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A Group of Hospital Liaison Committee (HLC) Members Speak Out
HLCs have been set up in most parts of the earth by the society to assist Witnesses in finding cooperative physicians who are willing to provide bloodless treatment. In their dealings with physicians, they often come face to face with the inconsistencies and discrepancies in the Watchtower Society's blood policy. One group of HLC brothers has come forward to express themselves on the blood issue. They have asked us to publish the following information which is directed to all of Jehovah's Witnesses, and especially "Hospital Information Services," in Brooklyn, New York. The information should also be of interest to medical and legal professionals. At the conclusion of this document, you may be interested in following the link to learn how the Watchtower Society trains these brothers to respond to the media when the life of a Witness child is endangered.
We are a group of eight brothers working at present for the Hospital Liaison Committees in different places and countries. We have been able to talk and communicate about our assignment and also share different experiences about the work that has been done. We are very pleased that much good has been accomplished in behalf of our brothers. Many not professing to be Jehovahs Witnesses have also benefited from the arrangement.
It is widely acknowledged, even by doctors, that blood is a dangerous medical treatment. In many of our presentations in different hospitals we often hear comments that clearly indicate that doctors usually do their utmost to avoid using treatments made from human blood. And it is noteworthy that these comments come from doctors working in the field of Hematology.
We cant deny the fact that medical devices, procedures and medications have developed dramatically. This has contributed to, and is the main reason for reducing the need for blood products. Additionally, there are numerous company's developing products to improve clotting capacity and maintain circulating blood volume. Hyperbaric Oxygen Therapy is another very important tool, and although many doctors resist it's use, they do acknowledge its value in treating acute anemia.
The Society has also emphasized the use of Erythropoietin which stimulates the production of red blood cells, and together with Iron Dextran there is evidence of greater benefit and results in treating Witness patients.
Many positive things can be said regarding alternative non-blood therapies, there is no denying that. At the same time the facts are, that our work would not be necessary if medical science were to find a replacement for blood. However, in August of 1997, blood is still a valuable product for saving lives and sometimes we overlook the benefit and the importance of using it. Even among the HLC members who have many years of experience in their assignment, you can find a complete ignorance of why blood is used. These brothers have been trained through Seminar's I and II, and the only thing that many know about blood, is that it is a dangerous medical treatment and should be avoided. Not just because of Biblical reasons, but because they believe that it is bad medicine, and that there are good alternative products available.
There exists a guideline or rule that developed among clinicians that stated a patient likely should be transfused if the hemoglobin level fell below 10 or the hematocrit below 30. It is called the 10/30 rule. Many doctors today still use this guideline, and sadly, some doctors even transfuse earlier without any medical reason. Another troubling question is, how low can we go without unnecessarily exposing the life of the patient? After the Seminars, presented by three brothers from Hospital Information Services for Jehovahs Witnesses in Brooklyn, the custom is to go and visit some hospitals and medical institutions. Brother Major Spry, Associate Director and the principle voice in Brooklyn around the blood issue, always try to send the message that the 10/30 rule is outdated and we want it down, much more. Often the doctors agree that it is alright to get it down, but one shouldn'tt forget that much depends on the patients age and condition. A young healthy person can endure more than an anemic, undernourished or aged patient. Therefore, each patient must be considered individually, and no standard position or policy can easily be defined.
Still, the brothers in Brooklyn have achieved some very good results by their work. One example of progress is noted in The American Journal of Surgery Consensus Conference: Blood Management Surgical Practice Guidelines, Volume 170, No. 6A (Suppl) December 1995. In this there is a proposal of about 11 policies for surgical blood management and proposed interventions that would achieve each policys intended outcome. The policies were designed to achieve four clinical outcomes: maximization of oxygen delivery, cost-effective minimization of transfusion risks, education of physicians and patients, and appropriate surgical management of special surgery subset, Jehovahs Witness patients.
In the same The American Journal of Surgery, page 14, there is a section entitled: Blood Management Policies For Jehovahs Witnesses. Policy 2 states:
In general, Jehovahs Witnesses refuse all allogeneic blood products and any autologous blood that has been separated from the body. These prohibitions do not prevent most Witnesses from accepting the use of cardiopulmonary bypass, dialysis, intraoperative blood salvage, and reinfusion. Although the casual observer may not discern a difference between these interventions and autologous blood that has been separated from the body, Jehovahs Witnesses distinguish acceptable therapy from unacceptable according to whether the diverted blood is still part of the circulatory system. In dialysis and cardiopulmonary bypass, blood remains part of the circulation. Autotransfusion devices can meet this test by dedicating an intravenous line from the collective device to the patient to maintain a closed circuit. Hemodilution can be similarly modified.
