The Jehovah’s Witness obstetric patient – a literature review

Abstract

To this day, haemorrhage, complicating up to 5% of labours, is one of the most common obstetric causes of morbidity and mortality in women [1]. Due to the speed of its development, peripartum haemorrhage can, in a very short time, lead to life-threatening hypovolaemic shock [2, 3]. Excessive blood loss requires comprehensive treatment to maintain peripheral tissue oxygenation, adequate volume of the intravascular compartment and coagulation [1]. In such circumstances there is an indication to transfuse red blood, plasma and platelets. Currently no other equally effective treatment is known. Jehovah's Witness (JW) women are in a high obstetric risk group. British data indicate that in the UK the risk of death related to obstetric complications is 65 times higher in this group than in the general population; in the USA such risk is estimated at 44 times higher [1-5]. Russo et al., describing a case of a JW pregnant multipara after two caesarean sections with placenta praevia invading her urine bladder, found the risk of death to be 130-fold higher than in a patient who would accept blood transfusion [6]. It is estimated that every year 1000 JW die because of blood refusal [4].

Perioperative management of patients declining transfusions of blood components—National survey of anaesthesiologists, abdominal surgeons and obstetricians in Denmark

“…Treatment of patients declining transfusion of blood components challenges medical staff ethically and clinically. 6,13,15,28 components as well as blood loss. 2,4,11,12,23,29 Minimising blood loss perioperatively reduces risk of adverse events.…”

“…Treatment of patients declining transfusion of blood components challenges medical staff ethically and clinically 6,13,15,28 . Doctors need a good understanding of available interventions acceptable to patients they provide care for.…”

“…11 All though care of patients declining transfusions of blood components are infrequent, the clinical dilemma as well as the ethical implications can impact both patients, physicians and other healthcare persons involved in the care. 3,[12][13][14][15][16] Specifically when dealing with major haemorrhage the treatment of patients declining transfusions of blood component can be challenging. [16][17][18][19][20] Legally, in Denmark adult patients have the right to decline transfusion of blood components even if it results in fatality.…”

“…Within the community of JW, there is a divergence over which other products are accepted: some will accept human albumin, while others will not, adding to the complexity of manging patients from JW 11 . All though care of patients declining transfusions of blood components are infrequent, the clinical dilemma as well as the ethical implications can impact both patients, physicians and other healthcare persons involved in the care 3,12–16 . Specifically when dealing with major haemorrhage the treatment of patients declining transfusions of blood component can be challenging 16–20 …”

Between Autonomy and Paternalism: Attitudes of Nursing Personnel Towards Jehovah’s Witnesses’ Refusal of Blood Transfusion

“…While JWs are known to refuse allogeneic blood transfusions, many people, including HCPs, are unaware of their regulations pertaining to blood products [ 15 ]. Although JWs refuse transfusions of whole blood (including pre-operative autologous donations) and primary blood components, such as red and white cells, platelets and unfractionated plasma, as well as haemoglobin (both natural and recombinant), since 2000 they have been at liberty to take, as acts of “individual conscience,” derivatives of primary blood components, such as haemoglobin-based blood substitutes, interferons, interleukins, albumin, globulins, cryoprecipitate, clotting factor concentrates, including fibrinogen concentrate, and immunoglobulins [ 9 , 15 – 17 ].…”