Thursday, May 7, 2009

Respect Or Tolerance?


Please forgive me if this turns out to be a little rude or insensitive....but I just worked 30 hours of trauma and am a little beat.

Thanks to the swine flu, a nice 13 year old boy was home during the day instead of at school. He was riding his scooter and was hit by a car at about 35 mph. He was hurt pretty bad...his skull was cracked open leaving a track open to the brain. There was a lot of bleeding as the skull is very vascular. We consulted the neurosurgery team and face team immediately to try to get him to surgery asap to give him the best chance possible.

When his mom arrived, she was appropriately distraught. I explained to her the injuries and the need for emergent surgery. Before I could finish the word surgery, she had cut me off to say loud and boldly "I am a Jehovas Witness and I want to sign right now that he can have NO blood." I told her I 'respected' her beliefs, but there was a good chance that her son was going to need blood or blood products to live. It didn't phase her, and she was pulling out her pen. I then told her that we would do our best not to use blood, but in the state we live in parents cannot deny kids the right to blood transfusions in emergent situations. So....she then wrote it out herself on a piece of paper and put it in the chart.

We are taught ethics in med school....and the blood issue with Jehovas Witnessess is very familiar. It usually isn't a problem unless its with children. I am not a total ass. When I am with my muslim friends...I am sure to order pizza without pork, even thought they are drinking beer. When I am with my Jewish friends...we go somewhere kosher, and I even bring coupons. One of my dearest patients in the past was a Jehovas Witness....and I made sure he got through his entire complicated hospital course without blood.

But this night it just hit me the wrong way. I wasn't rude to her. I didn't tell her we all sin in our different religions so I didn't understand why she wouldn't let this "sin" go so her child could live. I just muttered the same ole "I respect your....." But I don't think its respect any more. Its tolerance. We tolerate things that are different than we believe...and in the end just try to do our job. That night it was to keep HER child alive.

-ER Doc

22 comments:

Lilorfnannie said...

Well, maybe I can help with the understanding why part. I have some experience with that kind of thinking. Well, a lot of experience, different denomination though. Anyway. The reason why someone would choose to let their child die rather than accept blood products is because they think that the blood products, and the sin of not obeying God's word (as their church interprets it) would *irrevocably* taint their child's soul. They think the child would no longer go to heaven, not now or ever. Now, 70 or 90 years on this earth is barely a lightning flash compared to eternity, right? Besides which, on this earth, if they do not obey God's commands then they lose God's favor- so they've lost His blessings and Presence in this life as well. So for her, it is a choice between an earthly life, spent in unhappiness or even degenerating to drugs and prostitution and who-knows-what (because that is what Sin In Your Life leads to) devoid of God's presence and favor followed by an eternity in Hell, OR, an immediate death (when this earthly life is incredibly brief and only a preparation for the eternal anyways) followed by an eternity in Heaven with God. In that paradigm, the choice is a no-brainer. They view themselves as being only strangers and pilgrims on this earth, like non-native sojourners in a foreign country, here for a brief stay only. The ultimate goal in life is *only* to serve God and obey His commandments, and to try to get as many people as possible to go to Heaven as well, for their own good.

You are in a tough or impossible spot with these folks. You won't get anywhere threatening them with the law, because they don't view the law as really applying to them (and certainly not on spiritual issues). They are citizens of another (heavenly) country, remember? They will only view threats of the law with disdain, and view it as "persecution" of their beliefs, and wear it like a badge of honor. There might be some success with reasoning with their beliefs- explaining to them from the scripture why it is that blood products are NOT a sin, why they no longer have to follow the old testament commandments, and so forth. However that is asking them to change their entire paradigm for viewing the world- and it's a tall order. Myself I don't have a problem with doing that, because I know from scripture that this belief is wrong, and I agree with you with the damage it causes the innocents that need blood, etc. If they are on the edge already, it might work. Perhaps you can research on the web, find anti-JW sites and have a page-full of scriptures that explain exactly why it is o.k. to receive blood products, and memorize that- you might find a good spot to bring those out in talking to them. That would probably be going way beyond what hospital rules would let you do so of course I think you would never do something like that, but I mention it anyways. If they are firmly set then doing that might either cause them to smile grimly and say No thanks and that's it, or they might complain and make noise about it- but I think it's your only shot.

Lilorfnannie said...

Oh, I forgot. Another aspect to that kind of thinking is that they believe that if they obey God implicitly, then God will have their back (so to speak) when they need Him. If they obey Him 100% then He will either heal their child, or, at the very least everything that happens will be in God's will so that if the child dies it is all for the good of those who love the Lord, and it is for the best, even if they can't understand why with their finite minds at the moment. One is either clean or unclean, obeying or not obeying- no ifs ands or buts. There is really no option in their minds, and they are prepared to lose their child or their own lives or anything at all rather than lose God and suffer eternal hell.

Hope it helps :-)

Trust us....we're doctors said...

It does help, but in my mind we all sin no matter what relegion...so what's one more if it will save your kids life. But maybe that since weighs more to them, where to a christian all sins are supposed to be the same.

Trust us....we're doctors said...

Either way I'm tired of being told to respect....I think its really tolerance. What's the matter with that?

ERP said...

I am disgusted that someone would place their religious beliefs above the safety of their child. I had a young adult man refuse blood and die in front of his children and wife - he was in his early 30's and was totally savable. The family just went along with it. Now, transpose that to a child and it crosses the line. I would contact the hospital's ethics dept and transfuse the blood if I thought the kid would not survive without it - I would not be able to live with myself if I let someone's extreme religious views harm a child. Luckily, we are protected by the courts in these cases with minors. Personally, I believe that if the Jehova's Witness were formed today, they would be branded a cult for some of their bizarre and dangerous beliefs.

