Refusal of Blood Transfusions on Religious Grounds

Occasionally, a patient may be admitted to the hospital or present for consultation prior to surgery and state that he or she will not accept any donated blood and will not predonate his or her blood for use during the procedure. If the patient is competent and in control of his or her mental faculties, such direction must be respected by the hospital. If not (e.g., if a blood transfusion is administered while the patient is under anesthesia), the healthcare facility risks liability for battery, lack of informed consent, and negligence.

Most commonly, patients who refuse blood transfusions are Jehovah’s Witnesses, who object to blood transfusion on religious grounds. Jehovah’s Witnesses are members of a Christian faith founded in the 1800s. The religion is governed by a central body, the Watchtower Bible and Tract Society, based in Brooklyn, New York. In 1945, the governing body promulgated a rule prohibiting Witnesses from accepting blood transfusion and many blood-derived products (Singelenberg) This ban is based on interpretation of biblical passages such as “But you must never eat flesh with its life still in it, that is the blood” (Genesis 9:3-4); “You must drain out the blood and cover it with earth . . . because the life of every creature is its blood: whoever eats it is to be cut off” (Leviticus 17:10-14); and “abstain from . . . fornication, from anything that has been strangled, and from blood” (Acts 15:19-21).

Based on these and other similar passages, Jehovah’s Witnesses refuse not only transfusions of whole blood, but also packed red cells, plasma, white blood cells, and platelets. In addition, they do not accept preoperative autotransfusion of predonated blood or intraoperative techniques that involve storage of blood. However, the Watchtower Society does allow intraoperative salvage techniques that do not involve storage (i.e., those that maintain continuous extracorporeal circulation without significant interruption) and intraoperative hemodilution if the patient so chooses.

Individual Jehovah’s Witnesses may accept the transfusion of albumin, immunoglobulins, and hemophiliac preparations; the use of dialysis and heart-lung machines if they are not primed with blood; and tissue transplants. Because the Bible does not comment directly on these therapies, the Jehovah’s Witnesses’ position is that the individual patient may follow his or her own conscience. (Dixon...