Refusal of blood transfusions among Jehovah's Witnesses - are there biblical grounds? Jehovah's Witnesses and Blood Transfusion Misunderstanding of blood transfusion among Jehovah's Witnesses.

Bridegroom of Blood “And it happened on the way at the overnight stop that the Lord met him and wanted to kill him. Then Zipporah took a stone knife and cut off the foreskin of her son, and laid it at his feet, and said: You are the bridegroom of blood to me. And He left her” (Ex. 4:24–26). The story “Bridegroom of Blood” is one

Ritual of the Blood Covenant Exodus 24:6–8 tells of the conclusion of the Blood Covenant: “And Moses took half the blood and poured it into cups, and sprinkled the other half of the blood on the altar. And he took the book of the covenant (covenant), and read it aloud to the people, and they said they: everything that the Lord said we will do and be

Why so much blood? On the one hand, we should not forget that for a pagan the truest god will not be the one who speaks of mercy, but the one who turns out to be stronger. Here is a typical story about the rivalry between paganism and Christianity in Altai, transmitted by the German

We do not consider it possible for ourselves to think that “a few grams of blood from EVERY body inside” is not immoral, just as “a few moments of fornication” is not immoral (roughly, of course, but clearly).

But this is our personal opinion.

Another interesting point in favor of the ban on drinking the blood of ANY body:

In the Law of Moses there is another option for using blood (more precisely, the meat of a non-bleeded animal):

Deut.14:21: Do not eat any carrion; give it to the foreigner who [happens] in your gates, and let him eat it, or sell it to him, for you are a holy people to the Lord your God.

The question arises: if, according to Gen. 9:3, 4, the law about the inadmissibility of eating blood applies to all people, then why is there such an indulgence in the Mosaic Law for “foreigners”?

On Sat ( 2004 15.09. With. 26 Notable Thoughts from the Book of Deuteronomy) verses from Deut. 14:21 were explained by the fact that foreigners were not under the Mosaic Law and could use such meat “for various purposes,” gently hinting that they could not eat such meat, but use it for clothing, feeding dogs, etc. Although the text of Scripture says precisely that LET a foreigner EAT such meat, and not just use it for clothing, etc. - for “various purposes.”

However, the question remains: why then is there SUCH a difference in the requirements for people? A foreigner from the time of the Mosaic Law could not know the prohibition on carrion: Noah was not given any instructions about carrion (an animal that was not bled). FOR JEHOVAH'S PEOPLE ONLY, the handling of the blood of EVERY BODY has been explained in detail. Therefore, permission to eat carrion is given to those who have nothing Not knows about God's requirements - emphasizes the IMPORTANCE of the requirements TO OBSERVE THE PROHIBITION on the consumption of blood ONLY FOR JEHOVAH'S PEOPLE, who are enlightened on this subject in all details. From a person who is not part of His people, there is little demand. And Christians will be held accountable for this.

That is why we think that justifying the consumption of blood from EVERY BODY - internally for the sake of saving life in this age - is the same as justifying any other lawlessness for the sake of saving life in this age (murder and theft). Moreover,the use of blood in treatment -There is an alternative: bloodless medicine.
Currently in America, for example, civil and military medicine advocates exclusively for a bloodless method of treating patients, having come to the conclusion of its indisputable advantage precisely because of the refusal to transfuse the blood of Jehovah's Witnesses.

Perhaps the only thing we do not agree with in the RSD teaching about blood is the confusion regarding fractions, molecules and elements of blood and the deprivation of communication of those who nevertheless decide to use blood-based drugs or blood transfusions. Why? Based on four points:

1) God ordered to bleed the animal as much as possible in principle, taking into account that blood in the form of myoglobin and residues in the muscles inevitably remains, and there is no less of it in the thickness of the meat than in honey. drugs. IN actovegin ampoule, we think, there is much less residual animal blood than in a cutlet, for example, or liver pate.

The technology of bleeding the largest blood vessels of animals, which has existed since the time of the Great Patriotic War, allows, without fanaticism, to free the animal carcass from blood BASICALLY, and everything beyond this - the blood that is bound in the muscles in the form of, say, myoglobin - does not count , it is called meat and is part of it.

So, the blood of the main channel is the BASIS of the animal’s life and symbolizes ITS LIFE. In a suffocated animal or carrion, the blood does not flow out of the riverbed - it coagulates due to lack of oxygen, and therefore such an animal could not be eaten. (we are not talking about the dangers of blood, although it is actually harmful in terms of food due to the mass of pathogenic microorganisms that cause many diseases). The meat of an animal that has been bled by technology, one way or another, contains blood residues, but nevertheless, Jehovah’s people have always eaten such meat.

2) Availability of principle: everything sold at auction(except for outright blood, of course), eat WITHOUT any research- 1 Corinthians 10:25 (although here Paul spoke about parts of a meat carcass sacrificed to idols, however, the principle of buying and selling what is used for food applies, we think, to bloodless meat and to pies with meat from who knows who, and to sausages from unknown whom). Pavel did not advise going through what was sold at the auction to the point of fanaticism, otherwise the risk of dying from hunger is great: a fanatical conscience will always find something to cling to.

3) As is known, such a blood fraction as leukocytes - in large quantities found in the milk of a nursing woman, there are even more leukocytes there than in the corresponding amount of blood. There are from 4,000 to 11,000 leukocytes per cubic millimeter in the blood, while in the mother's milk in the first months of feeding there can be up to 50,000 leukocytes per cubic millimeter. This is 5-12 times more than in the same volume of blood ( directory data)

It turns out that infant consumes fractions of human blood in the form of leukocytes, however, this type of feeding is provided by God and nowhere in Scripture is there a prohibition on breastfeeding with milk containing blood fractions.

It turns out that the issue of using blood fractions has also not been studied enough to have Biblical grounds for prohibiting their use for treatment.

4) The Bible only records the attitude towards eating the blood of ANIMALS as food. Based on this, we can only come to the conclusion that it is impossible to transfuse the blood of animals, but, as it seems to us, even modern medicine will not think of this. Eat animal blood, even in the form of honey. a drug like “Hematogen” - would also be wrong from the point of view of this passage of Scripture - Acts. 15:28.

