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2002, 8 February. Alejandro G. Pérez Pimentel, pediatrician, Hospital General de Zona 8, Instituto Mexicano del Seguro Social, Uruapan, Michoacan SUMMARY Jehovah's Witnesses are a young religious association led worldwide Watchtower Society of New York, whose precepts are based ad pedem literae in the Bible, but original interpretations and sectarian connotations. The prohibition to be transfused is a unique standard currently in force and which distinguishes conditioning antagonize the medical field. Intend to base their position on biblical principles, scientific and organizational, and valid informed consent. Many have died for these beliefs. This paper presents to the health conscious motivations of the group to understand and object to its inconsistencies in all areas identified with useful arguments to try to preserve their lives. Introduction In recent months, several area general hospitals Instituto Mexicano del Seguro Social (IMSS) were visited by Jehovah's Witnesses, who presented his version of the informed consent
and group decision to avoid transfusion in any circumstance (a Jehovah's Witness lawyer said that this restriction is prevalent even in young children, whose parents must decide for themselves as well as adults in coma, with severe bleeding, if the card carrying the blood). By the way warned of the penalties applicable in case of transfusion to a Jehovah's Witness, from the professional disqualification to imprisonment.
Jehovah's Witnesses Charles Taze Russell (1852-1916) was a Bible scholar who was not included in the Bible societies of their time to make interpretations that are not shared, so that between 1879 and 1881 he founded a magazine:
Zion's Watchtower and its own group of Bible students
, which called itself the pastor, since 1931 this group is known as the Jehovah's Witnesses. (1) This pastor came up and extended his followers leaders -
Watchtower Bible and Tract Society (WTS) since 1881 - a plan for recruiting and retaining supporters, made extensive Bible studies and modifications to key texts of the Bible, with the effort to substantiate his teaching.
His technique de captación consiste en proselitismo intenso y exaltación de los valores del individuo, o bien, resaltar sus carencias, errores y necesidades, ofreciéndole ayuda y erigiéndose el grupo reclutador como solución a sus problemas. Forman grupos, denominados
congregaciones , en los que cada uno reúne entre 100 y 150 personas bajo la tutela de un
anciano (hay aproximadamente seis millones de testigos de Jehová en miles de congregaciones); en ellos se ofrece amistad profunda, convivencia continua y cordial al nuevo discípulo, quien se integrará en forma por demás estrecha.
Ya despertado el interés, se ha informado que mediante control mental se procura la transformación personality of the new member (one of the root causes for some classified as a cult to this religious group). (2) To achieve this purpose, selects and qualifies the information, the criticism is judged as errors, libel and destabilizing wills of detractors. The language becomes a fraternal own, basing their arguments on biblical quotations, allusions to the Lord and phrases like being in the truth
. (3) The WTS is exalted as a mediator between God and the new member ("... if we walk in the light of truth, we must recognize not only Jehovah God as our Father but his organization as our mother ...").( 4) It provides an extensive program of meetings and talks in the halls of the United
, which manifest the doctrinal principles and norms governing the functioning of the organization, rejecting personal opinions and criticisms. (5) messages permeate leaders consciences as unassailable and incontrovertible guidelines ("... the theocrats appreciate the Lord's visible organization and not be so foolish to assert against Jehovah's channel their own reasoning, feelings and human emotions ...").( 6)
other hand, are watching each other and in an environment so small there are no options: the conduct of the witness of the Lord is always excellent, whether out of conviction or fear, the absence of such conduct, every Jehovah's Witness is required to inform the offender. It has been suggested that there is a file that contains information about each witness grave sins committed, so that all information relating to the privacy of the witness is kept in the master files of the Society in New York and are never destroyed; well, anywhere in the world where you go a Jehovah's Witness will accompany your file. (7) For the evil deeds, it is said that sanctions are provided in the manual
Pay attention to yourselves and to all the flock , given by WTS, by which, the elderly take a legal action
ranging from simple call attention to the expulsion, whether civil laws (8).
