Jehovah's Witnesses and blood transfusions

Jehovah’s Witnesses believe that the Bible prohibits eating blood, and that this includes the storage and transfusion of blood, including in cases of emergency. This doctrine was introduced in 1945, and has been elaborated upon since then. Accordingly the organization has established Hospital Information Services responsible for education on and facilitation of “bloodless surgery.” This service also maintains Hospital Liaison Committees whose function is to provide support to adherents.

Although accepted by a majority of Jehovah’s Witnesses, evidence indicates a minority does not wholly endorse this doctrine. Facets of the doctrine have drawn praise and criticism from both members of the medical community and Jehovah's Witnesses alike.

Current doctrine
Using biblical texts such as ; and, the current doctrine states that:


 * Blood is sacred to God.
 * Blood means life in God's eyes.
 * Blood must not be eaten or transfused.
 * Blood leaving the body of a human or animal must be disposed of, except for autologous blood transfusions considered part of a “current therapy”.
 * Blood was reserved for only one special use, the atonement for sins, which led up to Jesus' shed blood.
 * When a Christian abstains from blood, he or she is in effect expressing faith that only the shed blood of Jesus Christ can truly redeem him or her and save his or her life.
 * Even in the case of an emergency, it is not permissible to sustain life with transfused blood.
 * Conscientious violation of this doctrine is a serious offense, after which a member is subject to organized shunning, known amongst Jehovah's Witnesses as being disfellowshipped or disassociated.

Medical implications
Certain medical procedures involving blood are specifically prohibited under the Watchtower organization’s blood doctrine. Other procedures are not doctrinally prohibited. For procedures where there is no specific doctrinal prohibition, individuals are to obtain details from medical personnel and then make a personal decision.

Use of red blood cells, white blood cells, platelets and blood plasma are specifically prohibited under this doctrine. Other fractions derived from blood are not prohibited. However, the Watchtower organization states, "some products derived from one of the four primary components may be so similar to the function of the whole component and carry on such a life-sustaining role in the body that most Christians would find them objectionable."

The following medical procedures are prohibited:
 * Transfusion of allogeneic whole blood, or of its constituents of red cells, white cells, platelets or plasma.
 * Transfusions of pre-operative donated autologous blood.

The following are examples of medical procedures and products not prohibited but are not promoted:
 * Blood donation strictly for purpose of further fractionation of red cells, white cells, platelets or plasma for either allogeneic or autologous transfusion.
 * Transfusions of autologous blood part of a "current therapy".
 * Hemodilution, a modified technique in which equipment is arranged in a circuit that is constantly linked to the patient's circulatory system.
 * Intraoperative blood salvage (autologous) or cell-saver scavenging, a method of picking up blood that has spilled from the circulatory system into an open wound, cleaning and re-infusing it.
 * Heart-Lung Machine, a method in which blood is diverted to an artificial heart-lung machine and directed back into the patient.
 * Dialysis, wherein blood circulates through a machine, is filtered and cleaned, then returned to the patient.
 * Epidural Blood Patch, consisting of a small amount of the patient's blood injected into the membrane surrounding the spinal cord.
 * Plasmapheresis, wherein blood is withdrawn and filtered, having the plasma removed and substituted, and returned to the patient.
 * Labeling or Tagging, blood is withdrawn, mixed with medicine, and then returned to the patient by transfusion.


 * Platelet Gel, blood is withdrawn and put into a solution rich in platelets and white blood cells.
 * Fractions from red blood cell
 * Hemoglobin, the content of red blood cells. Also see blood substitutes
 * Fractions from white blood cells.
 * Interferons
 * Interleukins
 * Fractions from platelets
 * Platelet factor 4
 * Fractions from blood plasma.
 * Albumin
 * Globulins
 * Clotting factors, including Factor VIII and Factor IX derived from large quantities of stored blood
 * Wound healing factor
 * Erythropoietin (EPO).
 * PolyHeme, a blood substitute solution of chemically modified human hemoglobin.
 * Hemopure, a blood substitute solution of chemically stabilized bovine hemoglobin derived from cow's blood.