There seems to be no problem with the ban on eating human blood. There remains only one question about the use of human blood for medical purposes. But there are no direct prohibitions on this, although, as it seems to us, it is stupid to even think that there could be. IT IS ENOUGH that God has shown the principle " soul OF EVERY BODY - in blood" - Lev. 17:14. AND " AVOID blood" This means there is no difference between whether the body of an animal or a person is used to extract blood from it - from any blood you have to ABSTAIN and that’s it.

But since there are still NO DIRECT instructions regarding the prohibition of human blood transfusion - the conscience of those who are faced with the question of life or death - can still admit that in the absence of such there is a small loophole for allowing an attempt to save a life through a blood transfusion, especially if remember also the biblical example extreme situation with impunity for drinking blood -1 Samuel 14:32-34.

However, even in this example, we do not have the right to ALLOW planning a blood transfusion for extreme situations, because this is called GIVING INSTALLATION and PLANNING a violation of God’s prohibition on blood. It’s one thing when you know for sure that you can’t give a blood transfusion, but you couldn’t stand the pressure and transfused it, and it’s quite another thing if you have a plan in your head to save a dying person through a blood transfusion.

In connection with these reflections, we believe that it is immoral to deprive of communication those who DO NOT PLAN to transfuse blood and are TAUGHT CORRECTLY, but in an extreme situation cannot withstand the severity of a possible loss and decide to transfuse blood to save a life.

What method to solve the problem of saving life in critical situation– every Christian decides according to his own conscience. And for decisions according to conscience one cannot be deprived of communication.

But be that as it may - TEACHING that God allows blood transfusions on the basis of the fact that Jesus gave 5 liters of blood for his brothers, and therefore we do not need to spare our two hundred milliliters - is WRONG, not according to the Bible and is an apostasy from God's principles regarding the blood of EVERY body.

Jehovah's Witnesses as a religious denomination

The organization of Jehovah's Witnesses is a branch of Christianity that professes scrupulous adherence to all moral principles set forth in the Bible. These principles include Jehovah's commandment never to use the blood of others. The texts of the Bible where this commandment is mentioned (Genesis, 9, 3-4; Leviticus, 17, P-12, Acts *, 15, 28-29), speaks of the prohibition of Jehovah God to eat blood, and not to infuse it intravenously.

Intravenous infusions did not appear until the 16th century. and the point, of course, is not in rationalistic interpretations of biblical texts, but in strict adherence by Jehovah’s Witnesses to the ideals set forth in the Bible. By the way, such observance of the commandments by them applies not only to the prohibition of using someone else’s blood, but also to all other modern ideals that came from the Holy Scriptures.

However, it is precisely this dogma - the refusal of other people's blood - that has led to conflicts between Jehovah's Witnesses and medicine as part of society, because their categorical refusal of blood transfusions sometimes creates significant difficulties for doctors and seems to many doctors to be a quirk that contradicts common sense and even some ideals society.

It is not our task to make a theological assessment of the faith of Jehovah's Witnesses, but since many doctors who encounter clinical practice with Jehovah's Witnesses, who consider their ban on blood transfusions to be religious nonsense, and themselves to be rabid suicidal sectarians, we note the following important facts.

At the same time, Jehovah's Witnesses are by no means suicides or psychopaths: they ask that any treatment methods be used to treat them, and even more so to save lives, including anesthesia, intensive care, resuscitation, transfusion of the most various drugs, but not blood or its components.

Today, in 230 countries around the world, there are about 6 million Jehovah's Witnesses and about 8 million sympathizers who attend their prayer meetings. Such a significant number of potential patients who refuse blood transfusions for reasons that are unconvincing to most atheists and believers of other faiths creates a problem that needs to be solved.

Let's look at the transfusion therapy practices that Jehovah's Witnesses accept and those they reject. As we have already noted, all other medical practice is accepted with gratitude by Jehovah's Witnesses.

Acceptable Methods

• All transfusion therapy with drugs that do not contain blood
• Extracorporeal methods (artificial circulation, hemodialysis, sorption methods, etc.) provided that the perfuser is initially filled not with donor blood, but with any colloidal or crystalline solution
• Reinfusion of one’s own blood flowing into the cavities, including through drainages after surgery. It is understood that the movement of the spilled blood did not stop, and the perfusors that return blood to the patient’s vessels can be considered a continuation of the circulatory system.
• Infusion of albumin, gammaglobulin, cryoprecipitate, blood clotting factors, use of fibrin glue.
• Use of erythropoietin and all hemostatic drugs.

Unacceptable methods

• Hemotransfusion of donor blood and its components.
• Autologous blood transfusion, if it was stored in a bottle, plastic bag, or preserved, i.e. didn't move.

That's all medical restrictions“freedoms” of doctors put forward by Jehovah’s Witnesses - do they really prevent us from treating these patients!

However, there are many doctors who find it difficult to comprehend that some patient, or more often a patient, who does not have a medical education, allows themselves to be controlled by a doctor!

We will consider the ambitiousness of such views in the next chapter, but here we note once again that in fact, hemotransfusion of donor blood and a significant part of autohemotransfusion methods are closed to Jehovah’s Witnesses. However, is the position of a doctor really so hopeless at the bedside of a patient - a Jehovah's Witness - with massive blood loss, who categorically refuses transfusion and its components?

Transfusion Jehovah's Witnesses

First of all, let us note three important circumstances.

1. Today, the attitude towards blood transfusion as the only or main method of intensive care for patients with acute blood loss has been revised. Moreover, it has been proven that blood transfusion has dangerous disadvantages that may exceed the advantages of its use.

2. Our understanding of the clinical physiology of hemorrhagic shock has changed, including thanks to the management of Jehovah's Witnesses with hemorrhagic shock without blood transfusion. It became clear that the main functional disorders are not associated with sharp decline hemoglobin, but with a reduction in blood volume (hypovolemia), microcirculation disorders and impaired blood clotting properties (coagulopathy). The survival limits of patients with enormous blood loss have expanded significantly.

