![]() Today some blood products are acceptable for all JW, while others are to be considered by an individual patient (Figure 1). Īs medicine developed, blood and plasma preparation became more and more nuanced, and JW gradually liberalized the transfusion ban. A JW patient who accepted blood products under pressure would be judged individually by the leaders. However, if the procedure has been carried out despite the patient’s objections, the recipient may stay in the community and be supported by fellow believers. Since 1961 reception of blood products has resulted in exclusion from JW congregation. The refusal of blood treatment worsened JWs’ relationship with state institutions and society. It was established in 1945, caused by JW leaders’ distrust of institutional medicine and their critical opinion about military service, as in those days blood transfusion was strongly associated with treatment of war wounds. The prohibition of blood transfusion amongst JW is generally considered characteristic and distinctive for the group, yet it was not established in the early days of the Congregation. ![]() The faithful see refusal of blood transfusion as an act of obedience to God, which will guarantee them eternal life. Anyone eating it will be cut off.”) and Deuteronomy (“Just be firmly resolved not to eat the blood, because the blood is the life, and you must not eat the life with the flesh.”). They equate blood transfusion with blood consumption, which would be contrary to biblical recommendations in Genesis (“Only flesh with its soul – its blood – you must not eat.”), Leviticus (“You must not eat the blood of any sort of flesh, because the soul of every sort of flesh is its blood. Nowadays, it has about eight million of followers. The Christian Congregation of Jehovah’s Witnesses was established in 1872 in the USA. In such circumstances “the good of the patient” is often differently understood by those involved, where physicians tend to perceive it as a choice of the most effective and safe procedures, whilst patients prefer to stay within the boundaries of religious rules. The patient’s refusal of treatment stemming from their religious beliefs presents much more of a challenge. Urgent situations, due to time limitations, may pose difficulties however, consensus is still possible, if there is the slightest chance of discussion. The effectiveness of persuasion can depend on communication between both parties and their motivation to cooperate. If such an objection derives from the patient’s lack of knowledge leading to fear and dilemmas, there is still a chance to dispel the patient’s doubts and convince them to accept therapy. Historical view, ethical and moral dilemmasīy the rules of the Code of Medical Ethics, the physician is obliged to treat the patient according to their best will and knowledge however, there are some situations in which, despite their best will and competence, physicians remain helpless because of the patient’s refusal of treatment. It is estimated that every year 1000 JW die because of blood refusal. Russo et al., describing a case of a JW pregnant multipara after two caesarean sections with placenta praevia invading her urine bladder, found the risk of death to be 130-fold higher than in a patient who would accept blood transfusion. British data indicate that in the UK the risk of death related to obstetric complications is 65 times higher in this group than in the general population in the USA such risk is estimated at 44 times higher. Jehovah’s Witness (JW) women are in a high obstetric risk group. Currently no other equally effective treatment is known. In such circumstances there is an indication to transfuse red blood, plasma and platelets. ![]() Excessive blood loss requires comprehensive treatment to maintain peripheral tissue oxygenation, adequate volume of the intravascular compartment and coagulation. ![]() Due to the speed of its development, peripartum haemorrhage can, in a very short time, lead to life-threatening hypovolaemic shock. To this day, haemorrhage, complicating up to 5% of labours, is one of the most common obstetric causes of morbidity and mortality in women. ![]()
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