Jehovah's Witnesses comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. Many Jehovah's Witnesses feel that accepting a blood transfusion will lead them to eternal damnation. A patient's self-determination, or autonomy, allows her to make decisions regarding her care. The decision to refuse blood or blood products has been upheld in court. This brings a new twist to the physician's obligation to “do no harm.” When one undertakes the care of one of these patients, it is important to understand the ethical and medicolegal ramifications. The decision to be the primary caregivers can only be made once the physicians have decided they can let the patient die when all other options have been exhausted. This commentary discusses the ethical concerns and reviews the alternatives available to a Jehovah's Witness.
There are many ethical and medicolegal issues involved in optimizing the care of a pregnant Jehovah's Witness.
Division of Maternal–Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The Mount Sinai Medical Center; and Morgan, Lewis and Bockius LLP, New York, New York
Address reprint request to: Cynthia Gyamfi, MD, Division of Maternal–Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The Mount Sinai Medical Center, 5 East 98th Street, Box 1171, New York, NY 10029; E-mail: firstname.lastname@example.org.
Received November 19, 2002. Received in revised form December 5, 2002. Accepted January 2, 2003.