Daily Archives: June 18, 2013

How Can Blood Save Your Life?

How Can Blood Save Your Life?

Injured girl

Each day people face ethical decisions about health: organ transplants, abortion, the “right to die.” Hopefully, you will never face those problems.

Yet, there is one issue that demands your attention: How can blood be used to save life?

With good reason, many now ask, ‘How safe are blood transfusions?’ But this is more than a medical issue. It has made news involving Jehovah’s Witnesses. Have you wondered why these ethical people, who believe in good medicine, refuse to accept blood?

As you will see, the medical and moral aspects of using blood bear directly on how you can save your most valued possession: LIFE.

Blood—Vital For Life

Blood—Vital For Life

How can blood save your life? This no doubt is of interest to you because blood is linked to your life. Blood carries oxygen through your body, removes carbon dioxide, helps you adapt to temperature changes, and aids in your fight against disease.

Circulatory System

The linkage of life to blood was made long before William Harvey mapped the circulatory system in 1628. The basic ethics of major religions focus on a Life-Giver, who expressed himself about life and about blood. A Judeo-Christian lawyer said of him: “He himself gives to all persons life and breath and all things. For by him we have life and move and exist.”*

People who believe in such a Life-Giver trust that his directions are for our lasting good. A Hebrew prophet described him as “the One teaching you to benefit yourself, the One causing you to tread in the way in which you should walk.”

That assurance, at Isaiah 48:17, is part of the Bible, a book respected for ethical values that can benefit all of us. What does it say about human use of blood? Does it show how lives can be saved with blood? Actually, the Bible shows clearly that blood is more than a complex biologic fluid. It mentions blood over 400 times, and some of these references involve the saving of life.

In one early reference, the Creator declared: “Everything that lives and moves will be food for you… . But you must not eat meat that has its lifeblood still in it.” He added: “For your lifeblood I will surely demand an accounting,” and he then condemned murder. (Genesis 9:3-6New International Version) He said that to Noah, a common ancestor highly esteemed by Jews, Muslims, and Christians. All humanity was thus notified that in the Creator’s view, blood stands for life. This was more than a dietary regulation. Clearly a moral principle was involved. Human blood has great significance and should not be misused. The Creator later added details from which we can easily see the moral issues that he links to lifeblood.

“The precepts hereby set down in a precise and methodical manner [in Acts 15] are qualified as indispensable, giving the strongest proof that in the apostles’ minds this was not a temporary arrangement, or a provisional measure.”—Professor Édouard Reuss, University of Strasbourg.

He again referred to blood when he gave the Law code to ancient Israel. While many people respect the wisdom and ethics in that code, few are aware of its serious laws on blood. For instance: “If anyone of the house of Israel or of the strangers who reside among them partakes of any blood, I will set My face against the person who partakes of the blood, and I will cut him off from among his kin. For the life of the flesh is in the blood.” (Leviticus 17:10, 11Tanakh) God then explained what a hunter was to do with a dead animal: “He shall pour out its blood and cover it with earth… . You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off.”—Leviticus 17:13, 14Ta.

Scientists now know that the Jewish Law code promoted good health. It required, for example, that excrement be deposited outside the camp and covered and that people not eat meat that carried a high risk of disease. (Leviticus 11:4-81317:15Deuteronomy 23:12, 13) While the law about blood had health aspects, much more was involved. Blood had a symbolic meaning. It stood for life provided by the Creator. By treating blood as special, the people showed dependence on him for life. Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God.

Christian Governing BodyAt a historic council, the Christian governing body confirmed that God’s law on blood is still binding

The Law repeatedly stated the Creator’s ban on taking in blood to sustain life. “You must not eat the blood; pour it out on the ground like water. Do not eat it, so that it may go well with you and your children after you, because you will be doing what is right.”—Deuteronomy 12:23-25NIV; 15:23Leviticus 7:26, 27Ezekiel 33:25.#

Contrary to how some today reason, God’s law on blood was not to be ignored just because an emergency arose. During a wartime crisis, some Israelite soldiers killed animals and “fell to eating along with the blood.” In view of the emergency, was it permissible for them to sustain their lives with blood? No. Their commander pointed out that their course was still a grave wrong. (1 Samuel 14:31-35) Hence, precious as life is, our Life-Giver never said that his standards could be ignored in an emergency.

BLOOD AND TRUE CHRISTIANS

Where does Christianity stand on the question of saving human life with blood?

Jesus was a man of integrity, which is why he is so highly regarded. He knew that the Creator said that taking in blood was wrong and that this law was binding. Hence, there is good reason to believe that Jesus would uphold the law about blood even if he was under pressure to do otherwise. Jesus “did no wrong, [and] no treachery was found on his lips.” (1 Peter 2:22Knox) He thus set a pattern for his followers, including a pattern of respect for life and blood. (We will later consider how Jesus’ own blood is involved in this vital matter affecting your life.)

Martin LutherMartin Luther pointed to the implications of the apostolic decree: “Now if we want to have a church that conforms to this council,… we must teach and insist that henceforth no prince, lord, burgher, or peasant eat geese, doe, stag, or pork cooked inblood… And burghers and peasants must abstain especially from red sausage and blood sausage.”

Note what happened when, years after Jesus’ death, a question arose about whether someone becoming a Christian had to keep all of Israel’s laws. This was discussed at a council of the Christian governing body, which included the apostles. Jesus’ half brother James referred to writings containing the commands about blood stated to Noah and to the nation of Israel. Would such be binding on Christians?—Acts 15:1-21.

That council sent their decision to all congregations: Christians need not keep the code given to Moses, but it is “necessary” for them to “keep abstaining from things sacrificed to idols and from blood and from things strangled [unbled meat] and from fornication.” (Acts 15:22-29) The apostles were not presenting a mere ritual or dietary ordinance. The decree set out fundamental ethical norms, which early Christians complied with. About a decade later they acknowledged that they should still “keep themselves from what is sacrificed to idols as well as from blood … and from fornication.”—Acts 21:25.

You know that millions of people attend churches. Most of them would probably agree that Christian ethics involve not giving worship to idols and not sharing in gross immorality. However, it is worth our noting that the apostles put avoiding blood on the same high moral level as avoiding those wrongs. Their decree concluded: “If you carefully keep yourselves from these things, you will prosper. Good health to you!”—Acts 15:29.

The apostolic decree was long understood as binding. Eusebius tells of a young woman near the end of the second century who, before dying under torture, made the point that Christians “are not allowed to eat the blood even of irrational animals.” She was not exercising a right to die. She wanted to live, but she would not compromise her principles. Do you not respect those who put principle above personal gain?

Scientist Joseph Priestley concluded: “The prohibition to eat blood, given to Noah, seems to be obligatory on all his posterity… If we interpret [the] prohibition of the apostles by the practice of the primitive Christians, who can hardly be supposed not to have rightly understood the nature and extent of it, we cannot but conclude, that it was intended to be absolute and perpetual; for blood was not eaten by any Christians for many centuries.”

WHAT OF USING BLOOD AS MEDICINE?

Would the Biblical prohibition on blood cover medical uses, such as transfusions, which certainly were not known in the days of Noah, Moses, or the apostles?

While modern therapy employing blood did not exist back then, medicinal use of blood is not modern. For some 2,000 years, in Egypt and elsewhere, human “blood was regarded as the sovereign remedy for leprosy.” A physician revealed the therapy given to King Esar-haddon’s son when the nation of Assyria was on the leading edge of technology: “[The prince] is doing much better; the king, my lord, can be happy. Starting with the 22nd day I give (him) blood to drink, he will drink (it) for 3 days. For 3 more days I shall give (him blood) for internal application.” Esar-haddon had dealings with the Israelites. Yet, because the Israelites had God’s Law, they would never drink blood as medicine.

Was blood used as medicine in Roman times? The naturalist Pliny (a contemporary of the apostles) and the second-century physician Aretaeus report that human blood was a treatment for epilepsy. Tertullian later wrote: “Consider those who with greedy thirst, at a show in the arena, take the fresh blood of wicked criminals … and carry it off to heal their epilepsy.” He contrasted them with Christians, who “do not even have the blood of animals at [their] meals… At the trials of Christians you offer them sausages filled with blood. You are convinced, of course, that [it] is unlawful for them.” So, early Christians would risk death rather than take in blood.

“Blood in its more everyday form did not… go out of fashion as an ingredient in medicine and magic,” reports the book Flesh and Blood.“In 1483, for example, Louis XI of France was dying. ‘Every day he grew worse, and the medicines profited him nothing, though of a strange character; for he vehemently hoped to recover by the human blood which he took and swallowed from certain children.'”

“God and men view things in very different lights. What appears important in our eye is very often of no account in the estimation of infinite wisdom; and what appears trifling to us is often of very great importance with God. It was so from the beginning.”—An Enquiry Into the Lawfulness of Eating Blood, Alexander Pirie, 1787.

What of transfusing blood? Experiments with this began near the start of the 16th century. Thomas Bartholin (1616-80), professor of anatomy at the University of Copenhagen, objected: ‘Those who drag in the use of human blood for internal remedies of diseases appear to misuse it and to sin gravely. Cannibals are condemned. Why do we not abhor those who stain their gullet with human blood? Similar is the receiving of alien blood from a cut vein, either through the mouth or by instruments of transfusion. The authors of this operation are held in terror by the divine law, by which the eating of blood is prohibited.’

Hence, thinking people in past centuries realized that the Biblical law applied to taking blood into the veins just as it did to taking it into the mouth. Bartholin concluded: “Either manner of taking [blood] accords with one and the same purpose, that by this blood a sick body be nourished or restored.”

This overview may help you to understand the nonnegotiable religious stand that Jehovah’s Witnesses take. They highly value life, and they seek good medical care. But they are determined not to violate God’s standard, which has been consistent: Those who respect life as a gift from the Creator do not try to sustain life by taking in blood.

Still, for years claims have been made that blood saves lives. Doctors can relate cases in which someone had acute blood loss but was transfused and then improved rapidly. So you may wonder, ‘How wise or unwise is this medically?’ Medical evidence is offered to support blood therapy. Thus, you owe it to yourself to get the facts in order to make an informed choice about blood.


* Paul, at Acts 17:2528New World Translation of the Holy Scriptures.

# Similar prohibitions were later written in the Qur´an.


Picture Credits: 1. A Chart of Veins and William Harvey: Reproduced from Medicine and the Artist (Ars Medica) by permission of the Philadelphia Museum of Art/Carl Zigrosser/Dover Publications, Inc. 2. Martin Luther: Woodcut by Lucas Cranach

Blood Transfusions—How Safe?

