Judge orders blood transfusion for Jehovah’s Witness child

15 December 2014 by

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An NHS Trust v Child B and Mr and Mrs B [2014] EWHC 3486 (Fam) – read judgment

I posted earlier this year a discussion of Ian McEwan’s pellucid and moving account of the difficulties encountered by judges when steering between the rock of parental faith and the hard place of children’s best interests (The Children Act, 2014).

This judgment, although handed down four months ago, has just been published, and confirms that judges may be resolute, however politely,  in the face of parents’ insistence that they know what is best for their children. 

Background Facts

The application concerned a very young child (B) who sustained burn injuries in an accident. The clinical team responsible for his care advised that the best practice treatment for his injuries was skin grafting and that there was a significant risk that he would require a blood transfusion . To avoid infection and for the best possible result, skin grafts should be carried out no later than 7 to 10 days from the initial burn. The Court was also told that in the event of a skin graft taking place without the ability to give a blood transfusion, there would be a risk of death as a result of sepsis developing.

B’s parents are both devout Jehovah’s Witnesses and as a result of their faith they did not agree to and object to B being given blood transfusions. They could not accept blood being provided to B during the course of any operation or indeed under any circumstances because blood, in their faith, is sacred.

As B is a child, no one else could give consent for this treatment other than this court.

The Court’s decision

It was clear to Moylan J that it could not be in B’s best interests for him to be exposed to a risk of death – however small – if that can be avoided. As Ward LJ said in In re A (Children)(Conjoined Twins: Surgical Separation) [2001] Fam 147,

although I must give “very great respect” to the parents’ wishes, they are “subordinate to welfare”

The risks consequent on a blood transfusion are nothing like the nature of the risk to which B would be exposed if he were not to receive a blood transfusion.

The judge therefore made the order in the terms sought by the NHS trust.

Note

The American biologist Jerry Coyne comments in his blog that he was struck by Mr Justice Moylan’s courtesy when dealing with such “religious inspired” obduracy:

although … parents [in these kinds of cases] insist that they are good parents, they show a striking lack of affect concerning the death of their child. Time after time I’ve read about parents martyring their child for their faith, and then showing no remorse at all about it—often ascribing the child’s death to “God’s will”.

A little harsh perhaps, but Coyne has a point which he discusses at greater length in his book Face versus Fact. Two points strike him about these kinds of cases, which obtain in this country as well as the States:

The first is that the parents usually either get off scot-free or are given a legal slap on the wrist, although if they withheld medical care on other than religious grounds they’d be punished severely for child abuse, mistreatment, or neglect.

The picture on the left incidentally contains images of children who have died in the United States as a result of refusing transfusions.

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15 comments


  1. Robin Lynn says:

    Bizarre. Most of the medical evidence posted refers to heart and other non-burns related issues. Did the posters read what the poor kid was suffering from? Well done the judge.

    1. Ray Martinez says:

      Your Right the child and the Family member should be the number one issue .
      this isn’t a spontaneous Decision for are Friends trust me. We are well educated and spend hours with Docter and there staff and Have Question answer for the medical teems around the world.

  2. cleefoard says:

    i hate this cult,they say they have the truth,if you have the truth why you keek changing your doctrine

  3. Ray Martinez says:

    Not surprisingly, many doctors are becoming wary of administering blood. “Blood transfusions are basically no good, and we are very aggressive in avoiding them for everybody,” says Dr. Alex Zapolanski, of San Francisco, California.

    The general public too is becoming aware of the dangers of transfusions. Indeed, a 1996 poll revealed that 89 percent of Canadians would prefer an alternative to donated blood. “Not all patients will refuse homologous transfusions as do Jehovah’s Witnesses,” states the Journal of Vascular Surgery. “Nonetheless, the risks of disease transmission and immunomodulation offer clear evidence that we must find alternatives for all of our patients.”

    A Preferred Method

    Thankfully, there is an alternative—bloodless medicine and surgery. Many patients view it not as a last resort but as a preferred treatment, and with good reason. Stephen Geoffrey Pollard, a British consultant surgeon, notes that the morbidity and mortality rates among those who receive bloodless surgery are “at least as good as those patients who receive blood, and in many cases they are spared the postoperative infections and complications often attributable to blood.”

    How did bloodless medical treatment develop? In one sense the question is rather odd, since bloodless medicine actually predates the use of blood. Indeed, it was not until the early 20th century that transfusion technology had advanced to the point where it was routinely used. Nevertheless, in recent decades some have popularized the field of bloodless surgery. For example, during the 1960’s noted surgeon Denton Cooley performed some of the first open-heart operations without the use of blood.

    With the rise of hepatitis among transfusion recipients during the 1970’s, many doctors began looking for alternatives to blood. By the 1980’s a number of large medical teams were performing bloodless surgery. Then, when the AIDS epidemic broke out, these teams were repeatedly consulted by others who were eager to adopt the same techniques. During the 1990’s many hospitals developed programs that offer bloodless options to their patients.

    Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions. “Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products,” notes D.H.W. Wong, in the Canadian Journal of Anaesthesia.

    One advantage of bloodless surgery is that it promotes better-quality care. “The surgeon’s skill is of the greatest importance in the prevention of blood loss,” says Dr. Benjamin J. Reichstein, a director of surgery in Cleveland, Ohio. A South African legal journal says that in certain instances surgery without blood can be “quicker, cleaner and less expensive.” It adds: “Certainly the aftercare treatment in many instances has proved cheaper and less time-consuming.” These are just a few of the reasons why some 180 hospitals around the world now have programs specializing in bloodless medicine and surgery.

    Blood and Jehovah’s Witnesses

    For Bible-based reasons, Jehovah’s Witnesses refuse blood transfusions.* But they do accept—and vigorously pursue—medical alternatives to blood. “Jehovah’s Witnesses actively seek the best in medical treatment,” said Dr. Richard K. Spence, when director of surgery at a New York hospital. “As a group, they are the best educated consumers the surgeon will ever encounter.”

    Doctors have perfected many bloodless surgery techniques on Jehovah’s Witnesses. Consider the experience of cardiovascular surgeon Denton Cooley. Over a period of 27 years, his team performed bloodless open-heart surgery on 663 of Jehovah’s Witnesses. The results clearly demonstrate that cardiac operations can be successfully performed without the use of blood.

    True, many have criticized Jehovah’s Witnesses for their refusal of blood. But a guide published by the Association of Anaesthetists of Great Britain and Ireland calls the Witnesses’ position “a sign of respect for life.” In truth, the Witnesses’ rigorous stand has been a major force behind safer medical treatment becoming available for all. “Jehovah’s Witnesses in need of surgery have shown the way and exerted pressure for improvements in an important sector of the Norwegian health service,” writes Professor Stein A. Evensen, of Norway’s National Hospital.

    To assist doctors in providing treatment without the use of blood, Jehovah’s Witnesses have developed a helpful liaison service. Presently, more than 1,400 Hospital Liaison Committees worldwide are equipped to provide doctors and researchers with medical literature from a data base of over 3,000 articles related to bloodless medicine and surgery. “Not only Jehovah’s Witnesses, but patients in general, are today less likely to be given unnecessary blood transfusions because of the work of the Witnesses’ Hospital Liaison Committees,” notes Dr. Charles Baron, a professor at Boston College Law School.*

    The information on bloodless medicine and surgery that has been compiled by Jehovah’s Witnesses has been of benefit to many in the medical field. For example, in preparing material for a book entitled Autotransfusion: Therapeutic Principles and Trends, the authors asked Jehovah’s Witnesses to provide them with information about alternatives to blood transfusion. The Witnesses gladly granted their request. With gratitude the authors later stated: “In all our reading on this subject, we have never seen such a concise, complete list of strategies to avoid homologous blood transfusion.”

    Progress in the medical field has caused many to consider bloodless medicine. Where will this lead us? Professor Luc Montagnier, discoverer of the AIDS virus, states: “The evolution of our understanding in this field shows that blood transfusions must one day die out.” In the meantime, alternatives to blood are already saving lives.

  4. Andrew says:

    “You need to realise that God said ‘Keep away from blood’ so although you atheists and agnostics smirk at the idea of God being real you will have to face Him soon.”

    Rose: are you going for a non-sequitur competition?

  5. Preston Mason says:

    Respect for blood in obedience to the bible goes deeper than just the operation table,. It goes in the issue of war, ( JW’s refrain even when their life is at stake)….wanton murder, ( very rare for JW’s to be involved in) and risking our life to save another person of any faith is not a problem for us, our preaching work under band is the spiritual side at our life’s risk, but also in civil wars where, JW’s won’t take a side,,at the risk of their lives. All because of the Bible’s direction.

    Our creator risked his son’s life,Jesus, the first of any thing that HE created, And his Jesus’s obedient blood was what was required (legally) so mankind could one day live with out dying. I am sure any human judge, the best would have tried to overturn that parental decision. But now we have a chance to live with out death being the absolute end, because of that decision! Point to one completely perfect decision for all of mankind, made by any gov. (judge). Has it been sustained and not amended, and after the amendments what is the case? First of all you can’t find one completely perfect decision by a judge. The bible has many.

    The ends and out of this comment can be found at… JW.ORG. When a person is interested in a subject, that person should get first hand knowledge about it.

    1. cleefoard says:

      u killing people with your false teaching,how come u have the truth,if Paul said do not juge anything till the Lord come 1cor4:5

    2. Ray Martinez says:

      Friends think about your comments .
      Use this time to Educate these nice Folks try to understand there Fears about us.

      Remember we Felt the same way before we were Witnesses.

