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Religion and Exsanguination

18 Jun

Jehovah’s Witnesses refuse blood transfusions and other blood products on religious grounds. It is within their right to do so, of course, but it does lead to some tricky medical situations. I’ve had many patients who were Jehovah’s Witnesses over the years and indeed their refusal to accept transfusions have led to problems, even deaths.

Many surgeons will not deal with people of this faith for that very reason. It ties their hands. It puts them in a very difficult situation in that if excessive bleeding occurs during surgery, the patient can easily die. Liability aside, it is a tragedy to see someone die before your eyes when you know saving them is simple. I know. Been there.

When I trained in cardiology at the Texas heart Institute in Houston, Texas I had the great pleasure of working with perhaps the most technically skilled surgeon ever–––Dr. Denton Cooley. He truly had magic in his fingers. He perform procedures that no one else would have touched. He took the most difficult cases in the world and often made them look simple. He did not hesitate to perform surgery on Jehovah’s Witnesses.

I remember one such case quite vividly. A young woman, just 21 years old, who came in for a repair of Tetralogy of Fallot, a complex continental heart problem that is typically partially relieved at a very early age and then the definitive correction waits until growth is complete. That was the case in this young woman. Tetralogy is in the group of congenital cardiac problems that we call cyanotic heart disease. Complex physiology and I won’t go into it here but what is relevant is that sufferers of these types of heart problems invariably bleed a great deal when surgery is performed. That was the case with this young lady.

I remember the night that the nurses and I spent circling around this young woman’s bed while she basically bled to death. It took several hours. It took long and repeated consultations with the family in which I explained over and over that saving her life was easy but watching her die was hard. They stuck to their beliefs. Until it was too late. It was probably around two in the morning when she finally passed. Not a dry eye in the house.

As I was writing my final notes and preparing to go tell the family that the worst had happened, one of the nurses came to me and said the family wanted to talk to me. I went out to the waiting room. The family said that they had talked it over and had decided that if a blood transfusion would save her life then that would be okay.

Anger does not do justice to the emotions that I felt. I think I broke a molar trying not to show it. It’s one thing to have devout religious beliefs. It is another thing to allow those to interfere with the health and well-being of another person. And it is indeed another thing entirely when those beliefs are not as rock solid as one would have you believe. Had they stuck to their religion, had they stuck to their beliefs, then this would’ve simply been a very sad situation, but the fact that their beliefs wavered at the 13th hour was infuriating.

And now a similar situation has arisen in a legal case. Harry Morales was stabbed and died from his wounds when he refused a blood transfusion because he was a Jehovah’s Witness. The person who stabbed him, Isead Galva, was brought to trial for the murder. The defense argued that even though their client had stabbed the victim, it was his refusal to accept standard medical care in the form of a life-saving blood transfusion that ultimately led to his death. Mr. Galva was acquitted at least in part on this basis.

I don’t know about you but I find this equally infuriating. So what if Mr. Morales held religious beliefs against blood transfusions? So what if his refusal to take that form of treatment did lead to his death? He should never have been there. He should never have had to make that decision. The act that instigated the cascade of events that led to his death was the knife wound allegedly delivered by Mr. Galva.

Two cases. Same outcome. But very different.

The first was a young woman who had a medical condition that would kill her were it not repaired. She died because of the religious beliefs of others (she was unconscious due to the anesthetic of surgery early on and later because she was in shock, so consent for a transfusion could not be obtained from her directly). The change of heart that came too late was the maddening part of that situation.

The second case is a man and a family that stuck to their beliefs. But he should never have been there and they should never have had to make that decision. It was not a life-saving procedure that put Harry Morales in danger but rather the criminal act of another.

The world sometimes spins in maddening directions.

 

10 responses to “Religion and Exsanguination

  1. Gary Phillips

    June 19, 2010 at 6:54 am

    Pretty damn interesting cases, Doug.

    Gp

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  2. Evelyn David

    June 19, 2010 at 1:42 pm

    I enjoy your blog very much. In regards to this post, I think the most complex moral situations involve children. Should a parent’s religious belief stand in the way of saving a child’s life?

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  3. Pat Brown

    June 19, 2010 at 8:57 pm

    It always is tragic when these things happen. It’s worse when parents inflict it on underage children who can’t legally give consent. But I’m curious about the statement about liability. A doctor or hospital couldn’t be sued for any form of malpractice could they if a patient died because they refused medical treatment, could they? If they can, then there’s something seriously out of whack with the medical/legal world.

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    • D.P. Lyle, MD

      June 20, 2010 at 9:57 am

      You can be sued by anyone at anytime for anything. Just watch the ambulance chaser TV ads. Most have no basis in science but work quite well for a shake down. And the new so-called reform doesn’t touch this.

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  4. Sue Rice

    June 20, 2010 at 12:10 pm

    My mother was a night nursing supervisor at a large pediatric hospital. They had a list (this was before speed dial) of judges they could call to get a court order making the child patient a ward of the court so life-saving treatment could be used despite the religious convictions of the family. A brutal solution, perhaps, but at least the parents have a live child.

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  5. Silverado Mom

    April 3, 2011 at 6:54 am

    I am curious why a cell saver machine, or blood thinners, or oxygenation of blood, or bloodless surgery not considered for these types of patients?

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    • D.P. Lyle, MD

      April 3, 2011 at 7:30 am

      Blood thinners would be counter productive since they would increase bleeding and increasing oxygenation is used but of little help since the problem with bleeding is the loss of oxygen-carrying cells–the RBCs–so it matters little how much oxygen is given since those RBCs remaining are already maxed out so to speak. Cell saving technologies are used but not all types of blood loss are amenable to this. An example would be bleeding into the bowel or abdomen after surgery when the patient is in the ICU. Cell saving is used during surgery but doesn’t really fit the ICU setting. Bloodless surgery is a misnomer. No such thing. There are surgical techniques–such as using lasers, etc–that cause less bleeding but not none–and these are used frequently. Still patients can bleed and get in trouble–trouble where the only way out is to give blood.

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      • Silverado Mom

        October 11, 2011 at 7:22 pm

        Sorry it’s taken me so long to get back. That’s all very interesting and I appreciate you giving me that explanation. I have a copy of Dr. Lapin’s video on “bloodless surgery”. It was fascinating to see him using the peddle while working. It’s my understanding, there are many doctors who have studied under him, advancing in these areas. But I am not a doctor and don’t pretend to know even an iota of what you do. I do feel that lawsuit happy America tends to put pressure on doctors to feel the need to assure success by way of transfusions. I’m not confident that the blood supply is all that safe either. I’d prefer to have my own, whenever possible. Your experiences must be so very fascinating.

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  6. CANBERRAS LEADING FORENSICS EXPERT

    October 11, 2011 at 4:24 am

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