Caring for the Jehovahʼs Witness Parturient

Abstract

A llogeneic blood transfusion is considered by Jehovah's Witnesses to be a violation of God's law, and this can present many ethical, legal, and health concerns when medical care is needed. Especially in cases dealing with childbirth, where substantial blood loss can occur, having an efficient and effective plan and line of communication between the parturient and her caregivers is crucial to ensure the most beneficial outcome for the patient while respecting her constitutionally protected right to make an informed choice about her medical treatment. The authors of this article reviewed concepts and care options as they related to the perioperative care of a Jehovah's Witness parturient. Courts have upheld that competent pregnant women have the right of bodily self-determination and therefore can refuse blood transfusion. This article established the importance of having a patient's care preferences and directives clearly expressed. For example, patients may do this in writing by using an advance health care directive, which would clearly delineate their personal decisions not only on blood transfusion but also in regard to derivatives of plasma or cellular blood components and autologous blood management, which are “conscience” items on which Witnessesmake individual decisions. Although patients have the right to decline treatments, the physician also has a duty to disclose any risks associated with refusing a treatment and to educate patients on alternative treatments. Communication between parturients and their medical caregivers is key throughout the entire treatment process. This article suggests using a perioperative surgical home model to coordinate care throughout the entire surgical experience as this model is fitting for the unique needs of the Jehovah's Witness population. The use of pharmacologic therapies is also recommended when alternatives to blood transfusion are needed. The authors of this article also suggest several options for reducing perioperative transfusion requirements and medical options for Jehovah's Witness patients who experience a massive hemorrhage. Blood conservation techniques should be considered as Jehovah's Witnesses have differing opinions about what treatments are allowed. Although some Jehovah's Witness parturients may consent to the use of acute normovolemic hemodilution and blood cell salvage, other Witnesses may have stricter specifications. Anesthetic and surgical techniques should be executed in a way that decreases blood loss. Again, the authors emphasize communication between patients and caregivers to expedite any necessary interventions in the threat or event of hemorrhage. The care of a Jehovah's Witness parturient must encompass all medical, ethical, and legal considerations. This article stresses the establishment of a communicative and comprehensive model early in the antepartum period that can be maintained throughout