Jehovahs Witnesses readily accept most drugs, such as iron dextran, aprotinin, desmopressin, and synthetic blood substitutes, because these agents contain no human blood products. Hemoglobin-based blood substitutes are unacceptable to Jehovahs Witnesses if they contain either human or animal blood.
As a matter of conscience, Jehovahs Witnesses may accept some products that contain blood products, such as immune globulin. Epoetin alfa, which contains a small amount of human albumin, is acceptable to most Jehovahs Witnesses. Albumin will likely be refused conscientiously when used as a volume expander, but the amount contained in Epoetin alfa is small and therefore generally acceptable.
This description of our position as an organization is quite accurate. However, there are a couple of problems that HLC members must address. First, and the question is often asked: What is blood? This may seem like a simple question to answer, but it is not, for there are a number of blood components that the Society permits Witnesses to take. Are these components not also blood, and how is it decided which parts of the blood are acceptable, and which are not? Since it is acceptable to introduce these "allowed components" into our bodies, it is understandable that Witnesses and medical personnel are confused by our position? Although this question has been in the minds of many brothers, no one dares to deal with the question publicly. Why?
When it comes to Hemodilution and Intraoperative autotransfusions, very few members of the HLC's have taken the initiative to try and understand exactly how these procedures work. All of these external devices and methods should create questions as to whether or not the blood is still a part of the body. But the friends simply accept these procedures since the Society does not forbid them.
It is interesting to note how brothers who are struggling to find medical solutions react to the article, Obstetrics and Gynecology, Volume 72, Number 6, December 1988, A Simplified Device For Intraoperative Autotransfusion. When the article is presented, and the brothers see the device and the way blood is collected and stored into a blood bag, in a lowered position, their first and immediate reaction is generally to reject the device.
Here is how the procedure works: During the surgery doctors use Blood Aspiration with Automatic Anticoagulant Mixing, and the blood is collected into a Blood Reservoir. It is then drained by gravity into the Blood Bag, and stored in a lowered position until it is filled. When the Blood Bag is filled, it is raised to the top of the assembly, and the blood is reinfused. Although it is hard to see the blood as still being a part of the circulatory system, the brothers accept the procedure once they are told that the Society has approved of its use, and that it does not violate any scriptural principles.
Albumin is another problem. We accept albumin as a matter of conscience, although the blood contains more albumin than white blood cells, which we must reject. Many doctors are also confused by this position, but they usually are so respectful, and most of them think that there are religious principles involved although a clear contradiction exists. What doctors dont know, and we are not permitted to explain to them, is that this position is clearly an organizational ruling for the members, and lacks any logical reason or scriptural support.
Another interesting feature about the use of Albumin that many members of the HLC's have commented on, is that we should never decide or interfere in the conscientious decisions of our brothers. The problem here is that the Society has so greatly emphasized the benefit of Erythropoietin that HLC members often forget or dont tell the brothers that between the two most common Erythropoietins: Eprex and Recormon, Eprex contains Albumin, but usually the HLC members dont feel any responsibility to inform them of this. Another sad part of all this is that the brothers, even many members of the HLC's, dont really understand how Erythropoietin works, and hence over-estimate it's value in treating Witnesses.
Erythropoietin (EPO) is a treatment used to raise the hematocrit, and stimulate the production of red blood cells which transports oxygen. Some members of the HLC's feel that the Society has overemphasized the benefit of Erythropoietin. The recommended dosage in case of emergency is between 200-1000 IUnits/kg=2pounds/Daily, and when a clear response appears, 3 times a week. Some companies selling the product even recommend more IUnits. The sad part of this is that today the scientific documentation of the real benefit of Erythropoietin is vague. The treatment is most frequently prescribed for patients with renal dysfunction's, or patients who have predeposited their own blood some 4 weeks before an operation can receive a EPO treatment. But if the patient is in good health and no indications of any serious infections appear, they usually don't need EPO. Even among the HLC members, there is confusion about the real benefit. Some suggest high dosages, not because a Witness patient needs it, or because an EPO treatment doesnt bring serious contra-indications as long the hematocrit level is low, rather they feel more comfortable knowing that if something goes seriously wrong, at least it was not because EPO treatment was not used. This lack of knowledge and lack of scientific documentation among the HLC members should be a matter of concern for the brothers. First of all, many brothers dont know that the real benefit of an EPO treatment comes usually after 2-4 weeks. In about 3 days one can find a small reticulocyte response, within 7 days for hematocrit response, and the final and necessary benefit usually comes after 2-4 weeks. This is important to understand, particularly in a case of acute blood loss.
