J Med Ethics: first published as 10.1136/jme.24.4.223 on 1 August 1998. Downloaded from Journal ofMedical Ethics 1998;24:223-230 Bioethics of the refusal ofblood by Jehovah's Witnesses: part 1. Should bioethical deliberation consider dissidents' views? Osamu Muramoto Kaiser Permanente, Portland, Oregon, USA Abstract literature describes JWs' refusal ofblood products Jehovah's Witnesses' (JWs) refusal of blood as definitive, absolute and consistent. Many courts transfusions has recently gained support in the have ruled that a JW's directive not to receive medical community because of the growing blood products should be complied with even at popularity of "no-blood" treatment. Many the cost of the patient's life. On the other hand, physicians, particularly so-called "sympathetic medical and judicial decisions rarely take into doctors", are establishing a close relationship with this account how this blood doctrine developed or is religious organization. On the other hand, it is little enforced in the JW community. known that this blood doctrine is being strongly Certain little-known JW practices regarding criticized by reform-minded current and former_JWs blood are morally questionable and may require copyright. who have expressed conscientious dissentfrom the the medical community to re-evaluate its support organization. Their arguments reveal religious ofthe doctrine. The JW religion recently has come practices that conflict with many physicians' moral under strong criticism by reformers and former standards. They also suggest that a certain segment of "regular" or orthodox J7Ws may have different members, including a former top official (govern- attitudes towards the blood doctrine. The author ing body member) who wrote two books that detail WTS history, religious practices and considers these viewpoints and argues that there are http://jme.bmj.com/ ethicalflaws in the blood doctrine, and that the internal conflicts,3 ' and revealed for the first time medical community should reconsider its supportive the secret inner workings of this religion. The position. The usual physician assumption that JWs effects of the decisions and policies on the rank are acting autonomously and uniformly in refusing and file members of the religion are set out in the blood is seriously questioned. writings of other former members.5 Another (J7ournal ofMedical Ethics 1998;24:223-230) important development comes from easy Internet Keywords: Religion; Jehovah's Witnesses; blood transfu- access which has enabled current and former JWs on September 23, 2021 by guest. Protected sion; medical ethics; physician-patient relations; informed to "come out of the closet" and voice their consent opinions without fear of retribution.8'-0 Jehovah's Witnesses have been strongly discouraged from 1. Introduction discussing critical religious issues with outsiders, Jehovah's Witnesses' (hereafter JWs) refusal of particularly with former members, and can be medical and surgical treatment using blood prod- "disfellowshiped" (excommunicated) for doing ucts is widely known in the medical community. so. However, the medical community is generally They are supported by physicians who accept the unaware of these issues. challenge of "bloodless" treatment,' at least for Thus, the following serious questions arise. adult cases. For example, the article, Surgical red Should we physicians continue accommodating blood cell transfusion practice policies, in The the JW patient's request for non-blood treatment American 7ournal of Surgery2 recommends as based on the "official" position of the WTS alone, "policy 1" to "accept the limitation that allogenic disregarding the views of reformers and dissi- blood cannot be used". This policy recommends dents, and the resulting ethical questions? How involving the local JW hospital liaison committee, can we avoid compromising our own sense of eth- appointed by the church organization (Watch ics when we know of unethical practices that may Tower Bible and Tract Society, hereafter WTS), compromise the autonomy of individual JW for assistance in making decisions. Most medical patients? In part 1, I will review the perspectives 224 Bioethics of the refusal of blood by J7ehovah's Witnesses: part 1. J Med Ethics: first published as 10.1136/jme.24.4.223 on 1 August 1998. Downloaded from provided by dissidents, and discuss the potential WTS policy; stifled freedom of speech, thought impact on medical professionals. and decision; breach of confidentiality by inside informers, and inconsistencies and contradictions that are undisclosed to the JW rank and file. This 2. History and doctrinal system material is based on WTS's own publications and It is beyond the scope of this paper to present a the testimony of current and former detailed account of the history and doctrine of JWs. JWs. An excellent monograph is available.5 The ENFORCEMENT OF CONFORMITY religion informally began in Pennsylvania in the Jehovah's Witnesses are directed to shun any 1870s under the leadership of Charles Taze Rus- friends or relatives who formally leave (disassoci- sell. He borrowed many