it. Threats of condemnation, expulsion from their church, shunning and public disgrace are a certainty if JWs defy expectations for their behaviors and decisions.
On account of this pervasive control, and since their id, worldview and religious hopes are woven into all the repetitive indoctrination, any contradictory info that causes discomfort and nervousness may be dismissed from their thoughts and blocked out. Details will not be thought-about resulting from worry and strict black and white considering. Many will routinely label what the physician tells them as misguided, ignorant of Biblical rules, and a temptation from The Devil to desert their obedience to Jehovah God and His chosen organization.
JW patients could also be troublesome to attach with in a conversation, appearing resigned to their “fate.” They could be reluctant to debate options, feeling it is ineffective to even attempt to explain to ‘outsiders’ what is going to happen to them in the event that they disobey their God and accept the blood remedy.
JW patients are caught in a terrible bind. If they refuse the life-saving remedy provided, they’ll probably die. In the event that they flout their beliefs and settle for the blood transfusion, they will be shamed and shunned by most, if not all, their friends and family. They danger their relationship with Jehovah God and consider that abandoning their beliefs will result in everlasting destruction. As nicely, these sufferers have already sacrificed a regular life to be a member of a strict, high-control group. All this investment makes it rather more troublesome to abandon beliefs.
At this level, the JW patient is in the middle of a full-blown existential crisis. Most be a part of and stay in the organization to keep away from the angst associated to normal human fears and insecurities. Belonging to a group that gives all of the answers and provides immortality, they could not really feel capable of make their life significant by means of their very own decisions and efforts.
Now, in spite of efforts to hide and shield themselves from having to cope with ultimate considerations of human existence, if they need to extend their life now, they should go towards one of their acquired beliefs about how to ensure everlasting life.
They deal with this whereas feeling bodily weak and emotionally distraught, and should have problem considering rationally. It’s a lot simpler to rely on programmed beliefs and well-rehearsed rationale, fairly than dealing with internal chaos.
Some conflicted JWs may be secretly relieved if they’re given a life-saving blood transfusion before the hospital discovers their “no-blood card”. This is a card stored of their wallet as an advance medical directive. Since there’s disparity in the commitment each particular person
JW.org has instituted a policy of sending a Three-elder Hospital Liaison Committee to the hospital when a JW is in medical disaster. JWs who don’t notify their local elders about anticipated or actual medical emergencies for themselves, or other believers, are seen as spiritually negligent. This committee’s presence and prayers serve to remind the patient of what is going to occur if they are disobedient. Any patient or household of an unconscious JW will certainly really feel they’re being torn between competing info from the medical group and the JW dogma.
Whereas there are not any quick fixes to this dilemma, there are assets corresponding to Advocates for JW’s Reform on Blood (AJWRB.org), tasked with supplying up-to-date references, informational instruments and studies on-line as a life-saving counterpoint to JW doctrines on blood refusal.
Breaking by way of manipulative mind-control takes time and the power to purpose, mirror and entertain new info; most medical emergencies do not afford the posh of time, and there’s minimal means to study one thing new in a high-stakes state of affairs.
Issues in Obtaining Knowledgeable Consent
The doctor’s efforts at this point to offer life-saving info, which outweighs primitive beliefs, might fall on deaf ears. Physicians can solely hope that repeated explanations of the dangers of refusal to deal with might pierce via the spiritual programming and dread of ensuing punishments. In this case, keep in mind that you’re not providing life-saving info and interventions to a typical patient with an open, affordable thoughts. You’re working urgently to convince individuals underneath the consequences of mind-control of the seriousness of their state of affairs.
Greater order considering (analysis, evaluation, organization, synthesis, complicated reasoning, essential considering, problem-solving, applying ideas to novel conditions, and so forth.) might not yet be developed or permitted in individuals conditioned to receive info from a single source and who unquestioningly obey. JWs may be baptized in youth and held to the identical standards as adults prior to any capacity for important considering. Furthermore, JW culture actively discourages greater studying; the majority of JWs would not have schooling beyond high school (thought-about a unnecessary use of assets that can be redirected to volunteering for the organization).
However, there are individual variations in the best way JWs have absorbed the beliefs of their church. Like automobiles in separate visitors lanes, the pace of the extremism does range by particular person within the organization. It’s to be hoped that there are already doubts in place that could be accessed when a individual’s life is threatened.
JW.org ceaselessly modifications the rules for what blood products and derivatives are allowed and never allowed. So, the patient might not have a clear understanding of what they’re accepting or rejecting, and the shortage of good options. They could overestimate the effectiveness of blood transfusion options, or lack readability on logistical and religious permissibility of advance donation of their very own blood, or blood fractions. There could also be earnest or paternalistic clouding of this info by the JW Hospital Liaison Committee (HLC).
All one can do is current the case for life-saving care and hope that some measure of cause prevails. Most hospitals have insurance policies and procedures in place to advocate legally for youngsters underneath the management of this undue affect.
Regardless of whether the JW patient maintains their refusal or accepts a blood transfusion, the affected person will endure considerable emotional pain. They may finally have to debrief with a skilled. This should take place out of earshot of the controlling HLC or other visiting JWs – tasked with making certain compliance and reporting variances. Speaking (if they’re in a position) will permit them to profit from the cognitive reorganization that takes place when one can inform their story of disaster and inside conflict.
A medical skilled who cares for a patient who expires as a consequence of their refusal of blood, must be provided therapeutic help or counseling.
Efforts to interact JWs in productive informed consent conversations (a number of could also be required) is worth it. The more the JW affected person knows their choices, the more possible they are to exercise them, or at the very least find some peace in their decision-making process.
Bonnie Zieman, M.Ed.
Licensed Psychotherapist (retired)
Board Member of Open Minds Foundation
Exiting the JW Cult: A Therapeutic Handbook
Cracking the Cult Code for Therapists
Shunned: A Survival Information
Kerry Louderback-Wood, Journal of Church and State. http://ajwrb.org/jehovahs-witnesses-blood-transfusions-and-the-tort-of-misreprersentation
These “no blood” cards are often signed throughout group meetings the place it isn’t troublesome to imagine that some signal underneath “duress”, especially as they know their cards will in all probability be inspected by JW elders on the assembly.