Another part of an EPO treatment is the Cost vs Benefit. Some doctors have recommended a small dose of EPO like 80 IUnits/kg/3 days a week. At the same time an HLC member without any scientific or medical reason, may recommend a dosage of of 600 IUnits/kg/each day the first week. In many places the patient will himself have to bear this expense. The costs may differ from one place to another, but we can conservatively estimate that the higher dosage recommended by the HLC member will drive up costs approximately $4,000.00, and this without any scientific justification, as optimal dosage regimens have not been determined for EPO.
Another question that has been raised among some Jehovahs Witnesses, as well as HLC members has to do with the issue of Umbilical Cord blood.
Today medical scientists are doing research about the use of umbilical cord blood and there are indications that it could contain and provide a vital lifesaving medical benefit. However, as in so many other cases, the Society is clearly opposed to us as Jehovahs Witnesses accepting, or even donating umbilical cord blood (See W97, 2/1 - Questions From Readers). However, since they permit some of the components found in umbiblical cord blood to be produced and used, it is hard to see any logic or and biblical basis for their prohibition.
Avoiding blood is a way of searching for quality medical treatment. But offering something that can replace blood is simply not possible at this time. Doctors are well aware of the situation and the need for something to replace blood transfusions. When a good alternative to blood exists, doctors will use it. Today the only real alternatives are the surgeons skill, some medications, technical devices and procedures available in some of the hospitals, and of course the risk of operating outside the critical limits.
We as HLC members should ask ourselves if our work is simply to find cooperative doctors? A comment expressed among some brothers within the HLC's was taken from the Bloodless Coordinators Corner on the Internet. www.noblood.com
Sometimes hospitals and doctors accept the challenge to treat us with alternatives, but that could be fatal if they are not prepared for it. Sometimes the doctors are very interested in doing an experiment with a Jehovahs Witness. Consider the statements made in the Bloodless Coordinators Corner, for this is the reality for many Witnesses right now in many countries when the hospital decides to cooperate without being prepared for it. As members of the HLC's we can confirm that from our experience. Note the following:
Our Guest Editorial comes from Bernice Goldstien, Coordinator for Bloodless Medicine and Surgery at Kadlec Medical Center in Richland, Washington. We thank Bernice for her contribution!
... Bloodless Surgery is not actually blood free. There is shed blood. 'Bloodless' is a term applied to transfusion free medicine. Bloodless Surgery is being requested by an increasing number of patients who recognize there are alternatives to blood transfusions.
In the past, the most one could hope for was a physician who agreed not to use blood as part of the treatment plan. According to Dr. Estioko, Cardiovascular Surgeon and Medical Director of the Bloodless Medicine A promise not to give blood transfusions is not enough. A cooperative doctor could kill you. What was he talking about? If the doctor agrees to operate without blood, what does he offer in it's place? There is more he can do! Much more!
... Clearly, an arrangement for non-blood medical management goes far beyond a promise from a physician not to give blood. It involves real commitment by the entire hospital.
Although Society is doing an excellent job of providing information about alternatives, the reality is, that in many countries the doctors and hospitals are not always prepared or even willing to handle a case with alternative therapy. Many cases have ended in tragedy, cases where our brothers were attended by a cooperative doctor, who was not qualified and lacked the required experience to handle the case. Often times because the doctor was not able to offer anything to adequately replace blood therapy. The sad part is that many HLC members do not realize that Witness patients often die because of a lack of commitment and the use of alternative treatment in the hospitals. The only real cooperation is often to simply let the patient die, and that is unacceptable. The medical staff should cooperate, and realize that another hospital or doctor might be of help, but this doesn't always happen, and tragically, many HLC members are not really qualified to evaluate these situations and know how to respond.
The most depressing feature of being a member of a HLC is when our children are involved. Why has the Society completely failed to gain one legal case when it comes to minor children? It is obvious, there is nothing so effective as human blood to transport oxygen and today there is nothing to replace its use in the medical field. We must appreciate the fact that the legal system protects our children. Even for us, as members of HLC's, we realize that it is much easier to work with the doctors knowing the rules and laws about minor children. Every Jehovahs Witness should know, although there have been cases where Witness parents have acted against it, that parental authority is not absolute and that there can be no guarantee of bloodless treatment for Witness minors in general. They should understand that the state, has the right to provide treatment believed to be necessary to safeguard a childs life or health.
When there are effective alternatives available, when there is a choice to be made, that choice should be made by the parent and not by some doctor, social worker, or judge. But here one needs to ask an important question: Who is qualified to make a decision about alternative nonblood management, and will that decision adequately meet or respond to the child's needs? As members of the HLC's we have been eye witnesses of cases where cooperative doctors have followed the parents wishes for alternative non-blood therapy, and the results have sometimes been tragic, with just one more unnecessary death being the result.