Blood Transfusions—How Safe?

Bag of blood

Before submitting to any serious medical procedure, a thinking person will learn the possible benefits and the risks. What about blood transfusions? They are now a prime tool in medicine. Many physicians who are genuinely interested in their patients may have little hesitation about giving blood. It has been called the gift of life.

Millions have donated blood or have accepted it. For 1986-87 Canada had 1.3 million donors in a population of 25 million. “[In] the most recent year for which figures are available, between 12 million and 14 million units of blood were used in transfusions in the United States alone.”—The New York Times,February 18, 1990.

“Blood has always enjoyed a ‘magical’ quality,” notes Dr. Louise J. Keating. “For its first 46 years, the blood supply was perceived as being safer than it actually was by both physicians and the public.” (Cleveland Clinic Journal of Medicine, May 1989) What was the situation then, and what is it now?

Even 30 years ago, pathologists and blood-bank personnel were advised: “Blood is dynamite! It can do a great deal of good or a great deal of harm. The mortality from blood transfusion equals that from ether anesthesia or appendectomy. There is said to be approximately one death in 1,000 to 3,000 or possibly 5,000 transfusions. In the London area there has been reported one death for every 13,000 bottles of blood transfused.”—New York State Journal of Medicine,January 15, 1960.

Have the dangers since been eliminated so that transfusions are now safe? Frankly, each year hundreds of thousands have adverse reactions to blood, and many die. In view of the preceding comments, what may come to your mind are blood-borne diseases. Before examining this aspect, consider some risks that are less well-known.

BLOOD AND YOUR IMMUNITY

Vial of blood

Early in the 20th century, scientists deepened man’s understanding of the marvelous complexity of blood. They learned that there are different blood types. Matching a donor’s blood and a patient’s blood is critical in transfusions. If someone with type A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions.

The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match. Why? Well, in his article “Blood Transfusion: Uses, Abuses, and Hazards,” Dr. Douglas H. Posey, Jr., writes: “Nearly 30 years ago Sampson described blood transfusion as a relatively dangerousprocedure… [Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex.”—Journal of the National Medical Association, July 1989.

Scientists are now studying the effect of transfused blood on the body’s defense, or immune, system. What might that mean for you or for a relative who needs surgery?

“Approximately 1 in 100 transfusions are accompanied by fever, chills, or urticaria [hives]… . Approximately 1 in 6,000 red cell transfusions results in a hemolytic transfusion reaction. This is a severe immunologic reaction that may occur acutely or in a delayed fashion some days after the transfusion; it may result in acute [kidney] failure, shock, intravascular coagulation, and even death.”—National Institutes of Health (NIH) conference, 1988.

When doctors transplant a heart, a liver, or another organ, the recipient’s immune system may sense the foreign tissue and reject it.Yet, a transfusion is a tissue transplant. Even blood that has been “properly” cross matched can suppress the immune system. At a conference of pathologists, the point was made that hundreds of medical papers “have linked blood transfusions to immunologic responses.”—”Case Builds Against Transfusions,” Medical World News, December 11, 1989.

A prime task of your immune system is detecting and destroying malignant (cancer) cells. Could suppressed immunity lead to cancer and death? Note two reports.

The journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands: “In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients.” Physicians at the University of Southern California followed up on a hundred patients who underwent cancer surgery. “The recurrence rate for all cancers of the larynx was 14% for those who did not receive blood and 65% for those who did. For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions.”—Annals of Otology, Rhinology & Laryngology, March 1989.

Danish scientist Niels Jerne shared the 1984 Nobel Prize for Medicine. When asked why he refused a blood transfusion, he said: “A person’s blood is like his fingerprints—there are no two types of blood that are exactly alike.”

What do such studies suggest regarding transfusions? In his article “Blood Transfusions and Surgery for Cancer,” Dr. John S. Spratt concluded: “The cancer surgeon may need to become a bloodless surgeon.”—The American Journal of Surgery, September 1986.

Another primary task of your immune system is to defend against infection. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr. P. I. Tartter did a study of colorectal surgery. Of patients given transfusions, 25 percent developed infections, compared with 4 percent of those who received no transfusions. He reports: “Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively… The risk of postoperative infection increased progressively with the number of units of blood given.” (The British Journal of Surgery,August 1988) Those attending a 1989 meeting of the American Association of Blood Banks learned this: Whereas 23 percent of those who received donor blood during hip-replacement surgery developed infections, those given no blood had no infections at all.

Dr. John A. Collins wrote concerning this effect of blood transfusions: “It would be ironic indeed if a ‘treatment’ which has very little evidence of accomplishing anything worthwhile should subsequently be found to intensify one of the main problems faced by such patients.”—World Journal of Surgery, February 1987.

DISEASE FREE OR FRAUGHT WITH DANGER?

Blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many.

After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses “other transfusion-associated infectious diseases,” such as syphilis, cytomegalovirus infection, and malaria. It then says: “Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis [African sleeping sickness and Chagas' disease], leishmaniasis, brucellosis [undulant fever], typhus, filariasis, measles, salmonellosis, and Colorado tick fever.”

BLOOD, RUINED LIVERS, AND…

“Ironically, blood-borne AIDS … has never been as great a threat as other diseases—hepatitis, for instance,” explained theWashington Post.

Yes, vast numbers have got very sick and have died from such hepatitis, which has no specific treatment. According toU.S.News & World Report (May 1, 1989), about 5 percent of those given blood in the United States get hepatitis—175,000 people a year. About half become chronic carriers, and at least1 in 5 develop cirrhosis or cancer of the liver. It is estimated that 4,000 die. Imagine the headlines you would read if a jumbo jet crashed, killing all aboard. But 4,000 deaths amount to a full jumbo jet crashing every month!

Liver

Physicians had long known that a milder hepatitis (type A) was spread through unclean food or water. Then they saw that a more serious form was spreading through blood, and they had no way to screen blood for it. Eventually, brilliant scientists learned how to detect “footprints” of this virus (type B). By the early 1970’s, blood was being screened in some lands. The blood supply appeared safe and the future for blood bright! Or was it?

Before long it was clear that thousands who were given screened blood still developed hepatitis. Many, after debilitating illness, learned that their livers were ruined. But if the blood had been tested, why was this happening? The blood contained another form, called non-A, non-B hepatitis (NANB). For a decade it plagued transfusions—between 8 and 17 percent of those transfused in Israel, Italy, Japan, Spain, Sweden, and the United States contracted it.

Then came headlines such as “Mysterious Hepatitis Non-A, Non-B Virus Isolated at Last”; “Breaking a Fever in the Blood.” Again, the message was, ‘The elusive agent is found!’ In April 1989, the public was told that a test was available for NANB, now being called hepatitis C.

You might wonder if this relief is premature. In fact, Italian researchers have reported another hepatitis virus, a mutant, which might be responsible for a third of the cases. “Some authorities,” the Harvard Medical School Health Letter(November 1989) observed, “worry that A, B, C, and D are not the whole alphabet of hepatitis viruses; yet others may emerge.”The New York Times (February 13, 1990) stated: “Experts strongly suspect that other viruses can cause hepatitis; if discovered, they will be designated hepatitis E and so on.”

Are blood banks faced with more long searches for tests to make blood safe? Citing the problem of cost, a director of the American Red Cross made this disturbing comment: “We can’t just keep adding test after test for each infectious agent that might be spread.”—Medical World News, May 8, 1989.

Even the test for hepatitis B is fallible; many still contract it from blood. Moreover, will people be satisfied with the announced test for hepatitis C? The Journal of the American Medical Association(January 5, 1990) showed that a year can pass before antibodies of the disease are detectable by the test. Meanwhile, people transfused with the blood may face ruined livers—and death.

Actually, the list of such diseases is growing. You may have read headlines such as “Lyme Disease From a Transfusion? It’s Unlikely, but Experts Are Wary.” How safe is blood from someone testing positive for Lyme disease? A panel of health officials were asked if they would accept such blood. “All of them answered no, although no one recommended discarding blood from such donors.” How should the public feel about banked blood that experts themselves would not accept?—The New York Times, July 18, 1989.

A second reason for concern is that blood collected in one land where a certain disease abounds may be used far away, where neither the public nor the physicians are alert to the danger. With today’s increase in travel, including refugees and immigrants, the risk is growing that a strange disease may be in a blood product.

Moreover, a specialist in infectious diseases warned: “The blood supply may have to be screened to prevent transmission of several disorders that were not previously considered infectious, including leukemia, lymphoma, and dementia [or Alzheimer's disease].”—Transfusion Medicine Reviews, January 1989.

Chilling as these risks are, others have created much wider fear.

THE AIDS PANDEMIC

“AIDS has changed forever the way doctors and patients think about blood. And that’s not a bad idea, said the doctors gathered at the National Institutes of Health for a conference on blood transfusion.”—Washington Post, July 5, 1988.

The AIDS (acquired immunodeficiency syndrome) pandemic has, with a vengeance, awakened people to the danger of acquiring infectious diseases from blood. Millions are now infected. It is spreading out of control. And its death rate is virtually 100 percent.

AIDS is caused by the human immunodeficiency virus (HIV), which can be spread by blood. The modern plague of AIDS came to light in 1981. The very next year, health experts learned that the virus could probably be passed on in blood products. It is now admitted that the blood industry was slow to respond, even after tests were available to identify blood containing HIV antibodies. Testing of donor blood finally began in 1985,* but even then it was not applied to blood products that were already on the shelf.

Bug

Chagas’ disease illustrates how blood carries disease to distant people. The Medical Post (January 16, 1990) reports that ’10-12 million people in Latin America are chronically infected.’ It has been called “one of the most important transfusion hazards in South America.” An “assassin bug” bites a sleeping victim in the face, sucks blood, and defecates in the wound. The victim may carry Chagas’ disease for years (meanwhile possibly donating blood) before developing fatal heart complications.

Why should that concern people on distant continents? In The New York Times (May 23, 1989), Dr. L. K. Altman reported on patients with posttransfusion Chagas’ disease, one of whom died. Altman wrote: “Additional cases may have gone undetected because [doctors here] are not familiar with Chagas’ disease, nor do they realize that it could be spread by transfusions.” Yes, blood can be a vehicle by which diseases travel widely.

Thereafter the public was assured, ‘The blood supply is now safe.’ Later, however, it was revealed that there is a dangerous “window period” for AIDS. After a person is infected, it could be months before he produces detectable antibodies. Unaware that he harbors the virus, he might donate blood that would test negative. This has happened. People have developed AIDS after being transfused with such blood!

Aids virus

AIDS virus

The picture got even grimmer. The New England Journal of Medicine (June 1, 1989) reported on “Silent HIV Infections.” It was established that people can carry the AIDS virus for years without its being detectable by current indirect tests. Some would like to minimize these as rare cases, but they prove “that the risk of AIDS transmission via blood and its components cannot be totally eliminated.” (Patient Care,November 30, 1989) The disturbing conclusion: A negative test cannot be read as a clean bill of health. How many will yet get AIDS from blood?

THE NEXT SHOE? OR SHOES?

Many apartment dwellers have heard the thump of one shoe hitting the floor above them; they may then get tense awaiting the second. In the blood dilemma, no one knows how many deadly shoes may still hit.

The AIDS virus was designated HIV, but some experts now call it HIV-1. Why? Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it “is not consistently detected by the AIDS tests now in use here,” reports The New York Times. (June 27, 1989) “The new findings… make it more difficult for blood banks to be sure a donation is safe.”

Or what of distant relatives to the AIDS virus? A presidential commission (U.S.A.) said that one such virus “is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease.” This virus is already in the blood donor population and can be spread in blood. People have a right to wonder, ‘How effective is the blood-bank screening for such other viruses?’

Dr. Knud Lund-Olesen wrote: “Since… some persons in high-risk groups volunteer as donors because they are then automatically tested for AIDS, I feel that there is reason to be reluctant about accepting blood transfusion. Jehovah’s Witnesses have refused this for many years. Did they look into the future?”—Ugeskrift for Læger (Doctors’ Weekly), September 26, 1988.

Really, only time will tell how many blood-borne viruses are lurking in the blood supply. “The unknown may be more cause for concern than the known,” writes Dr. Harold T. Meryman. “Transmissible viruses with incubation times measured in many years will be difficult to associate with transfusions and even more difficult to detect. The HTLV group is surely only the first of these to surface.” (Transfusion Medicine Reviews, July 1989) “As if the AIDS epidemic were not misery enough,… a number of newly proposed or described risks of transfusion have drawn attention during the 1980’s. It does not require great imagination to predict that other serious viral diseases exist and are transmitted by homologous transfusions.”—Limiting Homologous Exposure: Alternative Strategies, 1989.

So many “shoes” have already dropped that the Centers for Disease Control recommends “universal precautions.” That is, ‘health-care workers should assume that all patients are infectious for HIV and other blood-borne pathogens.’ With good reason, health-care workers and members of the public are reassessing their view of blood.


* We cannot assume that all blood is yet being tested. For example, it is reported that by the start of 1989, about 80 percent of Brazil’s blood banks were not under government control, nor were they testing for AIDS.

Quality Alternatives to Transfusion

 

 

 

 

You might feel, ‘Transfusions are hazardous, but are there any high-quality alternatives?’ A good question, and note the word “quality.”

Everyone, including Jehovah’s Witnesses, wants effective medical care of high quality. Dr. Grant E. Steffen noted two key elements: “Quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals.” (The Journal of the American Medical Association, July 1, 1988) “Nonmedical goals” would include not violating the ethics or Bible-based conscience of the patient. —Acts 15:28, 29.

“We must conclude that currently there are many patients receiving blood components who have no chance for a benefit from transfusion (the blood is not needed) and yet still have a significant risk of undesired effect. No physician would knowingly expose a patient to a therapy that cannot help but might hurt, but that is exactly what occurs when blood is transfused unnecessarily.” —Transfusion-Transmitted Viral Diseases, 1987.

Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the answer is yes.

Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that “one of the few benefits of the epidemic” was that it “resulted in various strategies on the part of patients and physicians to avoid blood transfusion.” A blood-bank official explains: “What haschanged is the intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration of alternatives.” —Transfusion Medicine Reviews, October 1989.

Note, there are alternatives! This becomes understandable when we review why blood is transfused.

The hemoglobin in the red cells carries oxygen needed for good health and life. So if a person has lost a lot of blood, it might seem logical just to replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood. (Another measure of the concentration is hematocrit, which is commonly about 45 percent.) The accepted “rule” was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30 percent hematocrit). The Swiss journalVox Sanguinis (March 1987) reported that “65% of [anesthesiologists] required patients to have a preoperative hemoglobin of 10 gm/dl for elective surgery.”

But at a 1988 conference on blood transfusion, Professor Howard L. Zauder asked, “How Did We Get a ‘Magic Number’?” He stated clearly: “The etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in obscurity, and unsubstantiated by clinical or experimental evidence.” Imagine the many thousands of patients whose transfusions were triggered by an ‘obscure, unsubstantiated’ requirement!

Some might wonder, ‘Why is a hemoglobin level of 14 normal if you can get by on much less?’ Well, you thus have considerable reserve oxygen-carrying capacity so that you are ready for exercise or heavy work. Studies of anemic patients even reveal that “it is difficult to detect a deficit in work capacity with hemoglobin concentrations as low as 7 g/dl. Others have found evidence of only moderately impaired function.” —Contemporary Transfusion Practice, 1987.

While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says: “With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three months … The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration with no apparent clinical difficulties.” —Pediatric Clinics of North America, February 1986.

“Some authors have stated that hemoglobin values as low as 2 to 2.5 gm./100ml. may be acceptable… . A healthy person may tolerate a 50 percent loss of red blood cell mass and be almost entirely asymptomatic if blood loss occurs over a period of time.” —Techniques of Blood Transfusion, 1982.

Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery. If the loss is rapid and great, a person’s blood pressure drops, and he may go into shock. What is primarily needed is that the bleeding be stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.

Volume replacement can be accomplished without using whole blood or blood plasma.* Various nonblood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as dextran, Haemaccel, and lactated Ringer’s solution. Hetastarch (HES) is a newer volume expander, and “it can be safely recommended for those [burn] patients who object to blood products.” (Journal of Burn Care & Rehabilitation, January/February 1989) Such fluids have definite advantages. “Crystalloid solutions [such as normal saline and lactated Ringer's solution], Dextran and HES are relatively nontoxic and inexpensive, readily available, can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease.” —Blood Transfusion Therapy —A Physician’s Handbook, 1989.

You may ask, though, ‘Why do nonblood replacement fluids work well, since I need red cells to get oxygen throughout my body?’ As mentioned, you have oxygen-carrying reserves. If you lose blood, marvelous compensatory mechanisms start up. Your heart pumps more blood with each beat. Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more oxygen is released to the tissues. These adaptations are so effective that if only half of your red cells remain, oxygen delivery may be about 75 percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. And most general anesthetics reduce the body’s need for oxygen.

HOW CAN DOCTORS HELP?

Skilled physicians can help one who has lost blood and so has fewer red cells. Once volume is restored, doctors can administer oxygen at high concentration. This makes more of it available for the body and has often had remarkable results. British doctors used this with a woman who had lost so much blood that “her haemoglobin fell to 1.8 g/dlitre. She was successfully treated … [with] high inspired oxygen concentrations and transfusions of large volumes of gelatin solution [Haemaccel].” (Anaesthesia, January 1987) The report also says that others with acute blood loss have been successfully treated in hyperbaric oxygen chambers.

Heart-lung machineThe heart-lung machine has been a great help in heart surgery on patients who do not want blood

Physicians can also help their patients to form more red cells. How? By giving them iron-containing preparations (into muscles or veins), which can aid the body in making red cells three to four times faster than normal. Recently another help has become available. Your kidneys produce a hormone called erythropoietin (EPO), which stimulates bone marrow to form red cells. Now synthetic (recombinant) EPO is available. Doctors may give this to some anemic patients, thus helping them to form replacement red cells very quickly.

Even during surgery, skilled and conscientious surgeons and anesthesiologists can help by employing advanced blood-conservation methods. Meticulous operative technique, such as electrocautery to minimize bleeding, cannot be overstressed. Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation.#

Patients on a heart-lung machine primed with a nonblood fluid may benefit from the resulting hemodilution, fewer red cells being lost.

“Older concepts about oxygen transport to tissues, wound healing, and ‘nutritional value’ of blood are being abandoned. Experience with patients who are Jehovah’s Witnesses demonstrates that severe anemia is well tolerated.” —The Annals of Thoracic Surgery, March 1989.

And there are other ways to help. Cooling a patient to lessen his oxygen needs during surgery. Hypotensive anesthesia. Therapy to improve coagulation. Desmopressin (DDAVP) to shorten bleeding time. Laser “scalpels.” You will see the list grow as physicians and concerned patients seek to avoid blood transfusions. We hope that you never lose a great amount of blood. But if you did, it is very likely that skilled doctors could manage your care without using blood transfusions, which have so many risks.

SURGERY, YES —BUT WITHOUT TRANSFUSIONS

Many people today will not accept blood. For health reasons, they are requesting what Witnesses seek primarily on religious grounds: quality medical care employing alternative nonblood management. As we have noted, major surgery is still possible. If you have any lingering doubts, some other evidence from medical literature may dispel them.

Little children too? “Forty-eight pediatric open heart surgical procedures were performed with bloodless techniques regardless of surgical complexity.” The children were as small as 10.3 pounds (4.7 kg). “Because of consistent success in Jehovah’s Witnesses and the fact that blood transfusion carries a risk of serious complications, we are currently performing most of our pediatric cardiac operations without transfusion.” —Circulation, September 1984.

The article “Quadruple Major Joint Replacement in Member of Jehovah’s Witnesses” (Orthopaedic Review, August 1986) told of an anemic patient with “advanced destruction in both knees and hips.” Iron dextran was employed before and after the staged surgery, which was successful. The British Journal of Anaesthesia (1982) reported on a 52-year-old Witness with a hemoglobin level under 10. With the use of hypotensive anesthesia to minimize blood loss, she had a total hip and shoulder replacement. A surgical team at the University of Arkansas (U.S.A.) also used this method in a hundred hip replacements on Witnesses, and all the patients recovered. The professor heading the department comments: “What we have learned from those (Witness) patients, we now apply to all our patients that we do total hips on.”

The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded: “The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah’s Witnesses.” (Transplantation, June 1988) Likewise, refusal of blood has not stood in the way even of successful heart transplants.

‘What about bloodless surgery of other types?’ you may wonder.Medical Hotline (April/May 1983) told of surgery on “Jehovah’s Witnesses who underwent major gynecological and obstetric operations [at Wayne State University, U.S.A.] without blood transfusions.” The newsletter reported: “There were no more deaths and complications than in women who had undergone similar operations with blood transfusions.” The newsletter then commented: “The results of this study may warrant a fresh look at the use of blood for all women undergoing obstetric and gynecological operations.”

At the hospital of Göttingen University (Germany), 30 patients who declined blood underwent general surgery. “No complications arose that could not also have arisen with patients who accept bloodtransfusions… . That recourse to a transfusion is not possible should not be overrated, and thus should not lead to refraining from an operation that is necessary and surgically justifiable.” —Risiko in der Chirurgie, 1987.

Even brain surgery without using blood has been done on numerous adults and children, for instance, at New York University Medical Center. In 1989 Dr. Joseph Ransohoff, head of neurosurgery, wrote: “It is very clear that in most instances avoidance of blood products can be achieved with minimal risk in patients who have religious tenets against the use of these products, particularly if surgery can be carried out expeditiously and with a relatively short operative period. Of considerable interest is the fact that I often forget that the patient is a Witness until at the time of discharge when they thank me for having respected their religious beliefs.”

Finally, can intricate heart and vascular surgery without blood be performed on adults and children? Dr. Denton A. Cooley was a pioneer in doing just that. As you can see in the medical article reprinted in the Appendix, on pages 27-9, based on an earlier analysis, Dr. Cooley’s conclusion was “that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others.” Now, after performing 1,106 of these operations, he writes: “In every instance my agreement or contract with the patient is maintained,” that is, to use no blood.

Surgeons have observed that good attitude is another factor with Jehovah’s Witnesses. “The attitude of these patients has been exemplary,” wrote Dr. Cooley in October 1989. “They do not have the fear of complications or even death that most patients have. They have a deep and abiding faith in their belief and in their God.”

This does not mean that they assert a right to die. They actively pursue quality care because they want to get well. They are convinced that obeying God’s law on blood is wise, which view has a positive influence in nonblood surgery.

Professor Dr. V. Schlosser, of the surgical hospital at the University of Freiburg (Germany), noted: “Among this group of patients, the incidence of bleeding during the perioperative period was not higher; the complications were, if anything, fewer. The special view of illness, typical of Jehovah’s Witnesses, had a positive influence in the perioperative process.” —Herz Kreislauf, August 1987.


* Witnesses do not accept transfusions of whole blood, red cells, white cells, platelets, or blood plasma. As to minor fractions, such as immune globulin, see The Watchtower of [June 15, 2000, pages 29-31].

# The Watchtower of [October 15, 2000], pages 30-1, considers Bible principles that bear on methods of blood salvage and on blood-circulating (extracorporeal) equipment.

You Have the Right to Choose

You Have the Right to Choose

A current medical approach (called risk/benefit analysis) is making it easier for doctors and patients to cooperate in avoiding blood therapy. Doctors weigh factors such as the risks of a certain drug or surgery and the probable benefits. Patients too can share in such an analysis.

Let us use one example that people in many places can relate to—chronic tonsillitis. If you had this problem, likely you would go to a doctor. In fact, you might consult two, since health experts often recommend getting a second opinion. One might recommend surgery. He outlines what that means: length of hospital stay, amount of pain, and cost. As to risks, he says that severe bleeding is not common and death from such an operation is very rare. But the doctor giving a second opinion urges you to try antibiotic therapy. He explains the type of drug, likelihood of success, and expense. As to risk, he says that very few patients have life-threatening reactions to the drug.

RELIEVING LEGAL CONCERNS

You may wonder, ‘Why are some doctors and hospitals quick to get a court order to give blood?’ In some places a common reason is fear of liability.

There is no basis for such concern when Jehovah’s Witnesses choose nonblood management. A doctor at Albert Einstein College of Medicine (U.S.A.) writes: “Most [Witnesses] readily sign the American Medical Association form relieving physicians and hospitals of liability, and many carry a Medical Alert [card]. A properly signed and dated ‘Refusal to Accept Blood Products’ form is a contractual agreement and is legally binding.”—Anesthesiology News, October 1989.

Yes, Jehovah’s Witnesses cooperatively offer legal assurance that a physician or hospital will not incur liability in providing requested nonblood therapy. As recommended by medical experts, each Witness carries a Medical Document card. This is renewed annually and is signed by the person and by witnesses, often his next of kin.

In March 1990, the Supreme Court of Ontario, Canada, upheld a decision that commented approvingly on such a document: “The card is a written declaration of a valid position which the card carrier may legitimately take in imposing a written restriction on [the] contract with the doctor.” In Medicinsk Etik (1985), Professor Daniel Andersen wrote: “If there is an unambiguous written statement from the patient saying that he is one of Jehovah’s Witnesses and does not want blood under any circumstances, respect for the patient’s autonomy requires that this wish be respected, just as if it had been expressed orally.”

Witnesses will also sign hospital consent forms. One used at a hospital in Freiburg, Germany, has space where the physician can describe the information he gave the patient about the treatment. Then, above the signatures of the physician and the patient, this form adds: “As a member of the religious body of Jehovah’s Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery. I am aware that the planned and needed procedure thus has a higher risk due to bleeding complications. After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components.”—Herz Kreislauf, August 1987.

Actually, nonblood management may have a lower risk. But the point here is that Witness patients happily relieve any needless concerns so that medical personnel can move forward in doing what they are committed to do, helping people get well. This cooperation benefits all, as Dr. Angelos A. Kambouris showed in “Major Abdominal Operations on Jehovah’s Witnesses”:

“Preoperative agreement should be viewed as binding by the surgeon and should be adhered to regardless of events developing during and after operation. [This] orients the patients positively toward their surgical treatment, and diverts the surgeon’s attention from the legal and philosophical considerations to the surgical and technical ones, thus, allowing him to perform optimally and serve his patient’s best interests.”—The American Surgeon, June 1987.

Each competent physician likely considered risks and benefits, but nowyou have to weigh the risks and possible benefits, as well as other factors that you best know. (You are in the best position to consider such aspects as your emotional or spiritual strength, family finances, effect on the family, and your own ethics.) Then you make a choice. Possibly you give informed consent for one therapy but decline the other.

This would also be so if it was your child that had the chronic tonsillitis. The risks, benefits, and therapies would be outlined for you, the loving parents who are most directly affected and who will be responsible to cope with the results. After considering all aspects, you can make an informed choice on this matter involving your child’s health and even his or her life. Perhaps you consent to the surgery, with its risks. Other parents might choose the antibiotics, with their risks. As physicians differ in their advice, so patients or parents differ as to what they feel is best. Such is an understood feature of making informed (risk/benefit) choices.

“Overuse of medical technology is a major factor in the increase of current health care expenditures… . Blood transfusion is of particular importance because of its cost and high risk potential. Accordingly, blood transfusion was classified by the American Joint Commission on Accreditation of Hospitals as ‘high volume, high risk and error prone.'”—Transfusion, July-August 1989.

What about use of blood? No one who objectively examines the facts can deny that blood transfusions involve great risk. Dr. Charles Huggins, who is the director of transfusion service at the large Massachusetts General Hospital, made this very clear: “Blood has never been safer. But it must be considered unavoidably non-safe. It is the most dangerous substance we use in medicine.”—The Boston Globe Magazine, February 4, 1990.

With good reason, medical personnel have been advised: “It is necessary to reevaluate as well the risk part of the benefit/risk relationship for blood transfusion and to seek alternatives.” (Italics ours.)—Perioperative Red Cell Transfusion, National Institutes of Health conference, June 27-29, 1988.

Physicians may disagree as to the benefits or risks in using blood. One may give many transfusions and be convinced that they are worth the risk. Another may feel the risks are unjustified, for he has had good results with nonblood management. Ultimately, however, you, the patient or the parent, must decide. Why you? Because your (or your child’s) body, life, ethics, and profoundly important relationship with God are involved.

YOUR RIGHT IS RECOGNIZED

In many places today, the patient has an inviolable right to decide what treatment he will accept. “The law of informed consent has been based on two premises: first, that a patient has the right to receive sufficient information to make an informed choice about the treatment recommended; and second, that the patient may choose to accept or to decline the physician’s recommendation… . Unless patients are viewed as having the right to say no, as well as yes, and even yes with conditions, much of the rationale for informed consent evaporates.”—Informed Consent—Legal Theory and Clinical Practice,1987.*

United States: “Underlying the necessity for patient consent is the ethical concept of individual autonomy, that decisions about one’s own fate should be made by the person involved. The legal ground for requiring consent is that a medical act performed without the patient’s consent constitutes battery.”—Informed Consent for Blood Transfusion, 1989.

Germany: “The patient’s right of self-determination overrides the principle of rendering assistance and preservation of life. As a result: no blood transfusion against the will of the patient.”—Herz Kreislauf, August 1987.

Japan: “There is no ‘absolute’ in the medical world. Doctors believe that the course of modern medicine is the best and follow its course, but they should not force every detail of it as an ‘absolute’ on patients. Patients too must have freedom of choice.”—Minami Nihon Shimbun, June 28, 1985.

Some patients have encountered resistance when they have tried to exercise their right. It might have been from a friend having strong feelings about a tonsillectomy or about antibiotics. Or a physician might have been convinced of the rightness of his advice. A hospital official might even have disagreed, based on legal or financial interests.

“Many orthopaedists elect not to operate on [Witness] patients,” says Dr. Carl L. Nelson. “It is our belief that the patient has the right to refuse any type of medical therapy. If it is technically possible to provide surgery safely while excluding a particular treatment, such as transfusion, then it should exist as an option.”—The Journal of Bone and Joint Surgery, March 1986.

A considerate patient will not pressure a physician to use a therapy at which the doctor is unskilled. As Dr. Nelson noted, though, many dedicated physicians can accommodate the patient’s beliefs. A German official advised: “The doctor cannot refuse to render aid… reasoning that with a Jehovah’s Witness not all medical alternatives are at his disposal. He still has a duty to render assistance even when the avenues open to him are reduced.” (Der Frauenarzt, May-June 1983) Similarly, hospitals exist not merely to make money but to serve all people without discrimination. Catholic theologian Richard J. Devine states: “Although the hospital must make every other medical effort to preserve the patient’s life and health, it must ensure that medical care does not violate [his] conscience. Moreover, it must avoid all forms of coercion, from cajoling the patient to obtaining a court order to force a blood transfusion.”—Health Progress, June 1989.

RATHER THAN THE COURTS

Many people agree that a court is no place for personal medical issues. How would you feel if you chose antibiotic therapy but someone went to court to force a tonsillectomy on you? A doctor may want to provide what he thinks is the best care, but he has no duty to seek legal justification to trample on your basic rights. And since the Bible puts abstaining from blood on the same moral level as avoiding fornication, to force blood on a Christian would be the equivalent of forcible sex—rape.—Acts 15:28, 29.

Yet, Informed Consent for Blood Transfusion (1989) reports that some courts are so distressed when a patient is willing to accept a certain risk because of his religious rights “that they make up some legal exceptions—legal fictions, if you will—to allow a transfusion to occur.” They might try to excuse it by saying that a pregnancy is involved or that there are children to be supported. “Those are legal fictions,” the book says. “Competent adults are entitled to refuse treatment.”

Some who insist on transfusing blood ignore the fact that Witnesses do not decline all therapies. They reject just one therapy, which even experts say is fraught with danger. Usually a medical problem can be managed in a variety of ways. One has this risk, another that risk. Can a court or a doctor paternalistically know which risk is “in your best interests”? You are the one to judge that. Jehovah’s Witnesses are firm that they do not want someone else to decide for them; it is their personal responsibility before God.

If a court forced an abhorrent treatment on you, how might this affect your conscience and the vital element of your will to live? Dr. Konrad Drebinger wrote: “It would certainly be a misguided form of medical ambition that would lead one to force a patient to accept a given therapy, overruling his conscience, so as to treat him physically but dealing his psyche a mortal blow.”—Der Praktische Arzt, July 1978.

LOVING CARE FOR CHILDREN

Court cases regarding blood mainly involve children. On occasion, when loving parents have respectfully asked that nonblood management be used, some medical personnel have sought court backing to give blood. Of course, Christians agree with laws or court action to prevent child abuse or neglect. Perhaps you have read of cases in which some parent brutalized a child or denied it all medical care. How tragic! Clearly, the State can and should step in to protect a neglected child. Still, it is easy to see how very different it is when a caring parent requests high-quality nonblood medical therapy.

“I have found the families [of Jehovah's Witnesses] to be close knit and loving,” reports Dr. Lawrence S. Frankel. “The children are educated, caring, and respectful.… There even appears to possibly be stronger compliance to medical dictates, which might represent an effort to demonstrate acceptance of medical intervention to the extent that their beliefs permit.”—Department of Pediatrics, M. D. Anderson Hospital and Tumor Institute, Houston, U.S.A., 1985.

These court cases usually focus on a child in a hospital. How did the youngster get there, and why? Almost always the concerned parents brought their child to get quality care. Even as Jesus was interested in children, Christian parents care for their children. The Bible speaks of ‘a nursing mother cherishing her own children.’ Jehovah’s Witnesses have such deep love for their children.—1 Thessalonians 2:7Matthew 7:1119:13-15.

Naturally, all parents make decisions affecting their children’s safety and life: Will the family use gas or oil to heat the home? Will they take a child on a long-distance drive? May he go swimming? Such matters involve risks, even life-and-death ones. But society recognizes parental discretion, so parents are granted the major voice in nearly all decisions affecting their children.

In 1979 the U.S. Supreme Court stated clearly: “The law’s concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life’s difficult decisions… . Simply because the decision of a parent [on a medical matter] involves risks does not automatically transfer the power to make that decision from the parents to some agency or officer of the state.”—Parham v. J.R.

“I fear it is not uncommon,” comments Dr. James L. Fletcher, Jr., “for professional arrogance to supplant sound medical judgment. Treatments that are regarded as ‘the best today’ are modified or discarded tomorrow. Which is more dangerous, a ‘religious parent’ or an arrogant physician who is convinced that his or her treatment is absolutely vital?”—Pediatrics, October 1988.

That same year the New York Court of Appeals ruled: “The most significant factor in determining whether a child is being deprived of adequate medical care… is whether the parents have provided an acceptable course of medical treatment for their child in light of all the surrounding circumstances. This inquiry cannot be posed in terms of whether the parent has made a ‘right’ or a ‘wrong’ decision, for the present state of the practice of medicine, despite its vast advances, very seldom permits such definitive conclusions. Nor can a court assume the role of a surrogate parent.”—In re Hofbauer.

Recall the example of parents choosing between surgery and antibiotics. Each therapy would have its own risks. Loving parents are responsible to weigh risks, benefits, and other factors and then to make a choice. In this connection, Dr. Jon Samuels (Anesthesiology News, October 1989) suggested a review of Guides to the Judge in Medical Orders Affecting Children, which took this position:

“Medical knowledge is not sufficiently advanced to enable a physician to predict with reasonable certainty that his patient will live or die… If there is a choice of procedures—if, for example, the doctor recommends a procedure which has an 80 per cent chance of success but which the parents disapprove, and the parents have no objection to a procedure which has only a 40 per cent chance of success—the doctor must take the medically riskier but parentally unobjectionable course.”

In view of the many lethal hazards in medical use of blood that have surfaced and because there are effective alternative ways of management, might not avoiding blood even carry the lower risk?

Naturally, Christians weigh many factors if their child needs surgery. Every operation, with or without the use of blood, has risks. What surgeon gives guarantees? The parents may know that skilled physicians have had fine success with bloodless surgery on Witness children. So even if a physician or a hospital official has another preference, rather than cause a stressful and time-consuming legal battle, is it not reasonable for them to work with the loving parents? Or parents may transfer their child to another hospital where the staff is experienced in handling such cases and willing to do so. In fact, nonblood management will more likely be quality care, for it can help the family “to achieve legitimate medical and nonmedical goals,” as we noted earlier.

The Blood That Really Saves Lives

The Blood That Really Saves Lives

Certain points are clear from the foregoing information. Though many people view them as lifesaving, blood transfusions are fraught with risks. Each year thousands die as a result of transfusions; multitudes more get very sick and face long-term consequences. So, even from a physical standpoint, there is wisdom right now in heeding the Biblical command to ‘abstain from blood.’—Acts 15:28, 29.

Patients are protected from many hazards if they request nonblood medical management. Skilled physicians who have accepted the challenge of applying this on Jehovah’s Witnesses have developed a standard of practice that is safe and effective, as is proved in numerous medical reports. Physicians who provide quality care without blood are not compromising valued medical principles. Rather, they show respect for a patient’s right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life.

We are not being naive in this matter, for we realize that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook. Hence, others, including some doctors, may find it hard to accept a patient’s decision to abstain from blood. One New York surgeon wrote: “I will never forget 15 years ago, as a young intern when I stood at the bedside of a Jehovah’s Witness who bled to death from a duodenal ulcer. The patient’s wishes were respected and no transfusions were given, but I can still remember the tremendous frustration as a physician I felt.”

Gravestone

He no doubt believed that blood would have been lifesaving. The year after he wrote that, however,The British Journal of Surgery(October 1986) reported that prior to the advent of transfusions, gastrointestinal hemorrhage had “a mortality rate of only 2.5 per cent.” Since transfusions became customary, ‘most large studies report a 10-percent mortality.’ Why a death rate four times as high? The researchers suggested: “Early blood transfusion appears to reverse the hypercoagulable response to haemorrhage thereby encouraging rebleeding.” When the Witness with the bleeding ulcer refused blood, his choice may actually have maximized his prospects for survival.

This same surgeon added: “The passage of time and treating many patients has a tendency to change one’s perspective, and today I find the trust between a patient and his physician, and the duty to respect a patient’s wishes far more important than the new medical technology which surrounds us… . It is interesting that the frustration has now given way to a sense of awe and reverence for that particular patient’s steadfast faith.” The physician concluded: ‘It reminds me that I should always respect a patient’s personal and religious wishes regardless of my feelings or the consequences.’

You may already realize something that many physicians come to appreciate with “the passage of time and treating many patients.” Even with the best of medical care in the finest of hospitals, at some point people die. With or without blood transfusions, they die. All of us are aging, and life’s end is approaching. That is not fatalistic. It is realistic. Dying is a fact of life.

The evidence shows that people who disregard God’s law on blood often experience immediate or delayed harm; some even die from the blood. Those who survive have not gained endless life. So blood transfusions do not save lives permanently.

Most people who, for religious and/or medical reasons, refuse blood but accept alternative medical therapy do very well. They may thus extend their life for years. But not endlessly.

That all humans are imperfect and are gradually dying leads us to the central truth of what the Bible says about blood. If we understand and appreciate this truth, we will see how blood can actually save life—our life—lastingly.

THE ONLY BLOOD THAT IS LIFESAVING

As noted earlier, God told all mankind that they must not eat blood. Why? Because blood represents life. (Genesis 9:3-6) He explained this further in the Law code given to Israel. At the time the Law code was ratified, the blood of sacrificed animals was used on an altar. (Exodus 24:3-8) Laws in that code addressed the fact that all humans are imperfect; they are sinful, as the Bible puts it. God told the Israelites that by means of animal sacrifices offered to him, they could acknowledge the need to have their sins covered. (Leviticus 4:4-713-1822-30) Granted, that was what God asked of them back then, not what he asks of true worshipers today. Yet it has vital import for us now.

God himself explained the principle underlying those sacrifices: “The soul [or, life] of the flesh is in the blood, and I myself have put it upon the altar for you to make atonement for your souls, because it is the blood that makes atonement by the soul in it. That is why I have said to the sons of Israel: ‘No soul of you must eat blood.'”—Leviticus 17:11, 12.

On the ancient festival called Atonement Day, Israel’s high priest took blood of sacrificed animals into the most sacred part of the temple, the center of God’s worship. Doing that was a symbolic way of asking God to cover the people’s sins. (Leviticus 16:3-611-16) Those sacrifices did not actually do away with all sin, so they had to be repeated each year. Still, this use of blood set a meaningful pattern.

God’s people refused to sustain their lives with blood, not because doing that was unhealthy, but because it was unholy, not because blood was polluted, but because it was precious.

A major teaching in the Bible is that God would eventually provide one perfect sacrifice that could fully atone for the sins of all believers. This is called the ransom, and it focuses on the sacrifice of the foretold Messiah, or Christ.

The Bible compares the Messiah’s role to what was done on Atonement Day: “When Christ came as a high priest of the good things that have come to pass, through the greater and more perfect [temple] not made with hands, … he entered, no, not with the blood of goats and of young bulls, but with his own blood, once for all time into the holy place [heaven] and obtained an everlasting deliverance for us. Yes, nearly all things are cleansed with blood according to the Law, and unless blood is poured out no forgiveness takes place.”—Hebrews 9:11, 1222.

It thus becomes plain why we need to have God’s view of blood. In accord with his right as Creator, he has determined its exclusive usefulness. Israelites of old may have reaped health benefits by not taking in animal or human blood, but that was not the most important point. (Isaiah 48:17) They had to avoid sustaining their lives with blood, not primarily because doing otherwise was unhealthy, but because it was unholy to God. They were to abstain from blood, not because it was polluted, but because it was precious in obtaining forgiveness.

The apostle Paul explained about the ransom: “By means of him [Christ] we have the release by ransom through the blood of that one, yes, the forgiveness of our trespasses, according to the riches of his undeserved kindness.” (Ephesians 1:7) The original Greek word found there is properly translated “blood,” but a number of Bible versions err in substituting the word “death.” Hence, readers might miss the emphasis on our Creator’s view of blood and the sacrificial value that he has linked to it.

The Bible’s theme revolves around the fact that Christ died as a perfect ransom sacrifice but did not remain dead. Following the pattern that God set on Atonement Day, Jesus was raised to heaven to “appear before the person of God for us.” He presented there the value of his sacrificial blood. (Hebrews 9:24) The Bible emphasizes that we must avoid any course that would amount to ‘trampling on the Son of God and esteeming his blood as of ordinary value.’ Only thus may we keep a good relationship and peace with God.—Hebrews 10:29Colossians 1:20.

ENJOY LIFE SAVED BY BLOOD

When we understand what God says about blood, we come to have the greatest respect for its lifesaving value. The Scriptures describe Christ as the one who ‘loves us and who loosed us from our sins by means of his own blood.’ (Revelation 1:5John 3:16) Yes, by means of Jesus’ blood, we can gain full and lasting forgiveness of our sins. The apostle Paul wrote: “Since we have been declared righteous now by his blood, shall we be saved through him from wrath.” That is how lasting life can be saved by blood.—Romans 5:9Hebrews 9:14.

Saving life with Jesus’ blood opens the way to endless, healthy life in an earthly paradise

Jehovah God long ago gave assurance that by means of Christ ‘all the families of the earth can bless themselves.’ (Genesis 22:18) That blessing includes restoring the earth to a paradise. Then believing mankind will no longer be afflicted with sickness, aging, or even death; they will enjoy blessings that far exceed the temporary aid medical personnel can now offer us. We have this marvelous promise: “He will wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away.”—Revelation 21:4.

How wise, then, for us to take to heart all of God’s requirements! That includes obeying his commands about blood, not misusing it even in medical situations. We thus will not live just for the moment. Rather, we will manifest our high regard for life, including our future prospect of everlasting life in human perfection.

JEHOVAH’S WITNESSES THE SURGICAL/ETHICAL CHALLENGE

Physicians face a special challenge in treating Jehovah’s Witnesses. Members of this faith have deep religious convictions against accepting homologous or autologous whole blood, packed RBCs [red blood cells], WBCs [white blood cells], or platelets. Many will allow the use of (non-blood-prime) heart-lung, dialysis, or similar equipment if the extracorporeal circulation is uninterrupted. Medical personnel need not be concerned about liability, for Witnesses will take adequate legal steps to relieve liability as to their informed refusal of blood. They accept nonblood replacement fluids. Using these and other meticulous techniques, physicians are performing major surgery of all types on adult and minor Witness patients. A standard of practice for such patients has thus developed that accords with the tenet of treating the “whole person.” (JAMA 1981;246:2471-2472)

PHYSICIANS face a growing challenge that is a major health issue. There are over half a million Jehovah’s Witnesses in the United States who do not accept blood transfusions. The number of Witnesses and those associated with them is increasing. Although formerly, many physicians and hospital officials viewed refusal of a transfusion as a legal problem and sought court authorization to proceed as they believed was medically advisable, recent medical literature reveals that a notable change in attitude is occurring. This may be a result of more surgical experience with patients having very low hemoglobin levels and may also reflect increased awareness of the legal principle of informed consent.

Now, large numbers of elective surgical and trauma cases involving both adult and minor Witnesses are being managed without blood transfusions. Recently, representatives of Jehovah’s Witnesses met with surgical and administrative personnel at some of the largest medical centers in the country. These meetings improved understanding and helped resolve questions about blood salvage, transplants, and the avoidance of medical/legal confrontations.

WITNESS POSITION ON THERAPY

Jehovah’s Witnesses accept medical and surgical treatment. In fact, scores of them are physicians, even surgeons. But Witnesses are deeply religious people who believe that blood transfusion is forbidden for them by Biblical passages such as: “Only flesh with its soul—its blood—you must not eat” (Genesis 9:3-4); “[You must] pour its blood out and cover it with dust” (Leviticus 17:13-14); and “Abstain from…fornication and from what is strangled and from blood” (Acts 15:19-21).1

While these verses are not stated in medical terms, Witnesses view them as ruling out transfusion of whole blood, packed RBCs, and plasma, as well as WBC and platelet administration. However, Witnesses’ religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these.2

Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood. Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them. However, many Witnesses permit the use of dialysis and heart-lung equipment (non-blood-prime) as well as intraoperative salvage where the extracorporeal circulation is uninterrupted; the physician should consult with the individual patient as to what his conscience dictates.2

The Witnesses do not feel that the Bible comments directly on organ transplants; hence, decisions regarding cornea, kidney, or other tissue transplants must be made by the individual Witness.

MAJOR SURGERY POSSIBLE

Although surgeons have often declined to treat Witnesses because their stand on the use of blood products seemed to “tie the doctor’s hands,” many physicians have now chosen to view the situation as only one more complication challenging their skill. Since Witnesses do not object to colloid or crystalloid replacement fluids, nor to electrocautery, hypotensive anesthesia,3 or hypothermia, these have been employed successfully. Current and future applications of hetastarch,4 large-dose intravenous iron dextran injections,5,6 and the “sonic scalpel”7are promising and not religiously objectionable. Also, if a recently developed fluorinated blood substitute (Fluosol-DA) proves to be safe and effective,8 its use will not conflict with Witness beliefs.

In 1977, Ott and Cooley9 reported on 542 cardiovascular operations performed on Witnesses without transfusing blood and concluded that this procedure can be done “with an acceptably low risk.” In response to our request, Cooley recently did a statistical review of 1,026 operations, 22% on minors, and determined “that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others.” Similarly, Michael E. DeBakey, MD, communicated “that in the great majority of situations [involving Witnesses] the risk of operation without the use of blood transfusions is no greater than in those patients on whom we use blood transfusions” (personal communication, March 1981). The literature also records successful major urologic10 and orthopedic surgery.11 G. Dean MacEwen, MD, and J. Richard Bowen, MD, write that posterior spinal fusion “has been successfully accomplished for 20 [Witness] minors” (unpublished data, August 1981). They add: “The surgeon needs to establish the philosophy of respect for a patient’s right to refuse a blood transfusion but still perform surgical procedures in a manner that allows safety to the patient.”

Herbsman12 reports success in cases, including some involving youths, “with massive traumatic blood loss.” He admits that “Witnesses are somewhat at a disadvantage when it comes to blood requirements. Nevertheless it’s also quite clear that we do have alternatives to blood replacement.” Observing that many surgeons have felt restrained from accepting Witnesses as patients out of “fear of legal consequences,” he shows that this is not a valid concern.

LEGAL CONCERNS AND MINORS

Witnesses readily sign the American Medical Association form relieving physicians and hospitals of liability,13 and most Witnesses carry a dated, witnessed Medical Alert card prepared in consultation with medical and legal authorities. These documents are binding on the patient (or his estate) and offer protection to physicians, for Justice Warren Burger held that a malpractice proceeding “would appear unsupported” where such a waiver had been signed. Also, commenting on this in an analysis of “compulsory medical treatment and religious freedom,” Paris14 wrote: “One commentator who surveyed the literature reported, ‘I have not been able to find any authority for the statement that the physician would incur… criminal … liability by his failure to force a transfusion on an unwilling patient.’ The risk seems more the product of a fertile legal mind than a realistic possibility.”

Care of minors presents the greatest concern, often resulting in legal action against parents under child-neglect statutes. But such actions are questioned by many physicians and attorneys familiar with Witness cases, who believe that Witness parents seek good medical care for their children. Not desirous of shirking their parental responsibility or of shifting it to a judge or other third party, Witnesses urge that consideration be given to the family’s religious tenets. Dr. A. D. Kelly, former Secretary of the Canadian Medical Association, wrote15 that “parents of minors and the next of kin of unconscious patients possess the right to interpret the will of the patient… . I do not admire the proceedings of a moot court assembled at 2:00 AM to remove a child from his parent’s custody.”

It is axiomatic that parents have a voice in the care of their children, such as when the risk-benefit potentials of surgery, radiation, or chemotherapy are faced. For moral reasons that go beyond the issue of the risk of transfusion,16 Witness parents ask that therapies be used that are not religiously prohibited. This accords with the medical tenet of treating “the whole person,” not overlooking the possible lasting psychosocial damage of an invasive procedure that violates a family’s fundamental beliefs. Often, large centers around the country having experience with the Witnesses now accept patient transfers from institutions unwilling to treat Witnesses, even pediatric cases.

THE PHYSICIAN’S CHALLENGE

Understandably, caring for Jehovah’s Witnesses might seem to pose a dilemma for the physician dedicated to preserving life and health by employing all the techniques at his disposal. Editorially prefacing a series of articles about major surgery on Witnesses, Harvey17admitted, “I do find annoying those beliefs that may interfere with my work.” But, he added: “Perhaps we too easily forget that surgery is a craft dependent upon the personal technique of individuals. Technique can be improved.”

Professor Bolooki18 took note of a disturbing report that one of the busiest trauma hospitals in Dade County, Florida, had a “blanket policy of refusing to treat” Witnesses. He pointed out that “most surgical procedures in this group of patients are associated with less risk than usual.” He added: “Although the surgeons may feel that they are deprived of an instrument of modern medicine … I am convinced that by operating on these patients they will learn a great deal.”

Rather than consider the Witness patient a problem, more and more physicians accept the situation as a medical challenge. In meeting the challenge they have developed a standard of practice for this group of patients that is accepted at numerous medical centers around the country. These physicians are at the same time providing care that is best for the patient’s total good. As Gardner et al19 observe: “Who would benefit if the patient’s corporal malady is cured but the spiritual life with God, as he sees it, is compromised, which leads to a life that is meaningless and perhaps worse than death itself.”

Witnesses recognize that, medically, their firmly held conviction appears to add a degree of risk and may complicate their care. Accordingly, they generally manifest unusual appreciation for the care they receive. In addition to having the vital elements of deep faith and an intense will to live, they gladly cooperate with physicians and medical staff. Thus, both patient and physician are united in facing this unique challenge.

BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?

BLOOD: WHOSE CHOICE AND WHOSE CONSCIENCE?

by J. Lowell Dixon, M.D.

PHYSICIANS are committed to applying their knowledge, skills, and experience in fighting disease and death. Yet, what if a patient refuses a recommended treatment? This will likely occur if the patient is a Jehovah’s Witness and the treatment is whole blood, packed red blood cells, plasma, or platelets.

When it comes to the use of blood, a physician may feel that a patient’s choice of nonblood treatment will tie the hands of dedicated medical personnel. Still, one must not forget that patients other than Jehovah’s Witnesses often choose not to follow their doctor’s recommendations. According to Appelbaum and Roth,1 19% of patients at teaching hospitals refused at least one treatment or procedure, even though 15% of such refusals “were potentially life endangering.”

The general view that “the doctor knows best” causes most patients to defer to their doctor’s skill and knowledge. But how subtly dangerous it would be for a physician to proceed as if this phrase were a scientific fact and to treat patients accordingly. True, our medical training, licensing, and experience give us noteworthy privileges in the medical arena. Our patients, though, have rights. And, as we are likely aware, the law (even the Constitution) gives greater weight to rights.

On the walls of most hospitals, one sees displayed the “Patient’s Bill of Rights.” One of these rights is informed consent, which might more accurately be called informed choice. After the patient is informed of the potential results of various treatments (or of nontreatment), it is his choice what he will submit to. At Albert Einstein Hospital in the Bronx, New York, a draft policy on blood transfusion and Jehovah’s Witnesses stated: “Any adult patient who is not incapacitated has the right to refuse treatment no matter how detrimental such a refusal may be to his health.”2

While physicians may voice concerns about ethics or liability, courts have stressed the supremacy of patient choice.3 The New York Court of Appeals stated that “the patient’s right to determine the course of his own treatment [is] paramount … [A] doctor cannot be held to have violated his legal or professional responsibilities when he honors the right of a competent adult patient to decline medical treatment.”4 That court has also observed that “the ethical integrity of the medical profession, while important, cannot outweigh the fundamental individual rights here asserted. It is the needs and desires of the individual, not the requirements of the institution, that are paramount.”5

When a Witness refuses blood, physicians may feel pangs of conscience at the prospect of doing what seems to be less than the maximum. What the Witness is asking conscientious doctors to do, though, is to provide the best alternative care possible under the circumstances. We often must alter our therapy to accommodate circumstances, such as hypertension, severe allergy to antibiotics, or the unavailability of certain costly equipment. With the Witness patient, physicians are being asked to manage the medical or surgical problem in harmony with the patient’s choice and conscience, his moral/religious decision to abstain from blood.

Numerous reports of major surgery on Witness patients show that many physicians can, in good conscience and with success, accommodate the request not to employ blood. For example, in 1981, Cooley reviewed 1,026 cardiovascular operations, 22% on minors. He determined “that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others.”6Kambouris7 reported on major operations on Witnesses, some of whom had been “denied urgently needed surgical treatment because of their refusal to accept blood.” He said: “All patients received pretreatment assurances that their religious beliefs would be respected, regardless of the circumstances in the operating room. There were no untoward effects of this policy.”

When a patient is a Jehovah’s Witness, beyond the matter of choice, conscience comes into the picture. One cannot think only of the physician’s conscience. What of the patient’s? Jehovah’s Witnesses view life as God’s gift represented by blood. They believe the Bible’s command that Christians must “abstain from blood” (Acts 15:28, 29).8Hence, if a physician paternalistically violated such patients’ deep and long-held religious convictions, the result could be tragic. Pope John Paul II has observed that forcing someone to violate his conscience “is the most painful blow inflicted to human dignity. In a certain sense, it is worse than inflicting physical death, or killing.”9

While Jehovah’s Witnesses refuse blood for religious reasons, more and more non-Witness patients are choosing to avoid blood because of risks such as AIDS, non-A non-B hepatitis, and immunologic reactions. We may present to them our views as to whether such risks seem minor compared to the benefits. But, as the American Medical Association points out, the patient is “the final arbiter as to whether he will take his chances with the treatment or operation recommended by the doctor or risk living without it. Such is the natural right of the individual, which the law recognizes.”10

Related to this, Macklin11 brought up the risk/benefit issue regarding a Witness “who risked bleeding to death without a transfusion.” A medical student said: “His thought processes were intact. What do you do when religious beliefs are against the only source of treatment?” Macklin reasoned: “We may believe very strongly this man is making a mistake. But Jehovah’s Witnesses believe that to be transfused … [may] result in eternal damnation. We are trained to do risk-benefit analyses in medicine but if you weigh eternal damnation against remaining life on earth, the analysis assumes a different angle.”11

Vercillo and Duprey12 in this issue of the Journal refer to In re Osborneto highlight the interest in ensuring the security of dependents, but how was that case resolved? It concerned a severely injured father of two minor children. The court determined that if he died, relatives would materially and spiritually care for his children. So, as in other recent cases,13 the court found no compelling state interest to justify overriding the patient’s choice of treatment; judicial intervention to authorize treatment deeply objectionable to him was unwarranted.14With alternative treatment the patient recovered and continued to care for his family.

Is it not true that the vast majority of cases physicians have confronted, or likely will, can be managed without blood? What we studied and know best has to do with medical problems, yet patients are human beings whose individual values and goals cannot be ignored. They know best about their own priorities, their own morals and conscience, which give life meaning for them.

Respecting the religious consciences of Witness patients may challenge our skills. But as we meet this challenge, we underscore valuable liberties that all of us cherish. As John Stuart Mill aptly wrote: “No society in which these liberties are not, on the whole, respected, is free, whatever may be its form of government … Each is the proper guardian of his own health, whether bodily, or mental and spiritual. Mankind are greater gainers by suffering each other to live as seems good to themselves, than by compelling each to live as seems good to the rest.”15

Why did Jesus give way to tears prior to the resurrection of Lazarus, as described at John 11:35?

Jesus weeping

When a loved one dies, we naturally shed tears because we will miss him. Though he had affection for Lazarus, Jesus did not give way to tears because Lazarus died. He shed tears out of compassion for the bereaved, as indicated by the context of John’s account.—John 11:36.

When Jesus first heard that Lazarus was sick, he did not rush to Lazarus’ bedside to cure him. The account says: “When [Jesus] heard that [Lazarus] was sick, then he actually remained two days in the place where he was.” (John 11:6) Why did Jesus delay? He had a purpose in doing so. He said: “This sickness is not with death as its object, but is for the glory of God, in order that the Son of God may be glorified through it.” (John 11:4) Death was not the “object,” or end result, of Lazarus’ sickness. Jesus intended to use Lazarus’ death “for the glory of God.” How? Jesus was about to perform a spectacular miracle by raising his dear friend from the grave.

In his discussion with his disciples on this occasion, Jesus compared death to a sleeplike state. That is why he told them that he was “journeying there to awaken [Lazarus] from sleep.” (John 11:11) To Jesus, raising Lazarus from death would be like a parent waking his child from a nap. So there was no reason for him to be pained over Lazarus’ death itself.

What, then, moved Jesus to give way to tears? Again, the context provides the answer. When Jesus met Lazarus’ sister Mary and saw her and others weeping, he “groaned in the spirit and became troubled.” Seeing their pain moved Jesus to feel hurt to the point of ‘groaning in the spirit.’ That was why “Jesus gave way to tears.” It greatly saddened Jesus to see his beloved friends stricken with grief.—John 11:33, 35.

This account demonstrates that Jesus has the power and ability to bring our loved ones back to life and health in the coming new world. It also helps us to appreciate that Jesus has fellow feeling for those who have lost loved ones to Adamic death. Another lesson we can learn from this account is that we should have compassion for those who are grieving over the death of their loved ones.

Jesus knew that he was going to resurrect Lazarus. Still, he gave way to tears, moved by his deep love and compassion for his friends. Likewise, our empathy may move us to “weep with people who weep.” (Rom. 12:15) Expressing such grief does not indicate that a person lacks faith in the resurrection hope. How appropriate, then, that Jesus set an example of showing sympathy for the bereaved by sincerely shedding tears even though he was about to raise Lazarus.

Pioneering Strengthens Our Relationship With God

preaching 41

Pioneering Strengthens Our Relationship With God

“It is good to make melody to our God.”—PS. 147:1.

1, 2. (a) What can result from thinking and speaking about a loved one? (See opening image.) (b) What questions will we consider?

THINKING and speaking about a loved one can strengthen our bond with that person. The same is true regarding our relationship with Jehovah God. As a shepherd, David spent many a night gazing at the starry heavens and meditating on their incomparable Creator. He wrote: “When I see your heavens, the works of your fingers, the moon and the stars that you have prepared, what is mortal man that you keep him in mind, and the son of earthling man that you take care of him?” (Ps. 8:3, 4) And after considering how Jehovah’s purpose with regard to spiritual Israel was being fulfilled in a marvelous way, the apostle Paul exclaimed: “O the depth of God’s riches and wisdom and knowledge!”—Rom. 11:17-26, 33.

As we share in the ministry, we think and talk about Jehovah. That in itself has positive effects. Many who are able to engage in the full-time ministry have found that one blessing that results from their increased share in Kingdom service is that it has deepened their love for God. Whether you are presently in the full-time service or you are working toward that goal, consider this: How can the full-time ministry strengthen your relationship with Jehovah? If you are a pioneer, ask yourself, ‘What will help me to continue in this rewarding avenue of service?’ If you are not yet pioneering, ask, ‘What adjustments can I make to begin doing so?’ Let us consider ways that full-time service can strengthen our relationship with God.

 FULL-TIME SERVICE AND OUR RELATIONSHIP WITH GOD

3. In the ministry, how are we affected by speaking about future Kingdom blessings?

Discussing future Kingdom blessings with others draws us closer to Jehovah. What scripture do you like to use when you go from house to house? Might your favorite be Psalm 37:10, 11; Daniel 2:44; John 5:28, 29; or Revelation 21:3, 4? Each time we discuss such promises with others, we are reminded that our generous God truly is the giver of “every good gift and every perfect present.” This draws us closer to him.—Jas. 1:17.