Lilorfnannie said...

Oh, JW's are definitely a cult, no doubt about it.

I think the response to the "we all sin, what's one more" thought is that we might all sin unknowingly, but not purposefully. For a Christian that loves and serves Jesus, they can't just be lassez-faire and just pick and choose what they want to obey. It doesn't work that way.

Of course the problem lies in understanding what the Bible really says, and what does God really require of us. We have the Bible as the ultimate guidebook, but over the centuries mankind has formulated all kinds of fairytales and man-made rules to control the populace, so it's pretty hard (at least for me) to know where to draw the line. I don't believe in fairytales or man-made rulebooks any more. But that's neither here nor there- hope the dialogue helps, as a manner of provoking thought at least anyways :-)

Lilorfnannie said...

Oh, and once a person becomes a Christian, they are supposed to receive the Holy Ghost (God's Spirit dwelling within them) so that their inner man is changed. They no longer have the desire to continue the old sinful ways- and God helps them to avoid sin. So in that manner of speaking, it is possible and desirable to live above willful sin. Just telling you the thought process :-)

LivingDeadNurse said...

wow what an interesting discussion...but you also have to look back in the bible when God asked Issac to sacrafice his son...i am not saying what JW believe is right but if God came down and said do this or forever be damn...you would rather go to hell? Maybe their religion is a little more strict than some others were you just as for forgiveness anf your forgiven. That its better to leave this world early and go to heaven than live here till their 90 and spend eternity in hell.. a very ethical question and hard to pick the right side

Anonymous said...

There is no god and no afterlife. Give the kid a transfusion. And no, you don't have to respect someone's illogical and unfounded beliefs.

Lilorfnannie said...

LivingDeadNurse- you have a point. Yes, God did ask Abraham to sacrifice his only son- even though it was only a test of faith, and God never actually intended for Abraham's son to be killed. He wanted to see what kind of faith Abraham had. Yes you have a point!

Anon.- religious faith is not "logical." It doesn't depend on brainpower and smarts. Two separate things. People that insist on trying to use their reasoning alone to approach spiritual matters will never truly understand the matter. And no I can't "explain" why ;-) There *is* a God and there *is* an afterlife :-) But you can't insist that other people conform to YOUR paradigm any more than you want to be forced to conform to THEIR paradigm. I have noticed that "liberal" people that are all for tolerating all kinds of sick deviancy seldom want to tolerate certain things such as Christianity- they just want the world to submit to THEIR paradigm, as usual.

Anonymous said...

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Doctor House
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ArkieRN said...

The Lord also expects us to forgive others. So, in that vein, go ahead and give the blood - they have to forgive you if they're following God's tenants.

Anonymous said...

Saving a kid's life trumps a parent's belief in a cult any day. Not to mention the bible passage they "quote" for this belief refers to drinking blood of animals sacrificed to pagan idols. There were no transfusions two to five thousand years ago.

Pattie, RN

Anonymous said...

Our very own President that the American people overwhelmingly voted for believe in "Choice". Many women believe in "Choice". This woman is exercising her "Choice". What is the difference between this and a woman chosing to abort her unborn fetus. Is the value of life based on "age" alone?

J. Murphy, MD

Da Blog said...

I'm not sure that lilorfnannie is too familiar with JWs, if she was she'd know we don't believe we're going to heaven or that people go to hell.

Just a couple points, worldwide and certainly across the US Jehovah's Witnesses have hospital liaison committees available to the medical profession. You can call anytime to discuss treatment options or be put in contact with other medical teams that may be more familiar with medical alternatives to blood. No one wants a HCP to be forced to do something he doesn't believe in. The 24/7 # is 718-560-4300, or certainly any local JW could put you in touch as well.

It is uncommon that blood is a major obstacle to tx anymore. Trauma is probably the last hurdle. The main point is to ask the family what they are comfortable accepting. PRBCs or FFP may not be ok but albumin may be. Thank you for tolerating the pt wishes on blood, even if it's something you disagree with. How is the kid?

PS.Your blog is fantastic!

Trust us....we're doctors said...

Thanks for the complement on the blog. You are showing some impressive tolerance yourself by not retaliating to some of our comments.

The kid is doing great...and we spared the blood transfusion so everyone was happy.

Lilorfnannie said...

No, I did not know that DaBlog, sorry! I guess I did not know as much as I thought I did. I did not know that the JW beliefe was THAT radically different from what I knew of.

Then, ignoring the issue of whether using or not using blood products is ultimately safer/more effective/what-have-you- if it is not a heaven or hell issue, why would it be worth their own child's life to refuse an emergency, life-saving transfusion? I can't conceive of any reason then, if it is not a heaven or hell issue.

Da Blog said...

I guess I would sum it up as a matter of respect for what we view as clear instructions from God in the Bible regarding blood products. Certainly it's not from any desire to die for our faith- Jehovah's Witnesses desire the best medical treatment, just without blood.

This article is a reprint from the JAMA. It's from 1981, but I think it explains the stand of witnesses well.
http://watchtower.org/e/hb/article_06.htm

Bianca Castafiore said...

"I even bring coupons"?!

Love it...

Bridget said...

This post and subsequent comments got me very interested in JH and their beliefs. I think Wikipedia clears it up:

http://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_blood_transfusions

A bit belated, but perhaps still relevant.

Mo said...

The issue to me is that the child did not choose that wacky religion, so why should he be forced to die because of it? If an adult wants to buy into all that...that's fine, but to force a child to adhere to a belief that could ultimately get him killed is abusive. IMHO, of course.

vixn said...

Hey Mo :)

We're on the same track!

- Jess