Wednesday, February 17, 2010

Faith and the issue of blood transfusion

The issue of faith and medical treatments is a complicated one. It is clearly wrong when parents refuse to provide medical treatment to their children because of their faith. However, it gets complicated with adults who refuse treatment. After all, it is their life and they have the ultimate say about their own treatment. Washington Post today has an article about a 36-year old Peruvian immigrant mother, Maribel Perez, who has struggled balancing her faith as a Jehovah's Witness and the blood transfusion she needs for her lung transplant.

There are several interesting bits in here: a) Maribel's view that she may be trading a few more years here on Earth in exchange for an eternal condemnation. Should one believe in this equation is a separate question, but if one does, like Maribel, then you can appreciate her struggle in making this decision. She also believes that God would punish her in this life also for going through with the blood transfusion, b) Her husband, her mother, and many of her friends clearly want her to go through with the lung transplant. But to make their case, they also use a religious argument - that God would want her to live longer for her kids, c) The members of her Jehovah's Witness congregation, who want her to refuse transfusion. In many ways, this is the group that is least affected by her death - and only gains for her steadfast refusal of transfusion, d) On top of all this, there is also an issue of the expenses of post-transplant care, and here, a tightly knit religious community would have been of help, but unfortunately, the Jehovah's Witnesses, take the opposite route.

Good, bad - these are complicated issue. I have the point of view that faith should not play a role in medical decisions, but I appreciated the complexity offered here in the article. Here are some of the details, starting with her initial refusal for transfusion:

So it was nothing less than shattering when, miraculously, a few weeks ago, one of the world's largest lung-transplant programs, at the University of Pittsburgh Medical Center, agreed to take her, and Perez said no.

Her reason had nothing to do with breath. It was because of blood.

Perez had become a Jehovah's Witness. The religion teaches that blood is sacred, the seat of one's soul, and that in the Bible, God specifically prohibits the consumption of blood, whether by mouth or through veins in a transfusion. Many Jehovah's Witnesses carry cards explaining that in an emergency they are not to receive blood and that no medical practitioner will be held liable if they die as a result.

"What's more important: five, six, 10 or 20 more years on Earth? Or living forever?" asked David Valdez, a Jehovah's Witness minister at the Kingdom Hall in Alexandria, where Perez worshiped. Breaking God's law on blood, Valdez explained, could condemn one to an eternity of nothingness.

On Jan. 7, after one of many visits from fellow Jehovah's Witnesses, Perez told her husband, Lorenzo, that she had signed a medical directive refusing a blood transfusion. Hearing that, he said, was like being slammed in the chest. "I had been fighting so hard for so long to keep her alive, I felt betrayed," he said in Spanish. "I was so angry. It was like I didn't know her anymore." His wife had chosen to die.

Without a transplant, as her doctor, Leslie Kingslow, explained, Perez has about a 50 percent chance of living an additional 18 to 24 months. Less if she contracts another infection. The two childhood bouts of inexpertly treated tuberculosis that so scarred her lungs also make hers a high-risk surgery that would almost certainly require a transfusion; without one, no transplant center would take her as a patient.

In a panic, Lorenzo called out to his wife's army of guardians. They descended upon her like avenging angels. How could she sign something like this? The Witnesses could be wrong, they pleaded; other faiths interpret the Bible differently. When that failed to move her, they called her a hypocrite. Told her that she had wasted so many people's time and faith. Then they softened. How could she leave her two children after struggling so mightily to stay with them? How could a loving God want her to choose death?

Perez, dressed in hospital socks and flannel pajamas festooned with pink teacups, sat on the side of a twin bed, her head bowed, her eyes locked onto the bare wood floor. When she spoke, it was in a faint whisper. "Mi relación con Dios es más importante que todo," was all she said. My relationship with God is more important than anything.

But we should also appreciate her own struggle with the decision and the fact that she also found solace in the same religion that was also coming in the way of her treatment:

After she signed the directive refusing transfusions, Perez was in torment, she said. She knew she was signing away her last chance at life.