WTS has taught a strict moral code that affects all aspects of the lives of its members, both in their daily conduct and in dress, (9) haircut and beard, avoiding or limiting smoking, drinking, dancing, playing chess, (10) the prohibition of transfused, (11) the refusal to salute the flag and military service. ( 12) All this serves to divide the world to members, interfering with the rules of civil coexistence, give them a distinctive external identity, creating in them a moral mentality (just obey the theocracy of the kingdom
represented by the WTS, not the hosts of Satan, government and churches) (13) and reinforce in their minds the legitimacy of their new status. WTS
New York (10 to 13
faithful and discreet slave and its leader) leads the governing body, area superintendents, branch, district, circuit and congregations. In these, the elders and ministerial servants
do with the publishers
. Its doctrine is based on the Bible and his own writings. Someone said that Russell played the Bible with the help of numerology, astrology and gnosticism. (14) By numerology has established the date of Armageddon
: 1874, 1914, 1925, 1942, 1975 and before the end of the last century. (15) Someone claims that the spiritist Johannes Greber (not a Jehovah's Witness) made changes to the New Testament
have been applied to the Bible of Jehovah's Witnesses. (16) In this context, can be read in
WT:
The blood of a person is the person himself, the flaws, excesses and drinking habits, poisons that can promote suicide, murder or theft are in the blood. The low moral caliber, sexual perversions, repression, inferiority complexes, sex crimes ... this is what comes up after a blood transfusion (17)
transfusions and contradictions The doctrine remains intact. Citing
new lights, WTS has changed its views on certain key issues. Accepted transfusions for many years, but since 1945 outlawed such arguments claiming biblical, medical and organizational: (18) Biblical Argument
In 463 citations from the Bible speaks of blood and several are prohibited intake, one of which is the everlasting covenant
(commandment of the Lord to Noah):
But flesh with the life that is your blood, you shall not eat. (Genesis 9:4)
And anyone ... to hunt animals or birds that may be eaten, spilled blood and cover it with soil. (Leviticus 17:13)
that you abstain from things sacrificed to idols and from blood and from things strangled and from fornication. (Acts 15:29)
Where in the Bible, there was punishment for the transgression of this mandate was limited to a simple reprimand (about Saul's warriors who ate meat with blood: Samuel 14:34,35), while that those who eat dead animals with their blood, all the pain was considered unclean for several hours (Leviticus 17:15).
At that time the animals were eaten by parties seeking to keep them alive until the end, not having refrigerator. It is obvious that this practice allowed the wounds became infected, which caused disease in humans and animals suffering in order to avoid them, required the sacrifice of animals (pulling the blood). All Judeo-Christian religions understand this, as authorized in the New Testament and, before animal sacrifice:
Of all that is sold in butcher shop, eat, asking no question for conscience sake. (Corinthians 10:25)
As is perfectly clear, all these quotations are taken from human blood will not have nothing to do with a transfusion and, much less to the human sacrifice of himself to die by not transfused. WTS, then pretends to Acts 15:29 a meaning without context: "abstain from blood means not putting it in any way in the body" (19), which differ among themselves, when Eduard Meyer
WT said that the real meaning to abstain from blood in this text is to abstain from eating blood (20).
Still, Jehovah's Witnesses do eat blood with meat (even after the animal slaughtered and exanguinated, contains 30 50% of its blood) and chicken meat (100% of their blood, because the animal is electrocuted to sacrifice), may be more consistent with vegetarianism.
In contrast, cells transfused blood are neither digested nor absorbed, but remain biologically and functionally intact, because it is a transplant and not vampirism. (21)
WTS ensures that eating blood is transfused to the sick and conviction of the fluid receiver who, if he survives disease that required transfusion, may be not only the pangs of conscience, feeling violated a divine precept, but also the most terrible punishment of religion: the expulsion (22) (prosecution for a old) or dissociation (the Jehovah's Witness excludes himself from the congregation, most publicized penalty since June 2001 and exempt from liability WTS), (23) is treated as a rebellion against the Lord.
The individual concerned is identified and shamefully ignored its (partial or total impairment of the normal communication and coexistence between the offender and his family and friends who remain active members), as well as being expelled from the halls of the kingdom and proselytism. But above all, be denied the right to live eternal life, because "to receive eternal life in paradise, we must serve God as part of this organization." (24) has been decoupled or expelled parents children under transfused. (25) Understandably, it is a situation so dramatic that you can pull over to suicide. Argument
doctor This argument is only one distractor. If transfusion without risks, however Jehovah's Witnesses are not transfundirían, nothing serves as reinforcement to a rejection of the blood. They say they do not believe that the supposed benefits of blood exceeding the lethal complications, above all, having medical alternatives that do not contain these risks, (26) and the numbers show that more people die from blood transfusion than those who refuse receive it.
