Jehovah’s Witnesses: Medicine Interview Ethics

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

The treatment of Jehovah’s Witnesses can be fraught with ethical dilemmas, especially in emergency situations: making it the perfect topic to throw at candidates during a medical school interview.

If you’re unfamiliar with their beliefs, Jehovah’s Witnesses are known to refuse blood transfusions even in life-threatening situations.

This directly pits a patient’s autonomy and the medical ethics principle of beneficence head to head.

In this article, I’m going to describe some background to Jehovah’s Witnesses and their beliefs, before moving on to look at a series of examples, any of which could very well come up in a medical school interview.

Learn about more medical ethics questions that come up time and time again here.

What Is A Jehovah’s Witness?

Jehovah’s Witnesses are a particular denomination of Christianity, with a worldwide membership of approximately 8.5 million followers.

They believe that the destruction of the present world at Armageddon is imminent and generally take the Bible very literally.

Jehovah’s Witnesses are led by the Governing Body of Jehovah’s Witnesses, a group of elders based in New York, USA.

They’re best known for their door-to-door preaching, distributing literature such as ‘The Watchtower,’ and refusing blood transfusions.

What Do Jehovah’s Witnesses Believe About Blood?

Jehovah’s Witnesses take the Bible as God’s holy word- and so take everything in it pretty literally.

For Jehovah’s Witnesses, there are 3 passages in the Bible that prohibit Christians from eating or indeed using blood products. One of which is:

“You must not eat the blood of any sort of flesh, because the soul of every sort of flesh is its blood. Anyone eating it will be cut off.”

Leviticus 17:14

Jehovah’s Witnesses interpret these verses as meaning that man should not gain any sort of nourishment from blood; whether that be by eating it, drinking it, or having it transfused intravenously in order to restore health.

Turning the page of a Bible

For the majority of Jehovah’s Witnesses, the prohibition against blood transfusions applies to whole blood, packed red blood cells, white blood cells, plasma, and platelets, including autologous transfusions (collection and then re-infusion of a patient’s own blood).

However, their teaching does not explicitly forbid the use of more minor blood fractions in their medical care.

For example, immunoglobulins, albumin, erythropoietin, or clotting factors for haemophilia. The decision as to whether to accept these will be a more personal one for the patient.

Do All Jehovah’s Witnesses Feel The Same Way?

As with any religion or belief, every Jehovah’s Witness will follow their faith to a different extent.

Although the majority have strong beliefs in the sanctity of their scripture, others may not feel the same way when it comes to a life-or-death situation.

This is why, if possible, it’s always vital to ask a Jehovah’s Witness what they want instead of just assuming.

The patient will always be the best person to tell you what they want in terms of their medical care.

What can complicate matters is the fact that if a Jehovah’s Witness goes against their faith’s teachings they will almost certainly be ostracised from their community.

This can mean a complete loss of their social network, job, and even all connection to their family.

This, therefore, creates very strong social pressures for a Jehovah’s Witness to conform to the rules.

As a medical professional, the ‘so what’ of this is that you should always conduct conversations regarding a Jehovah’s Witness’ wishes in private- away from the ears of any family members or friends.

What Are The Ethical Principles At Play?

As I mentioned at the top, interviewers love to use hypothetical scenarios involving Jehovah’s Witnesses because they perfectly pit two of the core tenants of medical ethics against each other: autonomy and beneficence.

It’s incredibly rare that a patient will flat out refuse a treatment that a doctor is offering to unambiguously help them and potentially even save their life.

This is what occurs when a Jehovah’s Witness refuses a desperately needed blood transfusion.

The doctor wants to do what they professionally believe is best for the patient- which means giving the transfusion.

However, the patient’s autonomy must be respected. If they’re saying they don’t want a medical treatment a doctor shouldn’t force it on the patient.

The way in which these two ethical principles interact with each other, and the outcomes and actions of the doctor, varies depending on the scenario.

I’m now going to consider a few example scenarios that should give you a head start in the event that similar questions are posed to you at your medical school interview.

An Adult Jehovah’s Witness With Capacity

An adult male has been stabbed and is rushed to the emergency department. He’s still conscious but has lost a lot of blood and is still bleeding heavily from an abdominal stab wound. As the lead doctor, you know a blood transfusion and rapid surgery are needed to save this man’s life. However, he refuses the blood transfusion on the grounds that he is a Jehovah’s Witness. He understands the significant risk of death if he does not accept the transfusion.

This man is likely going to die if he doesn’t accept a blood transfusion. But, he’s very clearly saying that he doesn’t want one.

With this being the case, a patient’s autonomy ‘trumps’ the principle of beneficence.

Just because you think giving a transfusion would be the right thing to do doesn’t mean you can ignore the patient’s wishes.

The correct thing to do in this case would be to withhold the transfusion as per the patient’s request- even if this means that the patient ultimately dies.

It also doesn’t mean you can give the transfusion as soon as the patient passes out from blood loss and so stops protesting.

You have to honour the patient’s wishes that they made clear to you.

However, this only continues to be the case if the patient has capacity in the first instance.