She curled into herself on the single bed in the room she shares with her 12-year-old daughter. She blew out short streams of breath to calm herself. She couldn't sleep.
God had resurrected her, lifting her from deathbeds and despair. Was it really His will that she now give up and die?

Perez was raised Catholic, but a neighbor who was a Jehovah's Witness impressed her with his knowledge of the Bible. Two years ago, she began attending services and Bible study classes. Lorenzo went a few times, but it wasn't for him. Still, he was happy that his fragile wife had found a place of solace. What no one understood, she explained later, was that in her darkest hours, when she lay dying in the hospice, and throughout that long, lonely year at Specialty Hospital, the word of God was the only thing that sustained her. Twice, she'd thought of ripping out the life-sustaining tubes that tethered her to the wall. Her belief in God stayed her hand.
She wanted desperately to do what He wanted.
    And then we have the different groups of people with different stakes in her well being and in her ultimate decision:

    That weekend, her mother called from Peru and begged her to change her mind and have the operation. Her doctors called. Her sister, a nurse, chimed in from Italy. Her sister-in-law reminded her of another relative, a Jehovah's Witness who refused a transfusion and died, leaving two toddlers behind.

    Fellow Witnesses continued to visit and urged her to stay strong, assuring her that just as soldiers die on the battlefield to defend their country, sometimes Jehovah's Witnesses die to protect the integrity of God's law. Lorenzo barred the Witnesses from the house, told the children they could no longer be part of the congregation and threatened that if Perez continued to refuse the transfusion, their marriage of 19 years would be over.

    Her children, schooled by the Jehovah's Witnesses, told her they'd be sad if she died but were proud of her for following her faith.

    Perez feared less for her eternal life than that God would punish her by taking her life if she went ahead with the transplant. "I was worried God wouldn't let me live after the operation," she said. Three days later, Perez told Lorenzo she'd changed her mind.

    "I began to think how much I loved my children, these marvelous gifts from God," she explained, gulping for air as tears rolled down her face. "God loves. He does not demand that we follow rules. The rules are ours." Her heart told her that God wanted her to choose life.

    Perez no longer talks to Jehovah's Witnesses, nor they to her. It is hard, she said. They are like her family. But the religion "disfellowships," or excommunicates, members who disobey its teachings. Contacted by a reporter and asked about Perez, a member of her congregation said, "She is not a Jehovah's Witness," and hung up.

    Ouch. Jehovah's Witnesses do not come out looking good from this story. But these issues are not limited to Jehovah's Witnesses. For example, I knew someone (a Muslim) who refused to have any medicine or treatment that had any derivatives from alcohol. I have also posted before about the Followers of Christ Church who refuse to have any medical care for themselves and for their kids, or the case of the rise of polio in many areas where the polio vaccine is considered as an "infidel vaccine" (see here and here).

    Read the full article here.


    Don said...

    I wonder if the JWs will still accept a convert who has had a blood transfusion in the past. If they do, is it simply because that individual "didn't know better"?

    emre said...

    The doctrine of prohibiting blood transfusions does not make sense. Why would god be so malicious as to create hemophiliacs and deny them the means to leave? God creates assorted means for blood to flow out of one's body but none for it to flow back in?

    Anyway, the odds of any JW's reaching heaven is, by their own admission, quite slim. Apparently the quota allows for only 144,000 luck souls and chances are there's a long line at the pearly gates. So why bother tormenting yourself in that interminable line and just get a transfusion?

    Snuze said...

    *points at Emre's comment*


    I believe that stringent interpretation has its place, but sometimes, people must also use the 'aql that has been gifted to them as well.

    *shakes head*

    Robyn said...

    As a Catholic, faith informs ALL my decisions, including medical ones. (Fortunately Catholics have no problem with blood transfusions, or any other life-saving medical procedure.) I think an informed adult should always be the final decision about his or her own medical care. Perez knows the medical consequences and she knows what that means for her faith. If she feels she has a grave enough reason to refuse the treatment she needs to save her life, her wishes should be respected.

    If she were (for the sake of argument) pressured or forced to receive a transfusion, that could be psychologically devastating.

    If it were a parent refusing a life-saving transfusion for her child, though... that's a much, much harder ethical question.

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