Let us note that by doing so, Jehovah's Witnesses unwittingly changed for the better the most important branch of critical care medicine—the management of patients with hemorrhagic shock. To put it another way, we can say that if Jehovah's Witnesses did not exist, they would have to be invented.

3. Jehovah's Witnesses, both healthy and sick, are completely contactable people with whom you can discuss and try to negotiate at least partial deviations from their dogma - the absolute refusal of blood transfusions. Of course, the doctor may be convinced of the absolute necessity of blood transfusion to save the patient’s life. Then he must try to convey his conviction to the patient so that he saves his own life, even at such a high cost to him. The elders of Jehovah's Witnesses themselves believe that this is a matter of conscience for each person. They do not prevent him from agreeing to a blood transfusion, but they do not push him to do so.

If, nevertheless, the patient insists on his complete refusal (we emphasize that both consent and refusal are a matter of conscience for each person), the sequence of medical actions should be as follows:

1. Trying to stop the bleeding. This and all subsequent actions are performed against the background of oxygen therapy.

2. Functional assessment of the patient’s condition: special attention to diuresis, central venous pressure, state of consciousness: do not make a cult of the hemoglobin value, blood pressure, do not use vasopressors for increasing era.

3. Immediately, without waiting for the results of the study of hemoglobin and hematocrit, infect crystalline solutions, controlling the volume of their administration mainly by the dynamics of the central venous pressure.

4. Determine the coagulation properties of blood, fearing that any blood loss will end with RVS syndrome, and subsequently carry out dynamic monitoring of these indicators.

5. Infuse albumin and other colloidal solutions, monitoring their effect on blood clotting properties.

6. If there are any approaching normal indicators Central venous pressure, diuresis, adequate consciousness and if bleeding has stopped, leave the patient alone, at any values ​​of hemoglobin, hematocrit and blood pressure.

7. Use as early as possible an available complex of drugs that stimulate hematopoiesis (erythropoietin, iron supplements, vitamins, etc.).

8. Correct the blood coagulation properties (vitamin K, heparin, antifibrinolytics, etc.), not forgetting the clear interdependence of the coagulation, anticoagulant and fibrinolytic systems.

9. If paragraphs are ineffective. 3-5 use perftoran transfusion.

10. Carry out functional control of all vital systems of the body, keeping in mind multiple organ failure, which is inherently any hemorrhagic shock. Correct multiple organ failure according to the results of functional control.

11. When initial success is achieved, do not try to improve blood quality by artificial measures: let the autoregulation systems do this. Then the improvement will be slower, but safer.

12. Contribute full restoration the patient’s functions after blood loss should be done with the help of: a) rest, b) analgesia, c) diet, d) various medications.

Thus, acute blood loss and hemorrhagic shock in Jehovah's Witnesses who refuse blood transfusions of donor blood extremely rarely create a hopeless situation for the doctor.

If the doctor is familiar with modern ideas about the clinical physiology of blood, blood loss and blood transfusion, he will find alternative methods suitable for a particular patient, and will do without transfusion of donor blood or its components. Such a doctor always rises to the occasion in planned calm situations and rarely finds himself in hopeless situations in acute situations.

However, many ethical and legal issues arise when treating Jehovah's Witnesses in hospitals when they require blood transfusions according to traditional medical standards. There are so many of these aspects that they are highlighted in the next chapter.

The main cause of many conflicts is not the religious dogmas of Jehovah's Witnesses themselves. They are simply more knowledgeable than other patients in the problems of not only blood transfusion, but also the rights of the patient. This literacy of theirs is a consequence of the constant work of the Hospital Information Service of Jehovah's Witnesses existing in Russia and other countries.

If all patients - atheists and believers of other religious denominations - used the services of this or a similar Service, perhaps medical workers would take a new look not only at their rights and responsibilities, but also at the rights and responsibilities of patients. And then conflicts would disappear in hospitals and mortal boredom would reign. As far as we know, no one has yet died from it (even though it is fatal), but unfortunately, deaths do occur from blood transfusion and improper intensive therapy for hemorrhagic shock.

ETHICAL AND LEGAL ISSUES IN BLOOD TRANSFUSION

There are two main reasons for ethical and legal conflicts associated with blood transfusion - iatrogenicity and oblivion of the rights of patients.

Blood transfusion is a method of intensive therapy, which is fraught with inevitable harm to the patient’s body, along with the benefit for which this method is used. Harm to the patient is a related area of ​​discussion among doctors and lawyers, and we will begin this discussion with the iatrogenic nature of blood transfusion.

Iatrogenic lesions during blood transfusion

Once upon a time, iatrogenics was the name given to a pathology that occurs due to incorrect actions of a doctor or misinterpretation of them by a patient. However, medical methods became more aggressive, and as a result, adverse consequences even of correct medical actions increasingly occurred. Therefore, iatrogenic damage should be defined as follows:

Iatrogenic injury is unintentional or unavoidable damage to body function or structure caused by medical effect

The main considerations when assessing iatrogenic injuries related to blood transfusion:

1) foreignness of blood, leading to inevitable immune reactions of the body, even in the presence of confirmed compatibility of blood groups;

2) possible infection, metabolic and functional inadequacy of the preserved blood,

3) a relatively complex technology of blood transfusion, although regulated by existing instructions, is nevertheless fraught with the possibility of procedural complications at all stages - from blood procurement to blood transfusion.

These three circumstances make it possible to systematize iatrogenic lesions associated with blood transfusion as follows:

• immune reactions to blood - from mild chills or hemolysis to blood transfusion shock and multiple organ failure;
• infection of patients, including pathogens of hepatitis, syphilis, human immunodeficiency (HIV) and many others. etc.;
• metabolic disorders;
• coagulopathy;
• complications of the procedure - from phlebitis to gas embolism.

Many adverse effects of blood transfusion, inevitable due to immune incompatibility of blood, can occur latently and go unnoticed, but manifest themselves later.

In the legal aspect, all iatrogenic pathology arising from blood transfusion can be linked to each of the reasons listed below or to their complex:

1) the inevitable action of the method, which is part of the essence and program of the blood transfusion itself.