Of course there are risks, both disease and death, attributable to blood transfusion in a report, the number of deaths per million units of blood transfused was 0 for hepatitis A, 0 to 0.14 for hepatitis B, 0.5 to 17 for hepatitis C, 0.5 to 5 for HIV, HTLV and parvovirus 0 , 0.1 to 0.25 for bacterial contamination of red cells, up to 21 for platelets, 0.67 to 0.2 for hemolytic reactions and ARDS. (27) is, the current risk of transfusion is 2 to 44 users per million, while in the world dies every day an average of three Jehovah's Witnesses for not transfused. (28)
Moreover, the fractions allowed for transfusion to Jehovah's Witnesses (factor VIII, for example) infected AIDS in hemophiliacs many followers of this religious movement, and have not been banned for it. (29)
other hand, Carlson and colleagues reported the following about 125 Jehovah's Witnesses who refused blood transfusion in surgery: 61.5% died of those whose preoperative hemoglobin was less than 6 g / dL, and died 33% when hemoglobin was 6.1 to 8 g / dL, hemoglobin from 8.1 to 10 g / dL, mortality was 7.1%, no fatalities occurred when the hemoglobin Preoperative was greater than 10 g / dL. (30), (31)
The medical options
transfusion have proposed Jehovah's Witnesses are bloodless surgery, epsilonaminocaproico acid, desmopressin, erythropoietin, Hartmann, dextran, hetastarch, aprotinin, conjugated estrogens, erythrocyte recaptured, hyperbaric oxygen and hypothermia. In addition, for neonatal hyperbilirubinemia propose using protoporphyrin, activated charcoal and immunoglobulins. Doctors know they are not useful as a therapeutic alternative to blood, and most are not trained to replace the blood with those options.
WTS has changed its doctrine on the blood (citing
new light, that is, new inspiration, something that today is certainly no longer be tomorrow). (32) Given the changes no longer transfusion scientists in but now whole blood fractions separately, initially WTS prohibiting the banned blood as a whole each and every one of its parts. (33) Then, to everyone's astonishment, has been increasingly tolerated for their adherents, certain fractions blood, minor components
: (34) Serum (1973), plasma proteins [albumin (1981), immunoglobulins, fibrinogen], coagulation factors (1978) and troncotutipotenciales cells (hematopoietic stem cells), (35 ), (36) bone marrow transplants, using accepted in donated blood components, interferon, cytokines, hemoglobin-based blood substitute (Hemopure R) (37) and procedures such as hemodilution, red cell recapture, extracorporeal circulation (cardiopulmonary pump, hemodialysis). But maintains the ban on older (erythrocytes, leukocytes, plasma, platelets) on the stored autologous blood (38) and blood donation. The justification for the fraction allowed is not passed through the placenta during pregnancy and allowed for is that they did.
Whole blood transfusion but is rejected as can be accepted in bone marrow transplant. The plasma is rejected if it is administered as such, but is accepted if given albumin, globulin factors coagulation, fibrinogen and serum separately. Leukocytes were rejected, but accepted as "peripheral blood stem cells and the ingestion of breast milk has more peripheral blood leukocytes. Autologous blood is rejected if it is stored or breaks the connection of a closed loop system in the patient, but remains permeable permitted if the circuit or if taken, peripheral stem cells, although they are stored. Hematopoietic stem cells, are prohibited if they are taken from the umbilical cord, but are tolerated if taken from peripheral blood or bone marrow. Blood donation is prohibited a Jehovah's Witness to another, or a person outside his religious doctrine, but certain sections are adopted if the donor is not a witness and a Jehovah's Witness transfused (39).
Jehovah's Witnesses have not always agreed with medical therapy :
We do well to bear in mind that among the drugs, serums, vaccines, surgical operations, etc.., of the medical profession, there is nothing of value, except for some occasional surgical intervention (40).
