by Anonymous Jehovah’s Witness correspondent*
Is it truly acceptable for a 20-year-old to die from a potentially preventable cause? This question compels me to stop procrastinating and write about the poignant ethical dilemma faced by Jehovah’s Witnesses regarding blood transfusions. Interestingly, I never stopped procrastinating when Eloise Dupuis,1and Mirlande Cadet, both died within a week of each other after giving birth in 2016 nor during the other 2 or 3 deaths of Jehovah’s Witnesses mentioned in the news each year.2 However, the death of Kalila Danisi struck a deeply personal chord.3 While her recent passing is profoundly saddening, it highlights a broader ethical dilemma that merits a thoughtful examination of beliefs that have evolved over the years in this religious group.
A comprehensive examination of the doctrine of Jehovah’s Witnesses provides a rich history of a religion with more than 8 million adherents worldwide. You can rest assured that a Witness in Virginia Beach, Virginia has a lot in common with one from Chiang Mai, Thailand despite numerous cultural, ethnic, and regional differences. One significant commonality is the dedicated refusal of blood transfusions, the blood doctrine.
The history and trajectory of the religion’s blood doctrine is quite perplexing. Originally, blood transfusions were allowed and even celebrated for their ability to save lives (Consolation 1940 December 25 p.19). However, in 1945, a significant shift occurred when blood transfusions were first stated as being against biblical principles (Watchtower 1945 July 1 p. 198-201). This marked the beginning of a series of changes in their doctrine. In 1961, under the presidency of Nathan H. Knorr, blood transfusions became a disfellowshipping offense (Watchtower 1961 Jan 15 pp.63-64). This new edict also specified that not only was whole blood not allowed, but also its fractions (Watchtower 1961 Nov 1 p.669).
Gradually, another significant shift in the doctrine occurred. In 1982, it was announced that fractions of blood plasma were permissible as a matter of conscience. (Awake! 1982 Jun 22 p.25). In 1995, using cell salvage was permitted even though blood is stored briefly outside the body (Watchtower 1995 Aug 1 p.30). In a more intriguing turn, in 2000, all fractions of red cells, white cells, platelets, and plasma were allowed, but prohibitions remained for whole blood and major components (Watchtower 2000 Feb 1 p.31). Today, a Jehovah’s Witness may use 100% of blood in fractionated form. If HBOCs (hemoglobin-based oxygen carriers) are available on a compassionate-use basis they may be accepted under the policy. These shifts illustrate an evolving and intricate doctrine that prompts a critical examination of its ethical implications.
Shifts in doctrine have not been unique, particularly concerning medical matters. In the past, organ transplants were considered acceptable (Watchtower 1961 Aug 1 p. 480). However, in 1967, the stance on transplants shifted dramatically, equating them to the abhorrent practice of cannibalism (Watchtower 1967 Nov 15 pp. 702-704). Similarly, from 1921 to 1952, the religion viewed vaccination as both unbiblical and unconstitutional (Golden Aug 1932 Mar 30 p.409). Yet, today, vaccinations and transplants are regarded as a matter of personal conscience. These shifts in perspective demonstrate the reevaluation and adaptation of doctrinal beliefs regarding medical practices. 45
The reshaping of doctrinal beliefs within Jehovah’s Witnesses is conceived and disseminated by the organization’s leaders, known as the Governing Body. As the self-proclaimed Faithful and Discreet Slave, they hold the authority to shape the doctrines adherents follow, with the belief that these men act as God’s spokesperson on earth. Consequently, interpretations of the Bible, despite originating from human beings, are elevated to divine status, making dissent from their teachings tantamount to refuting God himself.
The physical and psychological toll that such rigid doctrinal adherence can have on individuals underscores the urgent need for open and honest discussions about the Jehovah’s Witness blood doctrine and its potential implications for adherents’ medical decision-making and lives.
The absolute mandate to adhere to the blood doctrine within the Jehovah’s Witness community is deeply ingrained. Devout Witnesses understand that it is preferable to die rather than accept a life-saving blood transfusion, and this commitment is frequently unwavering. Watchtower literature, such as the May 22nd, 1994, Awake! Youths Who Put God First article proudly recounts stories of young Jehovah’s Witnesses who faithfully chose death after refusing blood transfusions. The narrative of sacrifice and obedience is further reinforced by examples like Governing Body member Anthony Morris commending the actions of a 15-year-old boy who died after refusing a transfusion at the 2016 Remain Loyal to Jehovah Convention.6
While the human toll of the doctrine is evident, it would seem that some contemporary bioethicists and medical personnel have failed to adequately consider the value of the lives lost. The failure to acknowledge the seriousness of the situation is epitomized by the complacency displayed toward those enforcing the doctrine.
I recently watched an episode from the Berman Bioethics Institute’s (affiliate. Johns Hopkins) monthly “Ethics for Lunch” discussion. In this discussion ethicists discussed a case study of a Witness who refused blood with a member of the religion’s Hospital Liaison Committee (HLC).7 During the discussion, the HLC member was able to express several half-truths about the enforcement of the blood policy. Ironically, the bioethicists failed to critically question the doctrine, instead accepting the HLC members viewpoint as representative of all Witnesses and remaining passive about whether the beliefs are worth the toll.
It is interesting to contrast this acceptance of the official Watchtower stance with the advice provided by Raanan Gillon, editor of the Journal of Medical Ethics.8 I believe that doctors and ethicists should feel empowered to be proactive in addressing patient autonomy, and the presence of truly informed consent or lack thereof. Particularly when patients, and especially adolescents, have been systematically programmed and indoctrinated to respond in specific ways, and face devastating consequences from their community and Jehovah’s Witness family if they deviate from current Watchtower policy.
The true cost of the blood doctrine cannot be illustrated more vividly than through an examination of the recent loss. The kindness that Kalila displayed is evident by the fact that this author, someone she only met once, attended her funeral after hearing of her death. The Jehovah’s Witness officiating her funeral spoke of how she saved money to travel to Thailand and engage in ministry work, in addition to tutoring Thai students in English. She was courageous, intelligent, and deeply devout. After feeling extremely weak and going to a local hospital, it was discovered that Kalila had a low blood count and required a blood transfusion. The speaker recounted how she adamantly declined the transfusion in accordance with her beliefs, even when her doctor implored her to accept it to regain her health. The speaker commended her loyalty in the face of opposition to “secularly trained individuals”. Despite my sadness, I have to acknowledge that Kalila acted in accordance with her convictions. However, in answer to my initial question. I have to say no, it’s never morally acceptable for a young person to die under preventable circumstances.
*The author maintains their status as a PIMO (physically in/mentally out) Jehovah’s Witness. Fear of draconian punishment forces them to remain anonymous. The person is well known to the editor of AJWRB who has corresponded, and spoken with them on numerous occasions over the years, and is assured of their bona fides. Their motivation is concern for their fellow Jehovah’s Witnesses.