Bloodless surgery
Main article: Bloodless surgery

While many Jehovah's Witnesses refuse blood on religious grounds, there are non-Witness patients who also choose to avoid blood on non-religious grounds out of concern for AIDS, non-A and non-B hepatitis, and immune system reactions. As a result, bloodless surgery and transfusion alternatives are more commonplace than in the past. However, the term bloodless surgery does not literally mean surgery where blood is not transfused. Also, in relation to Jehovah’s Witnesses and blood transfusion, bloodless surgery may at times employ techniques and medical applications contrary to their interpretation of Biblical law.

Thousands of physicians around the world have expressed a willingness to respect patient preferences and provide bloodless treatment. There are about 200 hospitals in the world featuring bloodless medicine and surgery programs as a special service for adult and pediatric patients who wish to avoid or limit blood transfusions, or to avoid treatment contrary to the Watchtower organization’s blood doctrine. Whatever the reasons for their choice, bloodless surgery has been successfully performed even in such invasive operations as open-heart surgery and total hip replacements.

The Pennsylvania Hospital is one example of a medical institution with a bloodless medicine program. Medical centers utilizing bloodless medicine programs are available in a number of countries, with over a hundred in the United States alone.

Jehovah's Witnesses have produced video documentaries showing the benefits of bloodless surgery techniques featuring interviews with many leading surgeons and prominent physicians in this field of medicine. However, experts on bloodless surgery express that bloodless medical and surgical techniques have limitations, and that the use of various allogeneic blood products and/or pre-operative autologous blood transfusion is the standard of care for some patient presentations.

In cases of certain medical emergencies when bloodless medicine is not available, blood transfusions may seem to be the only available way to save a life. Such situations are obviously very serious. In such instances, Jehovah’s Witnesses may ask their doctors to provide the best alternative care possible under the circumstances, with respect for their personal conviction. If asked, “Would you deliberately allow your child to die if blood would save it?” the Watchtower organization suggests Jehovah’s Witness parents answer, “I would demand that medical science do everything possible to save my child’s life short of giving it blood.” This has led to the death of members, as stated in the May 22, 1994 issue of Awake, p. 2: "In former times thousands of youths died for putting God first. They are still doing it, only today the drama is played out in hospitals and courtrooms, with blood transfusions the issue."

It should be noted however that in some countries, for example the UK, the parent or guardian's decision can and is overridden by medical staff within the confines of the law. An example of this would be where parent, both parents, or even both parents and child wish to refuse treatment. In this case medical staff may act without consent, by order of the courts in a non-emergency situation, or without such an order in an emergency situation.

Hospital Liaison Committees
To facilitate surgery without violating their belief against transfusions, in 1988 the Watchtower organization formed Hospital Information Services, an internal department which in turn established Hospital Liaison Committees to enroll doctors and surgeons who will practice bloodless surgery for Witness patients. As of 2003 about 200 hospitals in the world feature bloodless medical programs. As of 2006 there are 1,535 Hospital Liaison Committees worldwide ‘coordinating communication between 110,000 physicians’

Hospital Information Services researches thousands of medical journals worldwide to locate information on the availability and effectiveness of many forms of bloodless surgery and treatment to supply Hospital Liaison Committees, health care centers, and some doctors with information on these medical advances. This department provides information to the local Hospital Liaison Committees as well as to doctors and hospitals seeking assistance in treatment options for Witnesses.

The Watch Tower Society has published information about medical matters, blood transfusion in particular, in order to provide an explanation of their view, and also to promote the idea that the practice violates God's laws.

Many Witnesses carry a "Hospital Care Card" or an "Advance Medical Directive/Release card" ("No Blood" card) and, in some countries, a health-care durable power of attorney (DPA) form outlining their wishes in case of emergencies. They also give this information to medical personnel prior to surgeries or other medical procedures that might involve blood, organ transplants, or a decision whether or not to sustain their lives under certain circumstances.