2) incorrect choice of drug, dose or transfusion regimen, including due to unaccounted for individual physical and psychological characteristics sick.

3) procedural errors, often associated with non-compliance or violation of existing instructions.

Therefore, indications for blood transfusion should be limited only to urgent real needs, and not determined by long-standing traditions. Existing in last years enough effective methods, alternative blood transfusions, allow us to consider blood transfusion as a surgical intervention that always damages tissues and organs and is therefore performed only in cases where methods conservative treatment are not effective or there is not enough time to use them.

Iatrogenic lesions - both inevitable and associated with the wrong choice of blood product or transfusion regimen, as well as with procedural errors - are the main basis of legal conflicts arising in connection with blood transfusion.

Another reason for ethical and legal conflicts in blood transfusion is the violation of the rights of patients.

Blood transfusion and patients' rights

The rights of patients are clearly regulated in the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens,” adopted in 1993 and currently in force. The main articles of this legislation related to the rights of patients are repeated in the draft “Federal Law on Health Care in the Russian Federation”, adopted by the State Duma in the first reading in 1999.

In Art. 1 of the “Fundamentals of Legislation” states that “The State guarantees the protection of the health of citizens in accordance with the Constitution of the Russian Federation, federal laws and other regulatory legal acts of the Russian Federation, generally recognized principles and norms of international law and international treaties of the Russian Federation.”

Unfortunately, health care workers are often less familiar with the rights of patients than the patients themselves. This often results in ethical and legal conflicts that could have been avoided.

An interested, respectful attitude towards the rights of patients should be the norm of everyday medical practice also because blood transfusion is a medical action, which, like most any medical actions, is accompanied by a certain risk. In this regard, the following ethical and legal issues that may pose potential conflicts need to be discussed:

• informing the patient about the nature of the pathology requiring the use of blood transfusion, and about the blood transfusion itself as a medical action.
• patient consent to perform blood transfusion.
• patient's refusal to perform blood transfusion.
• the patient’s right to receive alternative methods to blood transfusion.
• making a final decision on blood transfusion, if there are differences in the views of the patient, his legal representatives and medical workers.

Informing patients

Patients have the right, justified by law, to receive full information about all problems related to the blood transfusion prescribed to them.

The patient must receive exactly the information that may influence his decision, and this information must be presented in a form that is accessible to the intelligence and education of the patient or his legal representatives.

In view of the special importance of this problem, which often gives rise to legal conflicts, we present in full Article 31 of the “Fundamentals of the Legislation of the Russian Federation for the Protection of Citizens’ Health.”

Article 31. The right of citizens to information about their health status

Every citizen has the right, in a form accessible to him, to receive available information about the state of his health, including information about the results of the examination, the presence of the disease, its diagnosis and prognosis, treatment methods, the risks associated with them, possible options for medical intervention, their consequences and the results of the treatment provided. .

Information about the state of health of a citizen is provided to him, and in relation to persons under the age of 15 years and citizens recognized as legally incompetent - ux legal representatives by the attending physician, the head of the department of a medical institution or other specialists directly involved in examination and treatment.

Information about the state of health cannot be provided to a citizen against his will. In cases of an unfavorable prognosis for the development of the disease, information must be communicated in a sensitive manner to the citizen and members of his family, unless the citizen is prohibited from telling them about this and (or) has not appointed a person to whom such information should be conveyed.

A citizen has the right to directly familiarize himself with medical documentation reflecting his state of health and to receive advice on it from other specialists. At the request of a citizen, he is provided with copies of medical documents reflecting the state of his health, if they do not affect the interests of a third party.

Information contained in medical documents citizen, constitutes a medical secret and can be provided without the citizen’s consent only on the grounds provided for in Article 61 of these Fundamentals.

In accordance with the law, a patient who is undergoing a blood transfusion must be informed of the following points so that the decision he makes can be considered conscious (informed):

1) the essence, advantages, necessity and expected result of blood transfusion,

2) possible dangers of the method, taking into account the individual characteristics of the patient,

3) possible consequences of refusing blood transfusion,

4) the availability of alternative methods suitable for a given patient, their advantages and disadvantages.

The information presented to the patient, both in essence and in form, must be objective, not mislead the patient, and especially not frighten him. In life-threatening situations, the doctor requires special sensitivity and an individual psychological approach so that the patient accepts the right

a sound decision, based on medical science and everyday practice.

We need to remember the words of the doctor, philosopher, musician, Nobel laureate Albert Schweitzer (1875-1965), given in the box:

Medicine is not only a science, but also an art of achieving the interaction of our own individuality with the individuality of the patient.

Consent for blood transfusion

In accordance with the existing law, any medical action - diagnostic or therapeutic - can be performed only with the consent of the patient, informed about the essence of this medical action. The patient's consent in typical situations can be oral, and sometimes written - with the patient's signature or only in the form of a note made by the doctor. There are no mandatory legal forms of such consent, and the nature of the entry in the medical history depends on the patient’s condition, his individual characteristics, the presence of relative contraindications, etc.

We believe that a detailed listing of all possible dangers, errors and complications of the method when informing a patient who does not have a medical education facilitates subsequent legal proceedings, if necessary. But it does not benefit either the doctor or the patient. They are both interested in the existence of good and constant psychological contact, and an essentially sadistic, but formally completely correct detailed presentation of possible misfortunes is unlikely to contribute to such contact. Persistent extortion of the patient’s signature on written consent, information, etc. can also work. Legally, the patient’s signature is required only in case of refusal of treatment, if such refusal is life-threatening and the patient is informed about this (see below, Article 33). In other cases, the patient’s signature is not required.

There are two important things to keep in mind.

First: there is only one way to write yes or no, but there are thousands of ways to say them. simple words. And for the patient to make a decision, no less important than the essence of the conversation is the intonation in which it is conducted and which indicate the doctor’s interest in the well-being of the patient, and not in obtaining an alibi in case an accident occurs.

