1. Making Ethical Decisions Presented by: Marc Blumstein Sarah Campbell Karen King Vona Martin Jessica Silva Roxanne White

2. Step 1: Identify the Ethical Dilemma Should a Jehovah's Witness freedom to accept or refuse medical treatment in order to uphold certain religious beliefs take precedence over a health care professionals oath to preserve life?

3. Step 2: What are the Facts? The Jehovah’s Witness religion was started in the early 1800’s by founder Charles Taze Russell Jehovah’s Witness beliefs are established by a governing body, which assumes responsibility for interpreting and applying scripture. In the medical community Jehovah’s Witness are known for refusing certain medical procedures because of their beliefs. Jehovah’s Witness do accept medical treatment but they do believe that blood transfusions is forbidden by biblical passage. "Only flesh with its soul—its blood—you must not eat" (Genesis 9:3-4); "[You must] pour its blood out and cover it with dust" (Leviticus 17:13-14); and "Abstain from... fornication and from what is strangled and from blood" (Acts 15:19-21). ”

4. Step 2: What are the facts? Table 1 Current policy and practice of prohibited and acceptable treatments Prohibited Blood Components and Procedures Acceptable Blood Components and Procedures Whole blood Plasma proteins (albumin, globulin, fibrin) Red blood cells Clotting factors Platelets Stem cells Plasma Hemodilution, cell saver Hemoglobin solution Bone marrow transplants Stored autologous blood Extracorporeal circulation (heart-lung machine, dialysis, plasmapheresis) Blood donation Use of donated blood (to take acceptable components)

5. Step 3: Stakeholders Patient Patient’s advocate Healthcare Professionals (the Doctors and Medical Staff) Administrators Religious Organizations (Jehovah’s witness)

6. Step 3: Stakeholders Maintain quality of life Receive quality healthcare Personal religious beliefs to be respected Care be prompt and with in reason Be made aware of all information concerning diagnosis and treatment Included in on all aspects of care Permitted to participate in decision making Patients

7. Step 3: Stakeholders Health Care Professionals: Want care given to benefit the patient Want to provide quality of care Want to follow policy and procedure Do no harm

8. Step 3: Stakeholders Administrators: Want care to benefit patient Promote quality of care Feel rules should be applied fairly Have a obligation to follow policy and procedures Want to allocate resources efficiently Respect a patients religious freedom

9. Step 3: Stakeholders Religious Organizations (Jehovah’s Witness ): Includes patient’s family, religious leaders and followers, and everyday citizens Concerned with quality of life and healthcare Concerned with respect for personal religious beliefs Concerned with patient rights

10. Step 3: Stakeholders Religious Organizations (Jehovah’s Witness): History of Jehovah’s witnesses Early 1900’s, donating blood and commercial and emergency use of blood was commended. 1944: forbade eating or drinking blood via transfusion or mouth (Genesis 9:4 and Leviticus 17:10-14) 1945: doctrine expanded to prohibit blood transfusions (whole blood) 1956: prohibited blood fractions 1989: left to individual to decide May 2001: doctrine stated that blood transfusions were not acceptable, later revised

11. Step 4: What options are available for the stakeholders? Patients: Patients should be able to refuse or accept treatment based on their beliefs Patients may seek care at other facilities if they feel their beliefs are not respected Parents of children should be able to determine which treatments their child will receive

12. Step 4: What options are available for the stakeholders? Options for Healthcare Professionals: Healthcare professionals may treat the patient according to their beliefs, even if it means withholding life-saving treatment Professionals should follow policies and protocols Healthcare professionals can have other professionals treat the patient if they are unable to support the patient’s beliefs

13. Step 4: What options are available for the stakeholders? Options for Administrators: Administrators need to ensure that the patient’s rights are upheld Administrators should work with the patients and caregivers to see if any compromise can be reached Administrators may also research the patient’s religious organization to verify if any additional information is available

14. Step 4: What options are available for the stakeholders? Options for Religious Organizations: Religious organizations should be available to help determine which method of care is best suitable for the individual patient Organizations should offer guidance but allow the patient to make their own decisions Religious organizations should work with all of the parties involved to ensure that the care given is the best for all concerned

15. Step 5:What should I do? We will respect the competent patient's right to determine his or her treatment. Competent is defined as someone who is able to make a decision for himself. They can understand and retain the information relevant to the decision, weigh that information as part of the process of making the decision, and communicate that decision. This reflects our respect for the autonomy of the individual. Autonomy-The right of patients to make decisions about their medical care without their health care provider trying to influence the decision.

16. Step 6: Is it Justified Two theories to help justify the decision: 1. Utilitarianism- states that actions are right to the extent that they tend to promote happiness and wrong to the extent that they promote the reverse of happiness. Jehovah’s Witnesses refuse blood transfusions, they consider it a violation of God’s law Refuse blood transfusion in a “life or death situation” They believe that their beliefs out way the consequences Obligation to withhold their beliefs, which is more important then being alive

17. Step 6: Justification continues 2. Deontological theory- Considers whether it is one’s duty to perform or not perform an action. It is the healthcare professionals job to follow their ethical obligation to help and treat patients. –Can a physician let a patient die because they refused to accept a blood transfusion? –Must follow Physician’s Oath “I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.” Nonmaleficence, or the principle of "doing no harm,“ Professionals would be doing harm by not treating the patient appropriately.

18. Court cases involving Jehovah’s Witnesses Numerous cases involving Jehovah’s Witnesses have been heard by Supreme Courts throughout the world. June 26 th, 2009 Supreme Court in Canada issued a decision saying courts must take into account maturity of minor before ruling of medical treatment. –Case involved young adult only identified as A.C. –Admitted to hospital with internal bleeding as a complication of Crohn’s Disease –Doctors ordered a blood transfusion, but patient and parents refused –Justice on the case stated: "A young person is entitled to a degree of decisional autonomy commensurate with his or her maturity.".

19. Step 7: How can this problem be prevented? People have the right to their own beliefs. Healthcare facilities can create protocols to follow for religious based patient care. The healthcare provider should talk to the patient about what they might accept and what they do not want. This should be done as soon as the situation warrants it.

20. Step 7: How can this problem be prevented? The Hospital Liaison Committee of Jehovah’s Witnesses provides information to hospitals. Provide assistance in hospitals with patients in major cities. This group can assist patients in making these health decisions within their beliefs.

21. References Jehovah's witnesses the surgical/ethical challenge. (1981). The Journal of the American Medical Association, 246(21), Retrieved from http://www.watchtower.org/e/hb/article_06.htm http://www.watchtower.org/e/hb/article_06.htm Jehovah Witnesses and Blood Transfusion retrieved from http://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_blood_transfusions http://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_blood_transfusions Muramoto, O. (n.d.). Recent developments in medical care of jehovah’s witnesses. Western Journal of Medicine, Retrieved from http://www.ajwrb.org/wjm/wjm.htm http://www.ajwrb.org/wjm/wjm.htm Home > doctrine & changes > jehovah’s witness beliefs jehovah’s witness beliefs. (2009, July 6). Retrieved from http://www.watchtowerinformationservice.org/doctrine-changes/jehovah- witness-beliefs/ http://www.watchtowerinformationservice.org/doctrine-changes/jehovah-