Faith and Freedom: Leukemia in Jehovah Witness Minors

Penson, Richard T.

doi:10.1159/000076900

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…The exact age at which children can make decisions for themselves is determined in individual cases. Their legal competence is determined by their ability to understand the pros and cons of a treatment, the other options and their implications, and their ability to weigh the choices [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are nearly one million Jehovah’s Witnesses in the United States and more than five million worldwide [ 19 ]. Founded in 1870, the group took the name ‘Jehovah’s Witnesses’ in 1931.…”

Section: Discussionmentioning

confidence: 99%

“…This determination focuses primarily on 3 Bible passages (Genesis 9: 3–4; Leviticus 17: 10–14; and Acts 15: 21–29), which forbid the ingestion of blood because it would compromise a believer’s chances for everlasting life [ 20 ]. Since 1961, the Watchtower Bible and Tract Society has published a policy whereby Jehovah’s Witnesses must shun fellow believers who consciously accepted a blood transfusion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sauer

Marc-Aurele

2016

Am J Case Rep

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Sauer

Marc-Aurele

2016

Am J Case Rep

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“…Although adult patients may refuse transfusion, the rights of parents to make this decision for their child have been refuted by the legal system. [99][100][101] Whenever possible, alternative methods for augmentation of Hb, such as through utilization of EPO, should be employed, and hospitals should have policies in place for "bloodless" surgeries to minimize blood loss and need for transfusion in such circumstances. 102 If necessary, a court order can be obtained to allow for RBC transfusion, a practice that most Jehovah's Witness families find acceptable in emergent situations.…”

Section: Jehovah's Witnessmentioning

confidence: 99%

Unique aspects of red blood cell transfusion in pediatric patients

Rai¹,

Kelly²,

Agrawal³

2016

IJCTM

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Red blood cell transfusion plays an integral role in the management of the anemic child, and multiple factors must be considered when performing transfusions in children as compared with adults. The practitioner must be aware of the particular indication for transfusion, normal hemoglobin for age, and the need for special requirements based on the age and type of patient. Additionally, the practitioner must be aware of potential unique complications in the pediatric population and also ensure a system is in place in order to report and evaluate such potential adverse reactions. Here, we review the underlying physiological factors, symptomatology, transfusion guidelines, transfusion reactions, and potential side effects with an emphasis on those aspects that are unique to children with anemia. Many gaps remain in fully understanding pediatric red blood cell transfusion that should be addressed over time with continued research and hemovigilance.

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“…Based on legal precedent set by multiple court cases in the United States, the government retains the power to intercede and act in the best interest of the child. 8 , 9 This doctrine, known as parens patriae , is applied in situations in which treatment is deemed reasonable and necessary. 8 Court cases specific to the issue of declining blood transfusion by a parent, such as the 1991 case of Elisha McCauley, have ruled that despite the parents' right to religious freedom, the best interest of the child outweighs the parents' objections when a child's life is at stake.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of pediatric oncology patients at risk for guardians declining transfusion of blood components

et al. 2022

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Background Transfusion of blood products is a necessary part of successful delivery of myelosuppressive regimens in pediatric cancer. There is a paucity of literature characterizing outcomes or management of pediatric patients with cancer when transfusion is declined. Aims The objective of this paper is to describe the clinical characteristics, care, and outcomes of patients with cancer at risk for declining transfusion. Methods and Results A retrospective cohort of patients aged 0–21 years with cancer managed at Children's Healthcare of Atlanta between 2006 and 2020 and with ICD‐9 codes indicating risk of “transfusion refusal” or Jehovah's witness (JW) religion was identified. Demographics, disease, and management were abstracted. Descriptive statistics were performed to examine associations with transfusion receipt. Among 35 eligible patients identified as at risk for declining transfusion, 89% had primary guardians who identified as JW, and 45.7% identified as Black, non‐Hispanic. Only 40% of guardians actively declined transfusion. Transfusion recipients had significantly lower hemoglobin (g/dl) and platelet counts (1000/μl) at initial presentation (9.6 vs. 11.9, p < .002 and 116.0 vs. 406.5, p = .001, respectively) and at nadir (5.9 vs. 8.7, p < .001 and ≤ 10 vs. 154, p < .001, respectively) than non‐recipients. Legal intervention was required in 36.4% of those who ultimately received a transfusion. Conclusion Among pediatric cancer patients whose medical record initially indicated a preference for no transfusion, 60% of guardians accepted blood products when prescribed for oncology care. Guidelines for systematic management and transfusion sparing approaches are needed to honor guardian's preferences when possible yet while maintaining equitable cancer outcomes in this population.

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Faith and Freedom: Leukemia in Jehovah Witness Minors

Cited by 6 publications

References 13 publications

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

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

Unique aspects of red blood cell transfusion in pediatric patients

Characteristics and outcomes of pediatric oncology patients at risk for guardians declining transfusion of blood components

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