Second: the medical history should not turn into a letter for the attending physician, consultants and the patient. Statement that the medical history is the only document, acquitting or convicting a doctor in the event of a criminal case, is erroneous. The testimonies of other patients, medical workers, etc. are no less, and sometimes even more important.

Legal principles of obtaining or impossibility of obtaining the patient’s consent, set out in Art. 32 “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” fully apply to blood transfusion:

Article 32. Consent to medical intervention

A necessary precondition for medical intervention is the informed voluntary consent of the citizen.

In cases where a citizen’s condition does not allow him to express his will, and medical intervention is urgent, the issue of its implementation in the interests of the citizen is decided by a council, and if it is impossible to convene a council, the attending (duty) doctor directly, with subsequent notification of officials of the medical institution.

Consent to medical intervention in relation to persons under the age of 15 and citizens recognized as legally incompetent is given by their legal representatives after providing them with the information provided for in part one of Article 31 of these Fundamentals. In the absence of legal representatives, the decision on medical intervention is made by a council, and if it is impossible to assemble a council, the attending (duty) doctor directly, with subsequent notification of officials of the medical institution and legal representatives.

As this article suggests, critical care medicine often does not allow for truly informed consent, including blood transfusions. It should be emphasized that failure to obtain such consent and the reasons for this must be reflected in the medical documentation with timely notification to officials.

Various diagnostic and treatment methods that have a real risk of complications require written informed consent of the patient. Blood transfusion, anesthesia, intensive care, invasive diagnostic methods, etc., are just such methods.

For all cases, an entry in the medical history made by a doctor according to the following scheme applies:

The patient is informed about the nature of the pathology, the proposed treatment, the possible dangers of the method(s) and has given his consent to the proposed plan.

In most cases, patients’ signatures are not required, and this form should only be used for diagnostic and treatment methods that are fraught with foreseeable consequences. dangerous complications, which certainly includes blood transfusion.

There are the most various shapes patients' consent to surgery and other medical actions. All of them should be considered as an intra-hospital form of work organization, facilitating the subsequent resolution of possible conflicts. However, the patient’s reluctance to sign such a form cannot serve as a reason for refusing to treat the patient at all, for his discharge from the hospital or for other repressive measures. It is only necessary to note this fact in the medical history if the disagreements could not be resolved with the help of consultants and other specialists.

Refusal of blood transfusion

The right of patients to refuse any type of treatment, including blood transfusion, is justified by Article 33 of the “Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens’ Health.”

Article 3Z. Refusal of medical intervention

A citizen or his legal representative has the right to refuse medical intervention or demand its termination, except for the cases provided for in Article 34 of these Fundamentals.

If a citizen or his legal representative refuses medical intervention, the possible consequences must be explained in a form accessible to him. Refusal of medical intervention with indication possible consequences is made as an entry in the medical documentation and signed by the citizen, or his legal representative, as well as a medical worker.

If the parents or other legal representatives of a person under 15 years of age, or the legal representatives of a person recognized as legally incompetent in the established manner, refuse medical care necessary to save the lives of these persons, the hospital institution has the right to go to court to protect the interests of these persons.

Mentioned in the right to refuse treatment, Art. 34 - “Providing medical care without the consent of citizens” - applies only to citizens who pose a danger to others due to their illness (mental, infectious) or behavior (who have committed crimes).

Most common cause If patients refuse blood transfusions, there is a risk of infection. Refusal of blood transfusion based on religious views is becoming increasingly common (members of the Jehovah's Witnesses organization).

Refusal of blood transfusions by patients for religious reasons requires the respectful attitude of doctors, since such a right is justified by paragraph 1 of Article 5 of the European Convention for the Protection of Human Rights and Fundamental Freedoms (ratified Federal law RF dated March 30, 1998 No. 54-FZ), as well as clause 1 of Art. 22 of the Constitution of the Russian Federation, according to which everyone has the right to freedom and personal integrity, both physical and moral (spiritual). Article 17 of the “Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens’ Health” states:

The state provides citizens with health protection regardless of gender, race, nationality, language, social origin, official position, social status, place of residence, attitude to religion, beliefs, affiliation public associations, as well as other circumstances.

In addition, the legal right to refuse blood transfusion for religious reasons is confirmed by Article 28 of the Constitution of the Russian Federation, as well as by the Convention for the Protection of Human Rights and Fundamental Freedoms, confirmed on May 11, 1994 by the Council of Europe:

Art. 9, part 2: Freedom to profess religion or belief is subject only to restrictions, established by law and necessary in a democratic society in the interests of public safety, for the protection of public order, public health or morals, or for the protection of the rights and freedoms of others.

Consequently, as long as patients do not encroach on either public order or the rights of other citizens by refusing blood transfusions, their demand must be respected. This, however, does not exclude the need to explain to patients the possible life-threatening consequences of their decision. In this case, medical workers should act only by methods of persuasion, but in no case with any threats or repression, including refusing to treat the patient at all and discharging him from the hospital.

Refusal to provide any, including alternative, medical care requested by the patient is a violation of Part 1, Art. 41 of the Constitution of the Russian Federation and Art. 6 of the Law of the Russian Federation “On health insurance citizens in the Russian Federation”, according to which everyone has the right to receive medical care and medical services.

When persuading a patient to agree to a blood transfusion, the doctor must keep in mind the changed ideas today about the limits of the relative safety of blood loss, the availability of a variety of alternative methods, and the undoubtedly existing dangers of blood transfusion. An attempt by a doctor to obtain the patient’s consent with deliberately false arguments may indicate the doctor’s professional ignorance, his insufficient ethics and culture, and is often fraught with the subsequent emergence of a legal conflict.

Jehovah's Witnesses are not fundamentally opposed to any methods of modern medicine, including organ transplantation. They only refuse transfusions of donor blood and its components. However, many of them, as already noted, agree to reinfusion of blood poured into the cavity, to autohemotransfusion during hemodilution during surgery, to the infusion of certain drugs obtained from blood (for example, albumin, gamma globulin, coagulation factors, etc.) , for use with reservations of extracorporeal circulation in hemodialysis and other methods when artificial circulation is necessary.