The Watchtower also makes available an "Identity Card" for parents to have their Minor children carry outlining parental (or legal guardian) medical preferences, and including information on how to contact a parent, relative, or somebody responsible for the child.

Acceptance within the Jehovah's Witness community
The Watchtower organization has expressly acknowledged division among Jehovah’s Witnesses regarding this doctrinal position, and that it has received repeated requests from individual Jehovah’s Witnesses that the doctrine be changed to sanction medical transfusion of donor blood. It also reports that some Jehovah’s Witnesses have voluntarily accepted blood transfusions contrary to Watchtower doctrine. The organization confirms that this has remained the case despite the initiation in 1961 of a policy of communal shunning for conscious and volitional acceptance of blood transfusion.

Since the elaboration of the blood doctrine to the point of prohibiting transfusion, a majority of Jehovah's Witnesses have adopted the Watchtower organization's position. Those Jehovah’s Witnesses who accept the blood doctrine are typically fervent in their conviction. However, the blood doctrine has not attained universal acceptance among Jehovah’s Witnesses; there remains a sizable minority of Jehovah’s Witnesses who do not fully agree with the Watchtower’s blood doctrine. In 1982, a peer-reviewed case study of a congregation of Jehovah’s Witnesses was undertaken by Drs. Larry J. Findley and Paul M. Redstone to evaluate individual belief in respect to blood among Jehovah’s Witnesses. The result showed 12% were willing to accept transfusion therapy forbidden under Watchtower doctrine. One peer-reviewed study examining medical records indicated a similar percentage of Jehovah’s Witnesses willing to accept blood transfusions for their children. Young adults also showed a willingness to accept blood transfusions. In another study, Jehovah's Witness patients presented for labor and delivery showed a willingness to accept some form of blood or blood products. Of these patients, 10 percent accepted whole blood transfusion.

In the August 1998 issue of Academic Emergency Medicine, Donald Ridley, a Jehovah’s Witness and Watchtower staff attorney, argued that carrying an up-to-date Medical Directive card issued by the Watchtower organization indicates an individual personally agrees with the established religious position of the Watchtower organization. However, the Watchtower organization has issued letters expressing serious concern regarding Jehovah’s Witnesses activating and maintaining these very documents. One letter cites reports that up to 50% of Jehovah’s Witnesses had failed to maintain up-to-date Medical Directive cards, with the result that individual Witnesses were not protected from routine transfusions. Another letter reports that a large majority of Jehovah’s Witnesses had not filled out the Watchtower-provided Durable Power of Attorney document.

With respect to religionists accepting official doctrine of their professed religion, the Watchtower organization states, “Nowadays official church dogma may bear scant resemblance to the personal beliefs of those who profess that particular religion.” Regarding Jehovah’s Witnesses accepting the Watchtower organization’s official position on blood, Drs Cynthia Gyamfi and Richard Berkowitz state, “It is naïve to assume that all people in any religious group share the exact same beliefs, regardless of doctrine. It is well known that Muslims, Jews and Christians have significant individual variations in their beliefs. Why should that not also be true of Jehovah’s Witnesses?” A Watchtower representative, Donald Ridley, expresses that Jehovah’s Witnesses pursue a range of objectives, not just one. He relates these interests include medical, psychological, social, economic, legal, educational and spiritual pursuits. Donald Ridley then expresses that “Maximizing the good in one of these spheres will come at a cost in some other sphere. Rational people will trade off benefits in different spheres until the aggregate total is maximized.”

Ambivalence and rejection of the blood doctrine dates back at least to the 1940s. After the Watchtower Society established the doctrine teaching that blood should not be eaten (circa 1927-31), Margaret Buber, who was never a Jehovah’s Witness, offered a firsthand eyewitness account of Jehovah’s Witnesses in Ravensbrueck concentration camp under Nazi Germany. She relates that an overwhelming majority were willing to eat blood sausage despite having alternate food to choose from and specifically after considering biblical statements regarding blood. The reliability of this testimony is confirmed by another observer, Gertrude Poetzinger, whose husband, Martin Poetzinger, was later appointed to the Governing Body of Jehovah's Witnesses in 1977.