If any doctor too jealous condemns your tonsils go and suicídese with a knife, it is cheaper and less painful. (41)
But on the other hand, say they have " worked for decades to develop a cooperative relationship with the medical community. "(42)
For many years it was banned immunizations:" Vaccination is a direct violation of the law of Jehovah / God, is a crime, an atrocity, and a deception, never prevented anything and never will. It is a great business. "(43) Then in 1952, allowed as a matter of individual conscience. (44) Regarding the transplants said:" Organ transplants are a form of cannibalism and should be avoided. "(45) then repented and allowed (46).
probably have died some Jehovah's Witnesses by such policies regarding changing transfusion, transplants and vaccines, however, have not found a written protest Jehovah's Witness for the death in parents, children or siblings, to comply with provisions that have suffered after turns. In
adamantly and absolutely rejects WTS blood transfusion, but says that the initiative is not theirs but of the followers: "They should choose a responsible manner which treatment is best for their children if their health problems are treated without blood. "(47) If the attending physician prescribes in elective surgery patients, they will seek another doctor to find one that handled without blood (medical
cooperative), which in the eagerness to please may violate professional ethics and the Hippocratic Oath
, to agree to work with methods that guarantee success unless, at a disadvantage for the patient.
For 10 years, created the Hospital Information Services, who coordinate the actions of 1400
liaison committees operating in 150 countries, with selected
elderly. The aim is to give his version of the blood, helping brothers, and injecting encouragement to patients and ensure that they or their relatives to refrain from being transfused, with or without medical cooperative. But also violate medical ethics and confidentiality of the patient and the hospital, requesting reports of Jehovah's Witnesses there and calling laboran48 large contingents of their own to prevent a member of the group is transfused.
In January of each year, Jehovah's Witnesses should be provided with a card
blood, where they engage in a public ceremony with the WTS not transfused, presumably also exempts professional beforehand to have to give bloodless care to a patient who requests it. You must be signed by the supporter in question and two witnesses. Argument
organizational
Rejection transfusion is a standard that distinguishes itself Jehovah's Witnesses from other religious organizations. Critics claim that this is the only objective. Jehovah's Witnesses themselves say
What doctors do not know, and we are not allowed to explain, is that our position (regarding the refusal of transfusion) is clearly an organizational rule for its members, and no logical reasons and support in Scripture (49).
Well, the prohibition of blood transfusion, it was difficult to sustain with biblical arguments and doctors, now makes more discretion: for an original mandate of the wielders of power in the group. There is no dispute, the witnesses entering Jehovah should be warned from the outset, on this rule and the doctrine: "one is free to choose religion, but once chosen, as to submit to their rules." (50) Many supporters, however, who profess in good faith that religion does not accept the position on the specific point WTS transfusions and are requesting the revocation (the Association of Jehovah's Witnesses for Reform on Blood Case, is a group that asks.) But the attitude towards the rejection is not open. If you ask an old
this answer that if a Jehovah's Witness accepts blood in a moment of weakness, and later regrets this action, will be offered spiritual support. This is inconsistent with the pressure exerted themselves followers of the doctrine of hospital personnel against possible transfusion at one of their own.
up in the future if new lights
for WTS and blood transfusion were to allow without penalty (or own or imposed), which seems possible because since June 2001 WTS's new attitude is less inflexible, it would appear that the current follower die today for a cause that another should not die tomorrow.
The dispute before the European Commission of Human Rights between the Government of Bulgaria (which does not recognize in his country wanted to Jehovah's Witnesses as a religious group because they demonize the government, military and prevent transfusion) and WTS, was closed by agreement (Strasbourg, March 1998) by which the government agreed to provide in their legislation, most soon as possible, a way of civilian alternative to military service for conscientious objectors, and register the applicant as a religious society. The WTS is committed to issue a statement regarding its position on blood transfusions, to include in its constitution that its members should have free choice in the matter for themselves and their children, without exerting any kind of control or sanction by the association. (51) However, the April 27, 1998 in New York WTS reported that "the terms of the agreement does not reflect a change in the doctrine of Jehovah's Witnesses." (52) Positions
institutional, legal and ethical * few months ago, approximately 40 Jehovah's Witnesses came to the Hospital General de Zona 8, Uruapan, stationed in the classroom and in the corridors of the hospital. His lawyer explained his version of the informed consent of the adult can refuse blood for themselves and their young children (and take responsibility for them) and comatose patients who carried the blood card. There was talk of sanctions physicians should perform a blood transfusion. Faced with almost total ignorance of the subject and institutional legislation in this regard, there were no aftershocks. Informed consent
The
informed consent is the free acceptance, by a competent patient (capacity) to decide for a diagnostic or therapeutic measure, having been properly informed of it by a doctor. (53)
The definition of this right, we describe two subjects, a determinant and a target of the action:
The health care provider gives complete information about the condition and outlines the management options they can offer. The competent patient has the power to reject or select from these management options. This is the crux of this right. If you accept (scenario 2), must authorize with your signature, but it is being rejected (in a situation 3a) this decision does not ipso facto allowed to claim medical alternatives not offered, which would go beyond the definition and the spirit of informed consent. When the patient, who rejected the proposed diagnostic or therapeutic procedure requires not offered by the physician and the latter for scientific or ethical reasons, deems inappropriate or unacceptable, or untrained for their realization, after duly inform, exercising their moral autonomy, would be exempt from action. However, in emergency situations (3b), it would abide by the rejection and give alternative (though there is already a legal case management without consent in the United States of North America). (54)
Ethics and human rights
moral philosophy applies its two fundamental principles in the doctor / patient: respect for human life and then respect for freedom informed patient, (55) must be subordinated. The doctor never intentionally cause the death of any patient, whether by act or omission, even if the specific request by the latter. The blood transfusion may be the primary or sole treatment to sustain life, why not use ethics procedures that would guarantee at least the survival, as calls medical options for blood.