We shouldnt be too dogmatic about the benefit and positive results of using blood products, but one thing is for sure. As long as there is nothing that can replace the blood products, they are going to be used, and many children are going to be saved by them. Judges are going to decide in favor of using blood products and protecting the child's life and health above the religious beliefs of the parents.
One of the arguments we use and present to the doctors has to do with the emotional damage done to a person whos conscience is violated by forcing a medical treatment made of human blood. Every reasonable person understands that it is unacceptable to force a treatment that violates a persons conscience. With most Witnesses, however, their conscience does not really enter the picture. They are simply responding to a situation based upon how the Society has ruled on it.
When we as as Jehovahs Witnesses look back and remember the wounded and dead brothers who did not accept vaccinations, blood serums, organ transplants or hemophiliac treatments, we must acknowledge that they took their stand largely because of an organizational policy and prohibition forced upon them. These positions have now been abandoned by the leadership, and we rarely if ever see brothers refusing vaccinations, organ transplants, or any of the blood components on the Society's approved list. This fact alone should cause anyone involved in these situations to pause and reflect seriously about the real issues involved. Is the issue truly one of conscience, and if so, whose conscience?
We are a group of eight members of the HLC's that have been carefully considering these points, and we would like to conclude this consideration with the following thoughts. In particular, we direct our comments to the brothers in Hospital Information Services for Jehovahs Witnesses in Brooklyn.'
Quoting your own words during Seminars I and II, we are supposed to be trained professionals in our area of providing information about alternative nonblood management and cooperative doctors. Thats fine, we have seen many blessings and the very good results of that work. We also hope that medical science can find something to replace the present blood products used in the medical field. What a blessing, not just for us as Jehovahs Witnesses, but for all people of the earth. Certainly all of the doctors are going to rejoice when a replacement for blood becomes available, and surely it will immediately be applied in hospital protocols and procedures for emergency care.
But, despite what is going to happen in the near future, discovering new synthetic blood products, new diseases and infections, or something else, the real questions are still going to be in our minds: Is the Societys blood doctrine actually correct? Why do so many brothers enter into an inner conflict about the issue when they consider the biblical facts? Has the Society really provided us with the truth, and all of the Biblical facts regarding blood? Do they realize that in accepting some minor blood components they have created a tremendous contradiction in their firm stand? Where are the serious and solid arguments against stored autologous blood transfusions? Do they appreciate that their position kills many precious minor children, unless the legal system steps in to provide protection for their life and health? Should our main concern as Jehovahs Witnesses be to look for medical alternatives, or to confront ourselves with the biblical facts about life and blood?
A group of Members in Hospital Liaison Committee's
Responding to the Media
How the Watchtower Society trains HLC members
What follows is a letter we received from an H.L.C. brother who has come face to face with the problems, and has come forward to voice his concerns:
I am a regular reader of the different material and information about blood at the Net. Also I have the special privilege to be part of a HLC (Hospital Liaison Committee). However, I understand that we are working in a very dangerous field because of so many contradictions in our blood doctrine. Personally I suffer and often work with a deep feeling of guilt, particularly when our brothers need to go through unnecessary pain and death. I can personally testify to about 4 deaths of our brothers, where they could have been saved. How? These brothers and sisters could have been saved if available alternative treatment approved by the Society had been used. But why did they not use it? The doctors could not use the treatments because the Witness patients objected on the grounds that the treatments contained fractions of human blood. These patients were not able to explain why the Society approves these treatments, but after the HLC explained to the brothers, and the doctors, the Society's position - they agreed. Sadly, in these 4 cases I have been through, the patients died because the necessary treatment was used too late.
I have shared the pain and loss with these brothers, hugging them, talking with them, sitting together with them in cold hospital corridors just to share some fellowship, and human compassion. These poor innocent brothers are victims and they can't understand and explain their position except for being faithful to organizational directives. First they abstain completely from all alternative blood products, but if the organization gives their approval, then in a matter of seconds they change their mind and heart.
Let me be very clear - I am ready to leave this assignment, I can't continue to support this cruel doctrinal enforcement. Precious children and wonderful Jehovah's Witnesses are dying for nothing. There is just one thing that keeps me in this HLC. We are three brothers in different places that are not supporting the Society's view. If someone in Brooklyn reads this, then I want them to know that we have been very successful in our work, among doctors and brothers, as to distributing information about our internal problems. We are not pushing the matter, we respect the individuals choice in this decision. But we also hope that Society could take note of what is going on, and in the name of the truth, love and justice, do what they must do for our dear brothers.
I want to use this opportunity to thank the Liberal Elder and some others out in the Net who hopefully can be a valuable tool in saving lives and changing erroneous doctrines.
A Member of HLC