In September of 1945, Jehovah’s Witnesses responsible for publishing Watchtower literature commented on blood transfusion in the Dutch edition of Consolation (now called Awake!). A translation into English reads,

“When we lose our life because we refuse inoculations, that does not bear witness as a justification of Jehovah’s name. God never issued regulations which prohibit the use of drugs, inoculations or blood transfusions. It is an invention of people, who, like the Pharisees, leave Jehovah’s mercy and love aside.”

History of doctrine
Charles Taze Russell, the first president of the Watchtower Society, referenced the Apostolic Decree recorded in the Bible in Acts 15:29. He wrote that “The things mentioned were merely to guard against stumbling themselves or becoming stumbling blocks to others.” In 1909, Russell wrote concerning abstinence from blood, “it was necessary to the peace of the Church that the Gentiles should observe this matter also.” Regarding stipulations of the Apostolic Decree, Russell concluded, “these items thus superadded to the Law of Love should be observed by all spiritual Israelites as representing the Divine will.”

After Russell's death in 1916, Joseph Franklin Rutherford succeeded Russell as president of the Watchtower organization. Under his administration Jehovah’s Witnesses depicted uses of blood as heroic and the Lord’s work. In 1925, blood transfusion was mentioned in an issue of Golden Age. It reported on Mr. B. W. Tibble who donated blood on forty-five separate occasions. The article highlighted his refusal of payment for donating, and the honor accordingly bestowed upon him by Order of the king. In 1927 the Watchtower organization addressed blood, stating, “God told Noah that every living creature… must not eat the blood…”. In 1931 this was expounded by the Watchtower organization teaching “that it was not the eating of the blood that God objected to, but it was bringing the blood of the beast in contact with the blood of man.” At this time the Watchtower organization taught that human blood was sacred and that it was wrong to contaminate human blood with animal blood. In 1940 while discussing interesting medical news, the Watchtower organization reported on a woman who accidentally shot herself with a revolver in her heart and survived a major surgical procedure during which an attending physician donated a quart of his own blood for transfusion. After Rutherford’s death in 1942, the Watchtower organization (under Nathan Homer Knorr’s administration) wrote in 1944, “the stranger was forbidden to eat or drink blood, whether by transfusion or by the mouth” and that this applied “in a spiritual way to the consecrated persons of good-will today, otherwise known as “Jonadabs” of the Lord’s “other sheep.”” In 1945, the application of the doctrine on blood was expanded to prohibit blood transfusions of whole blood, whether allogeneic or autologous. While the prohibition didn't specify any punitive measures for accepting a transfusion, by January of 1961 it became a disfellowshipping offence to conscientiously accept a blood transfusion. This represented an admitted shift toward increased strictness by the Watchtower organization imposing additional obligation upon the community of Jehovah’s Witnesses. As part of this doctrinal shift, the Watchtower organization warned that accepting a blood transfusion could prevent them from living eternally in God's new world, the hope held by members:


 * "It may result in the immediate and very temporary prolongation of life, but that at the cost of eternal life for a dedicated Christian."

In September of 1961, the Watchtower doctrine stated that accepting fractions from blood was in violation of God’s law. Two months later, in November, the doctrine was modified to allow fractions used from blood for purposes such as vaccination. This position has been expanded on since, to a point where a Watchtower-provided Durable Power of Attorney form provided the following acceptable option for Jehovah’s Witnesses:


 * ”I accept all fractions derived from any primary component of blood."

Publications by Watchtower frequently point out negative results from blood transfusions.


 * "And let the transfusion enthusiasts with a savior-complex ponder the fact that on many occasions transfusions do harm, spread disease, and frequently cause deaths, which, of course, are not publicized."


 * In the news article, Watching the World, reference is made to a man named Robert Khoury, who, after receiving a blood transfusion said, “When I recovered I found I had a terrible desire to steal.”


