Major abdominal surgery in Jehovah’s Witnesses

Rollins, Katie E.; Contractor, U.; Inumerable, R.; Lobo, Dileep N.

Abstract

Introduction

Patients who are Jehovah’s Witnesses pose difficult ethical and moral dilemmas for surgeons because of their refusal to receive blood and blood products. This article outlines the personal experiences of six Jehovah’s Witnesses who underwent major abdominal surgery at a single institution and also summarises the literature on the perioperative care of these patients.
Methods

The patients recorded their thoughts and the dilemmas they faced during their surgical journey. We also reviewed the recent literature on the ethical principles involved in treating such patients and strategies recommended to make surgery safer.
Results

All patients were supported in their decision making by the clinical team and the Hospital Liaison Committee for Jehovah’s Witnesses. The patients recognised the ethical and moral difficulties experienced by clinicians in this setting. However, they described taking strength from their belief in Jehovah. A multitude of techniques are available to minimise the risk associated with major surgery in Jehovah’s Witness patients, many of which have been adopted to minimise unnecessary use of blood products in general. Nevertheless, the risks of catastrophic haemorrhage and consequent mortality remain an unresolved issue for the treating team.
Conclusions

Respect for a patient’s autonomy in this setting is the overriding ethical principle, with detailed discussion forming an important part of the preparation of a Jehovah’s Witness for major abdominal surgery. Clinicians must be diligent in the documentation of the patient’s wishes to ensure all members of the team can abide by these.

Citation

Rollins, K. E., Contractor, U., Inumerable, R., & Lobo, D. N. (2016). Major abdominal surgery in Jehovah’s Witnesses. Annals of The Royal College of Surgeons of England, 98(8), https://doi.org/10.1308/rcsann.2016.0210

• Journal Article Type: Article
• Acceptance Date: Jun 5, 2016
• Online Publication Date: Jul 14, 2016
• Publication Date: Nov 1, 2016
• Deposit Date: Apr 18, 2018
• Publicly Available Date: Apr 18, 2018
• Journal: Annals of the Royal College of Surgeons of England
• Print ISSN: 0035-8843
• Electronic ISSN: 1478-7083
• Publisher: Royal College of Surgeons of England
• Peer Reviewed: Peer Reviewed
• Volume: 98
• Issue: 8
• DOI: https://doi.org/10.1308/rcsann.2016.0210
• Keywords: Jehovah’s Witness; Abdominal surgery; Blood loss; Blood transfusion; Patient perspective
• Public URL: https://nottingham-repository.worktribe.com/output/974416
• Publisher URL: https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2016.0210
• Contract Date: Apr 18, 2018