of his ideas from Second ate) or who are forced to leave (are disfellowshi- Adventists and other apocalyptic sects that specu- ped from) the organization. Former JWs who lated on "the end of the world" in Bible prophecy. voice disagreement with the leaders are labelled In 1884 Russell founded the WTS, which became "apostate" and treated the same way as those who the legal corporation used by the International are excommunicated for "sexually immoral" con- Bible Students, who changed their name to duct or other grave sins. The JWs' official "Jehovah's Witnesses" in 1931. Russell taught that magazine The Watchtower wrote about the shun- Jesus had invisibly returned from heaven to rule ning of "apostates" as follows. over the earth in 1874 by setting up God's kingdom, and that in 1914 Jesus would come to "... if a relative, such as a parent, son or daughter, judge the earth and destroy this world's political, is disfellowshiped or has disassociated himself, social, economic and religious institutions. When blood and family ties remain. Does that mean, nothing supernatural happened in 1914 and Rus- then, that in the family circle everything remains sell died disappointed in 1916, the religion almost the same when one member is disfellowshiped? fell apart. However, the second president, Joseph Definitely not. A disfellowshiped person has been Franklin Rutherford, re-grouped the religion with spiritually cut off from the congregation;copyright. the his charisma and re-shaped the doctrinal system former spiritual ties have been completely sev- many times, including the prediction of the arrival ered. This is true even with respect to his relatives, of Armageddon in 1918, 1920 and 1925, and including those within his immediate family moving the invisible return of Jesus from 1874 to circle. Thus, family members while acknowledg- 1914. Jehovah's Witnesses consider themselves ing family ties will no longer have any spiritual fellowship with him...." 11 the only true Christians, with all other Christian http://jme.bmj.com/ denominations being so-called "apostate Chris- "True Christians share Jehovah's feelings towards tendom". such apostates; they are not curious about The doctrines crucial to understanding the JW apostate ideas. On the contrary, they "feel a loath- mindset, as it relates to their adherence to the ing" towards those who have made themselves blood policy can be summarized as: 1) Armaged- God's enemies, but they leave it to Jehovah to don is near, in which all mankind will be destroyed execute vengeance...".12 except faithful who will live forever on earth; JWs on September 23, 2021 by guest. Protected 2) The WTS governing body is believed to be the Included amongst so-called "apostates" are "faithful and discreet slave" referred to in Jesus' substantial numbers of conscientious dissenters parable at Matthew 24:45, divinely appointed by and those who unrepentantly received blood Jesus Christ to lead the JWs; 3) The Bible cannot products. Current JWs are strictly charged to be understood without interpretation by the sever personal ties with them. Violators are them- "faithful and discreet slave"; 4) JWs who openly selves subject to disfellowshiping. Outsiders may criticize the leadership and the organization are not realize the trauma of leaving the organization, regarded as apostates, disloyal to Jesus and God; but for JWs it means total isolation from friends 5) Salvation is contingent on how well they and family members who remain in the organiza- perform as loyal JWs. tion. Unless they repentantly seek reinstatement, there will be no chance of resurrection, and eter- nal annihilation is their only future. The psycho- 3. Criticism and dissent logical trauma is devastating. There is no honour- Recent criticism by dissidents and internal able way for JWs to leave their organization. reformers reveals several important JW practices that are critical to re-evaluating our moral support LACK OF FREEDOM OF SPEECH AND THOUGHT of their blood policy. Here I will review four prac- A most serious problem is that free speech, or tices that are repeatedly criticized: intimidation more precisely, free thought and decision-making, and punishment to enforce strict conformity to are prohibited for JWs. These are crucial to Muramoto 225 J Med Ethics: first published as 10.1136/jme.24.4.223 on 1 August 1998. Downloaded from self-determination of medical care, yet are seldom is confidentiality. She must keep documents and mentioned in medical literature. Former govern- information pertaining to her work from going to ing body member Raymond Franz states: "Watch- unauthorized persons. Law codes in her state also tower training causes Jehovah's Witnesses to view regulate the disclosure of confidential information 'independent thinking' as sinful, an indication of on patients. One day Mary faced a dilemma. In disloyalty to God and his appointed 'channel.' " processing medical records, she came upon infor- The Watchtower warns JWs against "independent mation indicating that a patient, a fellow Chris- thinking" in harsh language: tian, had submitted to an abortion.