Consequently, one must try to agree with such patients on the conditions, volumes and limits of blood transfusion, but consent should be obtained only voluntarily and without deceiving the patient, even if such a lie seems to be saving the doctor. It must be remembered that patients who refuse blood transfusions are often no worse, and sometimes even better than doctors informed about the real (and not mythical) dangers of blood transfusion, and about alternative methods, and about the exaggerated advantages of blood transfusion.

Documenting the failure

If, after all the explanations, the patient continues to refuse blood transfusion, his refusal should be documented in this or similar document;

Due to my personal or religious beliefs, I request that no blood or blood products be administered to me while I am hospitalized, even if in the judgment of my attending physician or his assistants such treatment would be necessary to preserve my life or promote my recovery.

Therefore, I relieve all responsibility from the doctor (attending physician), his employees, assistants, consultants, the hospital blood collection and transfusion department, the hospital and its staff, no matter what adverse and undesirable consequences and results may arise due to my refusal to authorize the use of blood or blood products.

I fully understand the possible consequences of such a refusal coming from me.

(witness) (patient signature)

(date, time) (signature of the patient’s closest relative)

This form is a recommendation and can be filled out by the patient in advance, upon admission to the hospital and during their stay in it. The patient must also be informed that he can at any time refuse his previously made decision.

This document must be attached to the medical history. It is recommended that on the front page of the medical history, in the place where the patient’s blood type is indicated, a note is made that the patient is prohibited from blood transfusion.

If a patient who is competent in all respects has decided to refuse blood transfusion and has formalized such a decision, blood transfusion should not be used for him, but alternative methods discussed in Chapter 5 should be used.

Alternative Methods

If a patient refuses blood transfusion for religious or other reasons, the doctor is obliged to use alternative methods of treatment, even if they cannot completely replace blood transfusion. Currently, there are dozens of programs for conservative and surgical treatment hematological and surgical patients without the use of blood transfusion.

If alternative methods are not applied to a patient who refuses blood transfusion but needs treatment, then various measures of influence and punishment may be taken against doctors who made such an incorrect decision, up to and including the application of an article of the Criminal Code of the Russian Federation, which reads:

Article 124. Failure to provide assistance to a patient

1. Failure to provide assistance to a patient without good reason by a person obligated to provide it in accordance with the law or with special rule if this entailed through negligence the infliction of moderate harm to the health of the patient, -

is punishable by a fine in the amount of fifty to one hundred minimum wages or in the amount of wages or other

income of the convicted person for a period of up to one month, or correctional labor for a period of up to one year, or arrest for a period of two to four months.

2. That. the same act, if through negligence it entailed the death of a patient or the infliction of grievous harm to his health, -

shall be punishable by imprisonment for a term of up to three years with or without deprivation of the right to hold certain positions or engage in certain activities for a term of up to three years.

Decision making in difficult situations

If a patient refuses a blood transfusion, which is contrary to modern medical views, the priority of the decision still remains with the patient if he is competent in his physical and mental state. Without his consent, and especially contrary to his prohibition, no medical actions, including blood transfusion, should be performed. Attempts to eliminate the resistance of a competent patient with the help of psychotropic drugs, anesthesia, etc. should be considered criminal.

The doctor is obliged to take all measures to convince the patient by involving people who are authoritative for the patient, his own and his colleagues, but he does not have the right to act contrary to the patient’s decision. In accordance with Article 58 of the “Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens’ Health,” the doctor has the right to refuse to treat such a patient, with the exception of the situations specified in this article:

Art. 58: The attending physician may, in agreement with the relevant official, refuse to observe and treat the patient, if this does not threaten the life of the patient and the health of others, in cases of non-compliance by the patient with the instructions or internal regulations of the medical institution.

Neither the council of doctors, nor the administration of the medical institution and higher management bodies have legal law overcome the prohibition of a competent patient on any medical action, including blood transfusion.

If the patient is incompetent, his legally registered representatives (relatives, friends, lawyer, etc.) can make a decision for him. If medical professionals do not agree with the decision of the legal representatives, they can challenge it in court when the situation allows for the time to do so.

If there is a previously issued patient prohibition on blood transfusion, this document remains a priority and cannot be challenged in court.

Doctors should get used to the fact that there can be more than one correct opinion and view (your own or any authority), that moral convictions can differ, but the law is the same for everyone, and when views diverge, only the law applies.

The ethics committee (commission) may note the presence of mitigating or aggravating circumstances when breaking the law, but not replace the law. Therefore, the patient’s refusal to undergo blood transfusion cannot be disavowed by the Ethics Committee and the main efforts of the members of the Ethics Committee should be aimed at convincing the patient or, if this cannot be achieved, at protecting his rights.

The legal algorithm for the actions of medical workers when a patient refuses blood transfusion is presented below.

Thus, in difficult situations related to blood transfusion, when the opinions of different parties do not coincide, one must adhere to next principle making a final decision:

• the patient's decision is a priority;
• health professionals are consultants interested in the well-being of the patient;
• the state (Ministry of Health, court, ethics committee, etc.) monitors compliance with the law.

Legal liability of medical workers

Legal liability of medical workers most often arises from the following work defects related to blood transfusion:

1) violation of the rules for collecting blood, 2) violation of instructions for blood transfusion, 3) violation of the rights of patients: failure to inform or insufficiently inform the patient, inconsistent blood transfusion, blood transfusion contrary to the ban and non-use of alternative methods of treatment.

All three points can be considered in accordance with Article 68 of the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens,” which regulates the responsibility of medical workers

Article 68. Responsibility of medical and pharmaceutical workers for violation of the rights of citizens in the field of health protection

In case of violation of the rights of citizens in the field of health protection due to dishonest performance by medical and pharmaceutical workers of their professional duties resulting in harm to the health of citizens or their death, the damage is compensated in accordance with part one of article bb of these Fundamentals.

Compensation for damages does not exempt medical and pharmaceutical workers from bringing them to disciplinary, administrative or criminal liability in accordance with the legislation of the Russian Federation and the republics within the Russian Federation.

