Provide safe, culturally sensitive care.
- Jehovah’s Witnesses and their scriptural beliefs frequently are challenged within our current healthcare system.
- Blood transfusion for the Jehovah’s Witnesses patient isn’t an option, but it may be misinterpreted as refusing medical treatment.
- Nurses have access to ethical, legal, and cultural tools to help honor Jehovah’s Witnesses patient’s human rights.
Providing holistic and compassionate care in the face of complex ethical and legal situations requires that healthcare professionals possess emotional intelligence. Consider, for example, the approximately 1.2 million Jehovah’s Witnesses living in the United States (about 8.4 million worldwide) whose belief system requires them to decline many human blood products, even when facing death.
A common misconception about Jehovah’s Witnesses is that they believe their faith will heal illness and injury. When health issues arise, members of this religion do seek out the best possible medical care for themselves and their families, but they choose providers who specialize in providing care in line with their beliefs. However, when faced with a life-or-death decision that requires a blood or blood product transfusion, many Jehovah’s Witnesses view the experience as a threat to their faith. (See Jehovah’s Witnesses and blood transfusions.)
As integral members of the interprofessional healthcare team, nurses must possess empathy, compassion, and nonjudgment. They also must have knowledge of many ethical and legal issues. When caring for Jehovah’s Witnesses, your goals include providing a stress-free, calm, and healing environment to help alleviate patient and family anxiety about blood and blood product transfusions. Meticulous planning and execution, including implementation of the seven pillars of care, can assist you in advocating for individual patient needs. (see Seven pillars.)
Ethical and legal concerns
Patient rejection of blood or blood product transfusions (even when faced with death) may create an ethical dilemma for healthcare providers, but a mentally competent individual has an absolute moral and legal right to refuse or reject a transfusion. Exceptions include diminished decision-making capacity, a legal intervention, or a legal document that mandates treatment. Most Jehovah’s Witnesses will decline transfusion of whole blood products, but if possible, discuss the specifics alone with the patient. Some will accept a blood transfusion privately.
Schwab and colleagues describe blood management as a patient-centered, evidence-based approach to transfusion that seeks to provide the right care, in the right setting, in the right way, every time. It includes honoring the wishes of patients who decline blood products, which may create feelings of cognitive dissonance in nurses, physicians, and hospital staff. The principle of beneficence requires nurses, physicians, and hospital staff to act for the benefit of the patient and support a number of moral rules that protect and defend the rights of others, prevent harm, and remove conditions that may cause harm. Peyton describes successful care of patients who decline blood products as including respectful dialogue that doesn’t attempt to coerce them into accepting treatment.
Respect for the patient’s autonomy and legal rights requires obtaining informed consent before any medical intervention. Documentation protects both the patient’s right to make decisions about their own healthcare and the professional practice of nurses, physicians, and hospitals.
Admission documentation and screening
Effective care of patients who decline blood transfusion includes helping them to clearly document their specific wishes in a format that both the patient and hospital staff can easily access and understand. Begin this process during admission by clarifying medical and technical issues. Learn which medications (including interferons, clotting factors, RhoGAM, erythropoietin, and tissue adhesives) may contain a blood product and, as needed, consult with the pharmacy for more detailed information. Refer patients to bloodless centers as appropriate. More than 100 such centers, which have integrated principles of bloodless care (including minimizing diagnostic blood loss), exist in the United States. They employ healthcare providers who specialize in bloodless care.
Weeks before a bloodless procedure, physicians may prepare the patient by bolstering the patient’s hematocrit with iron supplements, recombinant products (erythropoiesis-stimulating agents, granulocyte colony–stimulating factors), or I.V. iron or tranexamic acid. The patient meets with physician a few days before the procedure to ensure their hemoglobin is at a safe level.
Many Jehovah’s Witnesses carry a signed and witnessed advance directive and a durable power of attorney for healthcare. In addition to scanning these documents into the patient’s health record, many hospitals provide a form that states the patient declines whole blood, red cells, white cells, platelets, and plasma, as well as a list of additional choices the patient will either accept or refuse.
Advance directives carried by Jehovah’s Witnesses list the blood products and autologous procedures that are and are not acceptable to the individual patient. Include a copy of this document in the patient’s record, and ensure treatment limitations are made clear to all members of the clinical team. As appropriate and to ease patient concerns, work with the local Hospital Liaison Committee for Jehovah’s Witnesses. (See Hospital liaisons.)
Durable power of attorney
A Jehovah’s Witnesses’ legal durable power of attorney for healthcare clearly states the patient’s decision not to accept blood transfusions. It also lists healthcare agents who can be contacted for assistance if needed. These documents are particularly useful when treating a patient who arrives at the hospital unconscious or otherwise unable to meaningfully participate in decision-making. Some durable power of attorney documents allow healthcare agents to override a patient’s written statements if the patient can’t. However, the document carried by many Jehovah’s Witnesses contains the following legal language: “I give no one (including my healthcare agent) any authority to disregard or override my instruction set forth herein.”
Compassionate, nonjudgmental care
Jehovah’s Witnesses’ religious and spiritual beliefs frequently are misinterpreted within the healthcare community, and some providers, including nurses, judge them for their treatment choices. Providing competent and compassionate care requires that nurses be prepared to protect the rights of all patients, including Jehovah’s Witnesses. You can accomplish this by using the ethical and legal tools that support and advocate for Jehovah’s Witnesses’ religious beliefs.
Bonnie L. Schuerger is a clinical nurse educator at Kent State University in Kent, Ohio.
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