The only health care professional is bound by professional ethics, to use validated practices, while no other better choice and tested, will inform the patient that he accepts the infusion or resort to any doctor, whether it is an institution, that the case is under review together with management and then be channeled to the Hospital Bioethics Committee to decide who, how and where they will attend.
For children, the most important human right that governed in the world is to respect and protect your life by the state, the refusal of some parents to transfusion violates this right. In Europe, the best interests of the child, the law allows a physician to perform a transfusion with the agreement of the prosecutor. In case of death of a child for lack of transfusion, the parents are prosecuted not because of their religious convictions, but failed to meet the obligation to exercise parental care (European Parliament). (56) U.S. North American approach is similar: the parents are free to become martyrs by choice, but that's not allowed, in identical circumstances, the martyrs of their children back before they have reached old enough to have broad legal discretion to decide for themselves. (57) Thus it was decided also in Canada. (58) The governing global human rights in Mexico to protect the lives of children.
Management Guidelines Legal IMSS (OF. 37/2316)
face urgent need for transfusion, it will take place even when the patient or their families object. If we accept the negative and the Jehovah's Witness is not transfused, the doctor may be liable professional (doctor's refusal to assist a person in a notorious case of emergency, Article 469 of the General Health Law) with imprisonment for six months to five years, a fine of 125 days of minimum wage and disqualification for two years, if there harm (death) would have permanently stopped the practice. If there is urgency, but not requiring transfusion or transfusion if needed but not urgent, and can supply the blood with alternatives in patients who refuse transfusion, they should occur. If I could not replace the need for blood by any other means and the beneficiary or their family members deny the application of blood, consider that there is subject to the requirements and processes of the Institute (Social Security Act), in full force discontinue care without personal responsibility for the handler.
Trying to summarize all this: it supports informed consent, ethics and guidelines of the IMSS transfused to any patient without jurisdiction, in case of urgent necessity, even in contravention of the provisions of the religious doctrine which we have referred . But in desperate need for transfusion in competent patient, the positions are divided. WTS, based on informed consent is legally required to respect the freedom informed patient non-Jehovah's Witness transfused, which was expressed on site the IMSS, even if the legal rules of the Institute and ethics requirements for personnel transfuse a patient in that situation, to save his life. Moreover, it said sanctions that creditor would if the medical staff carry out transfusions, neglecting the IMSS would impose itself if it were made.
is absurd that a doctor, to save the life of a fellow, along the lines of consciousness, of ethics of the institution and the Constitution, endangering their physical integrity, freedom and right to practice their profession. I can not believe that religious rules that make martyrs among its adherents, also have legal justification to sacrifice the medical staff when seeking to save a life. How is it possible that different legal statutes about so openly contradict one another, and encourage development of innocent victims in the chaos caused by the uncertainty?
This can not continue. It is the responsibility of the case to end the problem. Should be instituted universal laws fair and endorse the best interests to protect life, but which also respect the personal decision. This must be done before facing difficult situations and be more affected. Therefore ask the Congress, do hereby establish clear guidelines through legislation, specifically on professional guidelines, both public and private, in the three main variables of the doctor / patient, Jehovah's Witnesses or not, regarding the need for transfusion and medical liability situations in the same area, which are none other than implied by the definition of informed consent and the moral philosophy, and are already in force in other civilized countries.
A legislative initiative to Congress is:
