Cardiac Surgery for Children of Jehovah’s Witnesses: Navigating Difficult Ethical Waters

Tanenbaum’s Religious Diversity in Health Care program recently attended The Columbia University Center for Bioethic’s Lunch Seminar Series, sponsored by The Gold Foundation.  Dr. George Hardart, Associate Clinical Professor of Pediatrics, gave a talk on the moral, ethical, and religious dilemmas of performing cardiac surgery on the children of Jehovah’s Witnesses. 

Jehovah’s Witnesses believe that it is morally and spiritually abhorrent to accept a blood transfusion and that it is a sin which jeopardizes eternal life and salvation. They interpret the Bible to command that we must “abstain from blood” and the willing acceptance of a blood transfusion can be grounds for expulsion from the faith. 
 
While treating an adult Jehovah’s Witness in need of a blood transfusion can be morally and emotionally challenging for a doctor, the ethical dilemma becomes particularly complex when treating a child. An adult has the right to refuse a blood transfusion but the government has historically protected the rights of doctors to intervene when the life of a child is threatened by the religious convictions/restrictions of the parents. 
“Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstance to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.” (Prince vs. Massachusetts, 1944) 
Dr. Hardart set out to tackle this very complex ethical dilemma. He presented several cases involving Jehovah’s Witness children where the “standard of care” indicated blood transfusion. He then presented alternative options for care and asked the audience whether they would consider these alternatives given the families’ religious objection to blood transfusion. How much risk is acceptable when trying to honor the religious wishes of the family? 
 
Moreover, he asked the audience to broaden their definition of risk beyond health risks. He pointed out that the family felt a very real and substantial risk to the emotional and spiritual well-being of their family and religious convictions.   Should this risk factor be taken into consideration? If so, how much weight should it be given?
 
Loss of trust, which can lead to substandard care and can have long term health implications, is another risk to be weighed. An audience member pointed out that parents who have lost trust in their doctor, and by extension their health care community, may chose to delay or avoid seeking treatment for their child in the future.  In the worst case scenario, their negative experience can marginalize the whole religious community and lead to disparities in health care access. 

So how do doctors balance their medical, ethical, and legal responsibilities with their obligations to patients and the families of those patients? Ultimately there is no easy answer. What we do know is that communication, empathy, and trust are key elements in navigating these very complex ethical waters. If they can’t help us find a way out, they can at least help us find a way through.