When legal conflicts arise related to blood transfusion or any other medical action, there may be 4 types of liability for medical workers found guilty: disciplinary, administrative, civil and criminal. The first two types of liability are regulated by the Labor Code, civil - by the Civil Code of the Russian Federation, and criminal - by the Criminal Code of the Russian Federation*.

The civil liability of medical workers usually consists of compensation for moral and material damage to the patient, lost profits, etc. This responsibility and the principles for calculating material compensation in each specific case are clearly regulated by several articles of the Civil Code of the Russian Federation*. It should be noted that in courts today, much more often than criminal liability, it is the civil liability of medical workers and financial claims of patients, which can reach huge amounts, that are considered.

Conflicts related to blood transfusion are most often regulated by the following articles of the Criminal Code of the Russian Federation, which medical workers should be aware of:

Art. 26 - Crime committed through negligence,

Article 109 - Causing death by negligence

Article 118 - Causing grievous or moderate harm to health through negligence

Art. 124 - Failure to provide assistance to a patient.

Art. 293 - Negligence (this article applies only to officials and can be applied to a doctor if he performs managerial and organizational functions - head of department, chief of medicine, chief physician and so on.).

With regard to criminal negligence, three types should be distinguished:

• criminal negligence - neglect of a visible or known danger that the doctor did not foresee, but should have foreseen with the necessary foresight,
• criminal arrogance (frivolity) - an unreasonable hope of avoiding a complication that was foreseen,
• criminal ignorance - insufficiency of professional knowledge and skills when it is possible and necessary to obtain them.

To some extent, the doctor’s justification in legal conflicts related to blood transfusion can be provided by the following articles of the Criminal Code of the Russian Federation, with which medical workers should also be familiar:

Art. 39 - Extreme necessity.

It is not an arrest genius to cause harm to interests protected by criminal law in a state of extreme necessity, that is, to eliminate a danger that directly threatens the person and rights of this person or other persons, the legally protected interests of society or the state, if this danger could not be eliminated by other means and the limits of extreme necessity were not exceeded.

Art. 41 - Justified risk.

1. It is not a crime to cause harm to interests protected by criminal law with a justified risk in order to achieve a socially useful goal.

2. The risk is considered justified if the specified goal could not be achieved by actions (inactions) not related to the risk and the person who allowed the risk took sufficient measures to prevent harm to the interests protected by criminal law.

Art. 28 - Innocent causing harm.

1. An act is recognized as committed innocently if the person who committed it did not realize and, due to the circumstances of the case, could not realize the social danger of his actions (inaction), or did not foresee the possibility of socially dangerous consequences and, due to the circumstances of the case, should not or could not have foreseen them .

2. An act is also recognized as committed innocently if the person who committed it, although he foresaw the possibility of socially dangerous consequences of his actions (or inaction), could not prevent these consequences due to the inconsistency of his psychophysiological qualities with the requirements and extreme conditions or neuropsychic overloads .

The mentioned 3 articles of the Criminal Code can exempt a doctor from criminal liability if the circumstances under which the law was violated were force majeure, the doctor did not have the time and opportunity for consultations, or he did not know about the patient’s existing ban on blood transfusion. In other conditions, no references to noble motives, to the desire for the benefit of the patient, etc. cannot justify breaking the law.

The only worthy and, as a rule, fruitful way to prevent and resolve ethical and legal conflicts that may arise in connection with blood transfusion is to achieve psychological contact with patients through mutually respectful repeated interviews.

Physicians should be convinced that modernizing the doctor's thinking is no less important than modernizing equipment.

Zilber A.P. Blood loss and blood transfusion. Principles and methods of bloodless surgery.

15.12.2000
JEHOVAH'S WITNESSES ALLOWED BLOOD TRANSFUSIONS?

Based on materials from the South London Press, November 12, 1999,
"Gardian" from January 20, 2000, ITAR-TASS from April 17, 2000.
and The Times, June 14, 2000.

Leaders of the controversial Jehovah's Witnesses sect have unexpectedly announced that their members will now be allowed to receive blood transfusions. The “Brooklyn Elders” decided that a “witness” who agreed to a blood transfusion under conditions of a choice between life and death would no longer be “disfellowshipped,” that is, excommunicated from the sect. The decision is the biggest internal reform announced by the sect since the "Armageddon" and "end of the world" predictions for 1975 failed to materialize.

The current decision, taken after a secret meeting of twelve members of the "World Governing Council" at the sect's Brooklyn headquarters, was announced as a minor correction of position. Blood transfusions are now officially included in the list of “actions that do not entail deprivation of fellowship.”

Until this point, for decades, Jehovah's Witnesses had lauded as heroes of the faith adults and children who died or nearly died by refusing blood transfusions, which are absolutely, under all circumstances, prohibited. Here are just the recent facts.

In the fall of 1999, 36-year-old Englishwoman Juliet Mulenda died after a major operation. She was transferred to the intensive care unit after her lungs stopped functioning and she needed an emergency blood transfusion. However, the young woman’s relatives did not know that she was a “Jehovah’s Witness” and signed a document prepared by the sect prohibiting blood transfusions to her. At the same time, doctors according to the law could not do anything without the patient’s consent.

Beverly Matthews, 33, died of the same cause last November. She was married, but her husband did not share her religious views. Now he will be raising their young son alone.

In April of this year on the 1st clinical hospital A 21-year-old “witness”, Georgian citizen Liya Dzhankanidze, died in Tbilisi. Due to severe thrombophlebitis, Leah developed gangrene of her left leg. For several days, doctors and members of the public tried to persuade the patient and her mother to agree to a transfusion, but in vain. Leah underwent surgery without the necessary medical procedure and her life could not be saved.

This incident caused a great resonance in the republic. Member of the Georgian Parliament Guram Sharadze said that this is not the first case when young people, drawn into the Jehovah's Witness sect, refused blood transfusions, which threatened their lives. The deputy announced his intention to raise the issue of banning the activities of this sect.

The sect's leadership has already sent letters to elders throughout the UK (there are about 130 thousand Jehovah's Witnesses in this country) explaining that they should no longer excommunicate its members who agreed to blood transfusions from the sect. Similar letters were sent to Jehovah's Witnesses elders around the world.