 * The May 22, 1974 AWAKE! p. 18 quotes the United States Congressional Record: "'The Center for Disease Control has stated that the actual rate of hepatit[i]s may be well in excess of the official figure due to the failure of many physicians to report serum hepatit[i]s cases. The center estimates that as many as 35,000 deaths and 500,000 illnesses a year may be due to the presence of serum hepatit[i]s in blood for transfusions.'"


 * In a 1961 Watchtower, Dr. Américo Valério, A Brazilian doctor and surgeon for over forty years, was quoted as saying "Moral insanity, sexual perversions, repression, inferiority complexes, petty crimes—these often follow in the wake of blood transfusion." In addition, reference is made to the book, Who Is Your Doctor and Why?, wherein Doctor Alonzo Jay Shadman says: “The blood in any person is in reality the person himself. It contains all the peculiarities of the individual from whence it comes. This includes hereditary taints, disease susceptibilities, poisons due to personal living, eating and drinking habits. . . . The poisons that produce the impulse to commit suicide, murder, or steal are in the blood.”


 * "The heart is a marvelously designed muscular pump, but, more significantly, our emotional and motivating capacities are built within it. Love, hate, desire (good and bad), preference for one thing over another, ambition, fear--in effect, all that serves to motivate us in relationship to our affections and desires springs from the heart.... It is significant that heart-transplant patients, where the nerves connecting the heart and brain are severed, have serious emotional problems after the operation." In support of such statements, references are made to the Medical World News , and to Dr. D. E. Schneider, a neurologist and psychiatrist of New York.


 * The August 2006 Awake! highlighted dangers from Transfusion-related acute lung injury (TRALI), mentioning that this was the cause of around 500 deaths in the USA in 2002. The New Scientist magazine stated that "researchers now agree that TRALI occurs in about one in 5000 transfusions, which means there are at least 5300 TRALI reactions per year in the US alone, and something like 500 deaths."

In 1964, Jehovah's Witnesses were prohibited from obtaining transfusions for pets, from using fertilizer containing blood, and were even encouraged to write to dog food manufacturers to verify that their products were blood-free. Later that year, Jehovah's Witnesses doctors and nurses were instructed to withhold blood transfusions from fellow Jehovah's Witnesses. As to administering transfusions to non-members, The Watchtower stated that such a decision is "left to the Christian doctor’s own conscience."

In 1982, a Watchtower article declared that it would be wrong for a Witness to allow a leech to feed on his/her blood as part of a medical procedure, due to the sacredness of blood.

In 1989 The Watchtower stated, "Each individual must decide" whether to accept hemodilution and autologous blood salvage (cell saver) procedures. In 1990, a brochure entitled How Can Blood Save Your Life? was released, outlining Jehovah's Witnesses' general doctrine on blood.

In 2000, the Watchtower organization's stand on blood fractions was clearly stated. Members were instructed to personally decide if accepting a fraction would violate the doctrine on blood. In a later article, members were reminded that Jehovah's Witnesses do not donate blood or store their own blood prior to surgery.

In May of 2001, the Watchtower organization released revised Medical Directives and Identity Cards addressing its doctrinal position on blood. The Watchtower organization released these revised documents for distribution to commence as of May 3, 2001. These revised documents specified that “allogeneic blood transfusions” were unacceptable whereas the former document (dated 1999) stated that “blood transfusions” were unacceptable. The revised 2001 documents were active until December 20, 2001. At that time the Watchtower organization rescinded the 2001 revised document, stating, “After further review, it has been determined that the cards dated “md-E 6/01” and “ic-E 6/01” should not be used. Please destroy these items and make sure that they are not distributed to the publishers.” Elders were instructed to revert to the older 1999 edition of the Watchtower issued Medical Directives and Identity Cards.

Critical views
The disallowing of blood transfusions has met with internal objections by individual Jehovah's Witnesses, as well as criticism from the medical, ethical and legal communities, especially over the death of children of Jehovah's Witnesses who have fought against the administration of blood in emergencies.