  6. CAROL says:

    Blood Transfusions May Be Harmful To Some Patients
    Heart attack patients in the U.S. are far more likely to receive a blood transfusion than patients in other countries with the very same condition, but the outcome of their treatment is no better. Increasing evidence suggests transfusions may not only be unnecessary but may actually be harmful to some patients.
    Heart attack patients in the U.S. are far more likely to receive a blood transfusion than patients in other countries with the very same condition, but the outcome of their treatment is no better, according to Duke University Medical Center researchers.
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    The team examined almost 24,000 records of patients in 27 countries who suffered a certain type of heart attack, and found that non-U.S. patients were 80 percent less likely to get a transfusion when undergoing non-invasive treatments, 70 percent less likely to get blood when having an invasive procedure and 60 percent less likely to undergo transfusion as a result of coronary bypass surgery – a difficult and bloody procedure where transfusion rates might be expected to be similar.

    “This is interesting because the data also show that patients do pretty much the same, whether they get a transfusion or not,” says Dr. Sunil Rao, a cardiologist at Duke and the lead author of the study. “We have to conclude that some of us are doing too many transfusions or others are doing too few.” Rao says clinical guidelines aren’t clear enough to help them figure out which approach is best.

    The study, published in the January 1 issue of the American Journal of Cardiology, comes at a time when increasing evidence suggests transfusions may not only be unnecessary but may actually be harmful to some patients. In earlier studies, Duke scientists found that heart attack patients with hematocrit above 25 (hematocrit is a measure of the supply of oxygen-carrying red blood cells) were more likely to have a second heart attack and were four times more likely to die within a month if they got transfusions.

    Rao says most American physicians are trained to prescribe a transfusion when a cardiac patient’s hematocrit falls below 30.

    “But that’s not based on good science,” says Rao. “The first successful blood transfusion was done decades ago, and yet we still haven’t conducted the randomized, prospective clinical trials we need to do in order to find out which cardiac patients should get transfusions, and when they should get them.”

    Rao says there’s no doubt some transfusions are necessary. In extreme cases, for example, where patients undergo massive blood loss or become severely anemic, transfusion can save lives. But he feels physicians often rush to prescribe the procedure when it may not be needed. “We believe the body can automatically respond to lower hematocrit levels by manufacturing more red blood cells. We need to allow time for that to happen.”

    Researchers aren’t sure why transfusions might hurt some patients. Recent research by Duke’s Jonathan Stamler found that banked blood quickly loses nitric oxide, a chemical important in the transfer of oxygen from red blood cells to the tissues that need it.

    “It’s not surprising that outcomes are not better for heart attack patients who get transfusions,” says Stamler. “But they should be. The problem lies with the quality of banked blood. We need to correct that, and then do more studies.”

    “There is too much confusion and controversy over blood transfusions today,” says Rao. “It is amazing to me that in 2007, we don’t know how to appropriately prescribe transfusion. Blood is a national resource donated by the public. We need to be accountable to the public and to our patients as well.”

    The study was funded by the Duke Clinical Research Institute.

    Colleagues who contributed to the study include senior author Robert Harrington, director of DCRI; Christopher Granger, Kristin Newby and Jie-Lena Sun, also of DCRI; Robert Califf, director of the Duke Translational Medicine Institute, Karen Chiswell, North Carolina State University; Frans Van de Werf, Universitaire Ziekenhuizen Leuven; Harvey White, Auckland City Hospital; and Paul Armstrong, University of Alberta.

    http://www.sciencedaily.com/releases/2008/01/080103134411.htm

    http://WWW.JW.ORG

  7. david says:

    Medical opinions change. Many feel blood is overused and in a large way Jehovah’s Witnesses have been vindicated by the recent shift in thinking to bloodless and blood conservation technologies which provide that extra protection from a host of complications including infection and rejection responses patients are exposed to.

    1. Rebecca says:

      Medical or scientific shifts away from blood transfusions don’t vindicate Jehovah’s Witnesses’ rejection of blood transfusions, they simply make it easier for Witnesses to survive illness and injury without them.

  8. Rose White says:

    You need to realise that God said ‘Keep away from blood’ so although you atheists and agnostics smirk at the idea of God being real you will have to face Him soon.
    The child might have been given blood free plasma if needed.

  9. Andrew says:

    It is absurd that it needs litigation at the public expense to decide such a no-brainer.

  10. Congratulations to the Judge! What a relief.

    1. david says:

      Jehovah’s Witness patients who underwent heart surgery without blood transfusions at the Cleveland Clinic had fewer complications and shorter hospital stays compared with similar patients who received transfusions, according to a study by researchers at the Clinic and the National Institutes of Health.

      The study concluded Jehovah’s Witnesses had a better one-year survival rate following heart surgery than patients who received transfusions.

      Though blood transfusions are safe, patients can have reactions, Ciuffo said.

      “If I transfer blood to you that is not yours, I’m messing with your immune system,” he said. “Do you really want someone else’s blood in you if you can avoid it?”

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