4. Why is our appreciation for God’s goodness deepened when we see the spiritually destitute condition of others?

Seeing the spiritually destitute condition of those to whom we preach deepens our appreciation for the truth. People in the world have no reliable guidance to help them achieve success and happiness. Most worry about the future and have no hope. They search for the meaning of life. Even most who are religious have little knowledge of the Scriptures. They are much like the people of ancient Nineveh. (ReadJonah 4:11.When we have an increased share in the ministry, we see more clearly the contrast between the spiritual condition of those to whom we preach and that of Jehovah’s people. (Isa. 65:13) We are reminded of Jehovah’s goodness in that he does more than provide for our spiritual needs; he invites all to receive spiritual refreshment and a real hope.—Rev. 22:17.

5. How does helping others spiritually make us feel about our own problems?

Helping others spiritually makes it easier for us to avoid becoming overwhelmed by personal problems. Trisha, a regular pioneer, found this to be true when her parents got divorced. She relates: “It was one of the most emotionally upsetting events of my life.” One day when she was quite sad and felt like staying home, she nevertheless went to conduct a Bible study with three children whose home situation was very troubled. Their father had abandoned them, and their older brother had abused them. Trisha says: “Any problem or heartache I was dealing with was nothing compared to theirs. As we studied, their little eyes would light up and they would giggle with excitement and joy. Those children were a gift from Jehovah, especially that day.”

6, 7. (a) How is our faith strengthened when we teach Bible truths? (b) As we observe Bible students improve their lives by applying Scriptural principles, what happens to our appreciation for God’s wisdom?

Teaching Bible truths strengthens our faith. The apostle Paul wrote of some Jews in his day who failed to practice what they preached: “Do you, . . . the one teaching someone else, not teach yourself?” (Rom. 2:21) How different it is with pioneers today! They generally have many opportunities to teach the truth to others and conduct Bible studies. To do so effectively requires that they prepare for each study and perhaps do research to answer questions. A pioneer named Janeen explains: “Each time I have an opportunity to teach the truth to others, I feel that a deeper impression of these truths is engraved on my mind and heart. As a result, my faith is not stagnant but continues to grow.”

Observing Bible students improve their lives by applying Bible principles deepens our appreciation for God’s wisdom. (Isa. 48:17, 18) That helps us, in turn, be more determined to continue applying these principles in our own life. Adrianna, another pioneer, comments: “People’s lives can be a mess when they rely  on their own wisdom. But when they start relying on Jehovah’s wisdom, the benefits begin right away.” Similarly, Phil states: “You see how Jehovah is able to change people who were unsuccessful when they tried to change on their own.”

8. How does working alongside good associates in the ministry affect us?

Working alongside good associates in the ministry builds us up spiritually. (Prov. 13:20) Most pioneers spend considerable time in the ministry with fellow evangelizers. This provides more opportunities for “an interchange of encouragement.” (Rom. 1:12read Proverbs 27:17.A pioneer named Lisa observes: “In the workplace, there is often a spirit of competition and jealousy. Daily you are subjected to gossip and vulgar language. It’s all about getting ahead at any cost. At times, you are ridiculed or mocked because of your Christian conduct. However, working in the ministry with fellow Christians is truly upbuilding. At the end of the day, I come home refreshed, no matter how tired I am.”

9. Pioneering with our marriage mate can do what for the threefold marital cord?

Pioneering with our marriage mate strengthens the threefold marital cord. (Eccl. 4:12) Madeline, who pioneers along with her husband, explains: “My husband and I are able to spend time talking about our day in the ministry or something in our Bible reading that can be applied in our ministry. Each year that we pioneer together, we grow closer.” Similarly, Trisha says: “We are both focused on not getting into debt, so we don’t fight about money. We have the same service schedule, so we are very  involved in each other’s return visits and Bible studies, which helps us to keep the same pace emotionally and spiritually.”

Being active in the full-time service makes for a satisfying life (See paragraph 9)

10. When we put the Kingdom first and experience God’s support, how is our trust in Jehovah affected?

10 Our trust in Jehovah increases as we put Kingdom interests first, experience Jehovah’s support, and see him answer our prayers. To an extent, that is true of all loyal Christians. But those in the full-time service find that reliance on Jehovah can help them to remain as pioneers. (Read Matthew 6:30-34.Curt, who is a pioneer and a substitute circuit overseer, agreed to visit a congregation two and a half hours from his home. He and his wife, also a pioneer, had barely enough gasoline in their car to make it to the congregation but not back, and his payday was a week away. Curt comments, “I began to question if I had made the right decision.” After praying, they concluded that they would fulfill the assignment, confident that God would care for their needs. As they were about to leave, a sister called and said that she had a gift for them. It was the exact amount of money they needed to complete the trip. Curt says, “When you have experiences like this time and again, it is easy to see the hand of Jehovah.”

11. What are some of the blessings that pioneers experience?

11 Yes, pioneers have often found that as they expend themselves in Jehovah’s service and pursue intimacy with him, they are ‘overtaken’ by a seemingly endless stream of blessings. (Deut. 28:2) Still, pioneering has its challenges. No servant of God is immune to problems caused by Adam’s rebellion. Though some pioneers have found that they have had to discontinue their service for a time, the challenges can often be managed or even avoided. What may help pioneers to continue enjoying their privileged service?

REMAINING IN THE FULL-TIME SERVICE

12, 13. (a) A pioneer should do what if he is having trouble reaching his hour goal? (b) Why is scheduling daily Bible reading, personal study, and meditation so important?

12 Most pioneers have a very full schedule. It can be a struggle to get everything done, so good personal organization is important. (1 Cor. 14:33, 40) If a pioneer is having difficulty reaching the hour goal, he might need to reexamine how he is using his time. (Eph. 5:15, 16) He might ask: ‘How much time am I actually expending on recreation or leisure pursuits? Do I need to exercise greater self-discipline? Could I adjust my secular work schedule?’ Any Christian will admit that it is easy to add things to one’s schedule; thus, those in the full-time service may need to assess matters regularly and make adjustments if needed.

13 Daily Bible reading, personal study, and meditation ought to be part of a pioneer’s schedule. Accordingly, a pioneer needs self-discipline so that less important activities do not encroach on the time he has set aside for those essential things. (Phil. 1:10) For example, picture him coming home after a long day in the ministry. He intends to use the evening to prepare for the upcoming meeting. First, though, he reads his mail. Then he turns on the computer and reads and answers e-mail. While he is online, he goes to a Web site to see if the price has gone down on an item he wants to purchase. Before he realizes it, almost two hours have gone by and he has not yet begun to study what he had in mind for that evening. Why is that an issue? Professional  athletes must take care of their bodies if they want to have a long career. Similarly, pioneers need a good routine of personal study to replenish themselves spiritually if they are to persist in the full-time ministry.—1 Tim. 4:16.

14, 15. (a) Why should pioneers keep their life simple? (b) If a pioneer experiences difficulties, what should he do?

14 Successful pioneers strive to keep their life simple. Jesus encouraged his disciples to have a simple eye. (Matt. 6:22) He kept his own life simple so that he could accomplish his ministry without distraction. He could say: “Foxes have dens and birds of heaven have roosts, but the Son of man has nowhere to lay down his head.” (Matt. 8:20) Desiring to learn from Jesus’ example, a pioneer does well to keep in mind that the more material things he has, the more he will have to maintain, repair, or replace.

15 Pioneers realize that their privilege of service is not the result of any special merit on their part. Rather, any gift or service privilege that we might have is because of God’s undeserved kindness. Thus, in order to continue as a pioneer, each one must rely on Jehovah. (Phil. 4:13) Challenges and difficulties will arise. (Ps. 34:19) When they do, pioneers should look to Jehovah for direction and give him the opportunity to help, rather than quickly giving up their privilege of service. (Read Psalm 37:5.As they experience God’s loving assistance, they will be drawn closer to him as their caring heavenly Father.—Isa. 41:10.

CAN YOU JOIN THE PIONEER RANKS?

16. If you would like to pioneer, what should you do?

16 If you would like to experience blessings like the ones enjoyed by those in the full-time service, make your desire known to Jehovah. (1 John 5:14, 15) Talk to those who are currently pioneering. Set progressive goals toward becoming a pioneer. That is what Keith and Erika did. They had been working full-time and, like many couples their age, had bought a house and a new car soon after they got married. They say: “We thought those things would bring us satisfaction—but they never did.” When Keith got laid off from work, he served as an auxiliary pioneer. He recalls: “Pioneering reminded me of how much joy comes from being in the ministry.” They became friends with a pioneer couple who helped them to see the joy that results from leading a simple life and pioneering. What did Keith and Erika do? “We made a list of our spiritual goals, put it on our refrigerator, and checked each goal off as we reached it.” In time, they were able to pioneer.

17. Why would it be wise for you to consider adjusting your schedule or lifestyle in order to pioneer?

17 Can you enter the pioneer ranks? If you do not at this point see how that is possible, do all you can to increase your closeness to Jehovah by having a full share in the ministry. After prayerful examination, you may find that making some adjustments in your schedule or lifestyle will allow you to pioneer. If you can pioneer, the joys you receive will far outweigh any sacrifices you will make. You will have increased satisfaction that comes from putting Kingdom interests ahead of your own. (Matt. 6:33) You will experience the increased happiness that comes from giving to others. Furthermore, you will have more opportunities to think and talk about Jehovah, deepening your love for him and bringing him pleasure.

Tuesday, June 18

Tuesday, June 18

With my voice I shall call to Jehovah himself, and he will answer me from his holy mountain.—Ps. 3:4.

Trusting in Jehovah and filled with confidence, David wrote the above. In keeping with David’s orders, the ark of the covenant, symbolizing God’s presence, has been taken to Mount Zion. (2 Sam. 15:23-25) Fittingly, then, David refers to having his prayer answered from Jehovah’s holy mountain. Certain that prayer to God will not be in vain, David experiences no dread. Instead, he sings: “As for me, I will lie down that I may sleep; I shall certainly awake, for Jehovah himself keeps supporting me.” (Ps. 3:5) Even at night, when the danger of surprise attack is the greatest, David is not afraid to go to sleep. He is sure that he will awake, for his past experiences have made him absolutely confident that he can trust in God’s unfailing support. So can we if we adhere to “the ways of Jehovah” and never depart from him.—2 Sam. 22:21, 22w11 5/15 5:6, 7