Former Jehovah's Witness Geoffrey Anuin responded to this by explaining: “Unfellowshipped Jehovah's Witnesses are declared apostates and antichrists. Their friends and relatives who remain in the sect are obliged to stop all communication with them and not even respond to their greetings if they accidentally meet on the street.”

Anuin predicted widespread outrage over the sect's decision and added that he knows of two former members who now intend to sue the sect. “I know people who have been disfellowshipped simply because they questioned this very ban. All their friends and acquaintances abandoned them and they had to move to another place,” he added.

Indeed, now Jehovah's Witnesses have to answer serious questions, and the first of them is: why did hundreds of people die, believing that a blood transfusion would forever close their path to salvation? Who will be responsible for their deaths? How can the leaders of the sect look into the eyes of the relatives and friends of the deceased victims? After all, just yesterday they assured them that blood transfusion is not possible under any circumstances and that the “criminal” who transfused blood is deprived of communication once and for all. And for ordinary members of the sect, the current decision provides another chance to think about how accurately the “Brooklyn elders” demonstrate the will of God on earth. Will they use it?

If we consider this issue from biblical point of view , then Jehovah's Witnesses have the most serious reasons adhere to this position. The Bible repeatedly and quite clearly speaks about the servants of God “abstaining from blood” (Acts 15:20,29; Gen. 9:4; Lev. 7:26; 17:10; Deut. 12:16,23; 2 Sam. 23:17).

Biblical scholar Adam Clarke, in view of this, wrote: “The eating of blood was prohibited by the Law, because it indicated the blood that would be shed for the sins of the world; the Gospel also prohibited its use, because it should always be considered as a reminder of the blood that was shed for the remission of sins.”

Joseph Benson also emphasizes: “It is worth noting that the prohibition against eating blood, given to Noah and all his descendants, and most seriously repeated to the Israelites in the Law of Moses, was never repealed; on the contrary, it was confirmed in the New Testament, in the 15th chapter of Acts, and thereby became valid for all times" (The Holy Bible with Critical, Explanatory and Practical Notes).

The scholar Joseph Priestley draws the same conclusion: “The prohibition given to Noah against the consumption of blood seems to have been binding on all his posterity... If we explain the prohibition of the apostles by the custom of the early Christians, of whom it can hardly be supposed that they misunderstood its essence and limits, then one cannot help but conclude that it was absolute and indefinite, since for many centuries not a single Christian ate blood.”


Historical data confirm this statement regarding the position of the early Christians on the issue of blood. So, for example, Tertullian wrote: “Where are those who, wanting to get rid of epilepsy, greedily drink the fresh blood of criminals slaughtered in the arena during gladiatorial games?” Unlike the pagans, who ate blood, Christians, according to Tertullian, “do not eat the blood of even animals, ... abstain from all strangled and carrion for fear of being defiled by the blood hiding inside. Finally, among the tortures of Christians you use, there are botulus [sausages] filled with blood. You know very well that Christians are not allowed to do that through which you want to turn them away from Christianity” (Tertullian “Apology”).

Minucius Felix wrote about the people of his time, living in Rome in the 2nd century, that they “learned to heal epilepsy with human blood,” and he called this action “a great evil.” He also adds: “No less guilty are those who eat animals that were sprinkled with human blood in the arena or were fed human meat. As for us, we are not allowed to see or even hear about murder; and we are so afraid of shedding human blood that we even abstain from the blood of animals that we eat. (Minutius Felix “Octavius”).

It follows that the early Christians did not consider it acceptable to consume blood even out of a desire to be cured serious illness! At the same time, the disciples of Christ did not eat blood and before fear starvation! Rather, they were ready to sacrifice their lives rather than consume the blood of others.

Clement of Alexandria strongly condemned those pagans who considered it acceptable to use the blood of camels for food in the absence of food. He wrote about such people: “and if there is not enough food, then they do not spare their blood, just as rabid wolves do. But these animals, more meek than the barbarians, do not remember the injustice done to them, bravely pass through the deserts, carrying their masters and feeding them. May they perish, these brutal camel drivers, for whom the blood of these animals serves as food!” (Clement of Alexandria “Teacher”, book three).

In this regard, another historical message is indicative, when Emperor Julian the Apostate ordered that all food sold in the markets of Constantinople, without exception, be sprinkled with blood sacrificed to idols. This meant that the Christians, fiercely hated by Julian the Apostate, had to simply die of hunger, since, as the emperor understood, Christians would not eat food sprinkled with the blood sacrificed to the pagan gods under any circumstances. Even in the face of starvation! However, the command of the wicked emperor could not extend to the household supplies of Christians and to the supplies of wheat and honey, which were very common food at that time and therefore were kept in sufficient quantities in houses. According to church history, Christians mixed boiled wheat with honey and consumed it as food, which allowed them not to die of hunger and at the same time not to betray the Christian faith by drinking blood.

In the end, Jehovah's Witnesses, while refusing to directly receive blood transfusions into their bodies, nevertheless do not refuse other treatment methods . And in this they are not at all an exception. In a similar way, meanwhile, today an increasing number of people are acting responsibly about their treatment and future health. For example, in the United States, of all patients using bloodless methods of treatment, only less than a third are Jehovah's Witnesses.

The most common mistake that occurs today in the relationship of doctors with Jehovah's Witnesses is that their right to refuse blood transfusions is not only not taken into account, but as a repressive measure they are discharged from the hospital without using any alternative methods of treatment. Sometimes the reason lies in the lack of qualifications of doctors, and sometimes in the fact that they are offended by their best feelings, because some medically illiterate patient allows himself to dictate terms. This is a misconception about the essence of the problem, because every citizen, regardless of literacy, has equal rights" (A.P. Zilber. Symposium "Bloodless surgeons on the threshold of the 21st century - modern views on blood transfusion therapy", 04/19/1999) .

What does it mean to “abstain from blood”? (Acts 15:20,29)

For more information about problems associated with blood transfusion, see the website "No blood!" jw-noblood.ucoz.ru