Some feel there are several inconsistencies and contradictions in the current policy, and groups such as Associated Jehovah's Witnesses for Reform on Blood are striving to have these concerns addressed.

If a person has previously been disfellowshipped for accepting a blood fraction that is now permissible, they are not automatically reinstated, as the disfellowshipping is considered to be a result of showing disrespect to Jehovah Gods organization as much as the issue of blood.

Jehovah's Witnesses' stance on blood has been controversial, particularly in the case of children. In the United States, many physicians will agree to explore and exhaust all non-blood alternatives in the treatment of children at the request of their legal guardians. However, some state laws require physicians to administer blood-based treatment to minors if it is their professional opinion that doing so is necessary in order to prevent immediate death or severe and permanent damage.

In her article in the Journal of Church and State, Kerry Louderback-Wood alleges that for the Watchtower organization to label the currently acceptable blood fractions as "minute" in relation to whole blood causes followers to misunderstand the scope and extent of allowed fractions. She also claims that Witness publications exaggerate the medical risks of taking blood and the efficiency of non-blood medical therapies in critical situations.

Witnesses respond that blood as the fluid per se is not the real issue. They say the real issue is respect and obedience for God’s personal property- blood. That the matter blood is not at stake, is seen in the fact that members are allowed to eat meat which will still have some blood left in it. As soon as blood is drained from an animal, the respect has been shown to God and then a person can eat the meat even though it will contain a small amount of blood. Jehovah's Witnesses view of meat and blood  thus is different than the Jewish view that goes to great lengths to remove any little trace of blood. 

Raymond Franz, a former member of the Governing Body of Jehovah's Witnesses, revealed in his book Crisis of Conscience that, for some years prior to 1975, hemophiliacs writing or phoning Jehovah's Witnesses headquarters were told that they would be allowed to take a clotting factor derived from blood just once as "medication," but that taking it more than once would be considered "feeding on blood," and was thus prohibited. In a meeting on June 11, 1975, the Governing Body adjusted its position, deciding to allow hemophiliacs to take clotting factors repeatedly. This change of policy was privately communicated to those who had earlier enquired, but was not published until 1978, when it was mentioned briefly in a Watchtower article discussing serum injections.

Immunoglobulin injections are also controversial, requiring 3 litres of blood to manufacture and often coming from pooled blood sources containing the blood of up to 60,000 people.

Online articles

 * Beliefs of Jehovah's Witnesses regarding medical treatment (JW Public Relations Website)
 * Jehovah's Witnesses and the Apostolic Decree to "Abstain From Blood"
 * How Can Blood Save Your Life? published by Watch Tower Bible and Tract Society
 * Assorted articles on medical care and blood published by Watch Tower Bible and Tract Society
 * The Serious Hazards of Transfusion(SHOT)
 * Hospitals services
 * Jehovah's Witnesses teachings on blood from religioustolerance.org
 * Raymond Franz a former member of the Governing Body of Jehovah' Witnesses critiques this blood policy controversy in detail.
 * Rado Vleugel's story A former Witness talks about his disfellowshipment after "apostasy".
 * The Jensen Letters Correspondence between a Jehovah's Witness elder and the Watchtower Society seeking answers to critical questions about important aspects of their blood doctrine. The correspondence begins in 1998 and concludes in 2003 with the writer's resignation as an elder.
 * Ethical Issues in Compulsory Medical Treatment: A Study of Jehovah's Witnesses
 * BBC News - Refusing blood 'source of regret'

Websites

 * Official website of Jehovah's Witnesses and Watch Tower Bible and Tract Society of Pennsylvania Incorporated
 * Official website of NoBood—Blood Management and Avoidance
 * Official website of Associated Jehovah's Witnesses for Reform on Blood

Témoins de Jéhovah et transfusion sanguine Testemunhas de Jeová e a questão do sangue Jehovan todistajien verioppi 耶和华见证人和血