Attempting to Honor Beliefs of Jehovah’s Witnesses at the Edge of Viability in an Infant Born at 23 Weeks’ Gestational Age

Abstract

Patient: Male, 23 weeks’ gestational age newbornFinal Diagnosis: 23 weeks’ extreme prematurity • intraventricular hemorrhage • anemia • respiratory distress syndromeSymptoms: Hypotension • metabolic acidosis • tachycardiaMedication: —Clinical Procedure: Transfusion of packed red blood cellsSpecialty: Pediatrics and NeonatologyObjective:Rare diseaseBackground:Infants born at 23 weeks’ gestation have a poor prognosis and require intensive care, including blood transfusions, to survive. Generally speaking, the decision to forgo life support is acceptable. Jehovah’s Witnesses believe that life is sacred and want lifesaving interventions except for blood transfusions. Therefore, an ethical dilemma exists when a baby is born on the edge of viability to parents that are Jehovah’s Witnesses. In this case, if parents and healthcare professionals disagree on the best interests of the child, the medical team should obtain a court order from the state to intervene.Case Report:We present the case of an infant born at 23 weeks’ gestation to parents who are Jehovah’s Witnesses. The parents wanted full life-support, except for blood transfusions, to be given. The clinical team obtained a court order to transfuse the infant. The infant unfortunately died despite all efforts.Conclusions:Currently, it is nearly impossible to honor the beliefs of Jehovah’s Witnesses to provide lifesaving treatments without blood transfusions for infants born at the border of viability. If the goal is to prolong life, the standard of care for a premature infant is for a doctor to obtain a court order to override the beliefs and wishes of Jehovah’s Witness parents and transfuse blood products as medically indicated. Although bloodless techniques for high-risk surgeries are under development, care for premature infants at 23 weeks’ gestation necessitates red cell transfusions.

The Jehovah’s Witness obstetric patient – a literature review

“…Lifesaving blood transfusion in children is acceptable under some conditions, even against parents' will [3,11,23]. Bester et al consider the issue of teenage JW patients, where a double consent for medical procedures is needed, signed both by the patient themselves and by their parent.…”

Surgeon’s dilemma: should I save patient’s life at any cost?

“…The doctor should not be passive but ought to act with due diligence to inform his/her patient about potential consequences of his/her refusal. It does need to be aimed to convince but rather to enable a deliberate decision to be taken [21].…”