Capacity means that the patient is in the right mind to be able to understand the situation, weigh up their options, make a balanced decision and then communicate that decision…

An Adult Jehovah’s Witness Without Capacity

An unconscious adult female is brought to the emergency department following a road traffic accident. She was severely injured in the crash and has lost a lot of blood. As the doctor, you know she needs a blood transfusion to increase her chances of survival. However, one of the paramedics who brought her in mentions that he thinks she’s a Jehovah’s Witness.

In this situation the patient doesn’t have capacity- as she’s currently unconscious.

This means we’re not able to directly ask the patient what she wants.

Other causes for a patient to lack capacity can include a serious head injury causing confusion, being drunk, being on drugs, having dementia or having learning difficulties (as a few examples).

Generally, in medicine, when a patient lacks capacity we as the treating clinicians act in what we think are the patient’s best interests.

If an old lady with dementia comes to hospital with a urinary tract infection, she’ll be given antibiotics to treat the infection even if she says she doesn’t want to take them- because she lacks capacity.

So, if the paramedic hadn’t mentioned that he thinks this patient may be a Jehovah’s Witness, she’d have been given a blood transfusion even though she wasn’t able to consent to it- as the doctors believe it to be in her best interests.

In the example described above, the correct course of action would involve trying to find out what the patient would have wanted, even though she can’t tell you in the moment.

A patient having their blood taken in hospital

Advanced Directives

An advanced directive is a legal document that is used by patients to set out their wishes for medical situations in which they aren’t able to communicate them.

For example, terminally ill people can sign an advanced directive saying they don’t want to be taken to hospital, no matter how unwell they become. This is because they’d prefer to die in the comfort of their own home.

Alternatively, a Jehovah’s Witness might sign an advanced directive saying under no circumstances would they want to receive a blood transfusion.

This would be a legal document that the doctors could use as proof of the patient’s wishes.

In our example then, you’d want to look through the patient’s notes or any belongings she came in with in case she’s carrying an advanced directive.

Proxy Consent Or Refusal

If an advanced directive can’t be found, treatment decisions for a patient can be made by proxy- that is, by a person chosen by the patient to be able to make medical decisions on their behalf.

This can be formalised by appointing someone with power of attorney for health.

Again, this is most frequently used by patients coming to the end of their life. They can give someone power of attorney for health so that they can help make medical decisions for them in their final days.

Alternatively, if no one has been mandated by the patient, proxy consent or refusal can be obtained from the patient’s spouse, parent, grandparent, adult child or brother or sister (in that order).

In our example, reaching out to the patient’s family could help build a picture of what the patient would likely have wanted.

Is the whole family devout Jehovah’s Witnesses or was the paramedic mistaken in thinking the patient followed that religion?

By looking for documentation and trying to speak to family, the doctors would hopefully be able to determine whether the patient would have consented to a blood transfusion if she was conscious.

A Child With Jehovah Witness Parents

As a result of complications during a routine operation, a toddler loses a significant amount of blood on the operating table. The doctors agree that a blood transfusion is medically indicated to give the child the best chance of survival. However, both parents are Jehovah’s Witnesses and do not give their consent for the transfusion.

Parents generally have the power to decide what is in the best interests of their child.

If a mother takes her child to the doctor for a vaccination, but the child refuses to give the doctor their arm, the doctor doesn’t respect the child’s autonomy.

The mother will very likely hold the child tightly while the doctor administers the vaccine!

This is because young children aren’t deemed to have the capacity to make most medical decisions- the toddler isn’t able to weigh up the pros and cons of getting (or not getting) the vaccine.

This broadly works because parents and doctors are often pretty much on the same page as to what’s in the best interests of the child.

Where it breaks down is when parents and doctors disagree as to what is best for the child- such as in this case.

In the absence of an emergency, cases such as this will often end up in court.

The burden of proof lies with the parents to show that there is a medically accepted alternative choice available.

If a child’s parents refuse to consent to the administration of a blood transfusion, only on religious grounds, and the doctor disagrees with their alternative, they can legally ignore the parents and administer the transfusion.

However, this is not a decision one doctor will make on the day. A hospital’s legal team will be involved in order to land on the best course of action.

Making Decisions In An Emergency

The three examples I’ve looked at so far have all been urgent, but none of them absolute time-critical emergencies.

In an absolute emergency, the doctor should always act in what they believe to be the best interests of the patient.

That translates to giving the blood transfusion even if they’re not 100% certain the patient would have wanted it.

It’s always better to have an alive patient who’s angry about receiving a transfusion compared to a dead patient who would have wanted one.

Sometimes there just won’t be time to carefully look for an advanced directive, ring around a patient’s family members, or indeed go to court to get a ruling on whether a transfusion should or should not be given.

In these circumstances, the doctor should act as they see fit to best treat the patient.

Final Thoughts

As much as medicine interviewers like to talk about them, I can’t say I’ve ever actually treated a patient where their religion affected their medical care.

Having said that, discussing Jehovah’s Witnesses and blood transfusions is a great way to test your understanding of some of the medical ethics principles at play.

Once you’ve got your head around them, you should be able to deal with any Jehovah’s Witness questions that might come your way at your medical school interview.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.