Listening to Leviticus: Transfusions for a Jehovah's Witness

Dr Bruce Campbell's story:
I had met the man lying on the operating table before me two weeks ago. Physically, he was substantial and rough-hewn with clear, intelligent eyes and an engaging, peaceful demeanor. A series of studies revealed a large mass of a goiter into his upper chest, though there were no signs of cancer.

During the initial office visit, we covered the standard discussion of surgical risks. I presented each and discussed prevention and management.

"Doctor," he told me, you have to know I am a Jehovah's Witness." He smiled and matter-of-factly outlined his convictions without any hint of embarrassment or sign that he was primed for an argument; he readily acknowledged that there might be real and serious consequences if he started bleeding during the operation. I was only too aware that the tenets of his faith prohibit the use of any blood transfusions. Despite the risks, he remained completely serene. My anxiety, on the other hand, started at that moment to take shape.

Would he refuse all types of transfusions? Yes. Would he agree to donate blood ahead of time in case we needed to transfuse it back to him? No. Could we salvage his own blood, process it, and return it to him during the operation? No. Did he realize that his blood cell count might possibly get so low that it could be very dangerous? "Doctor, I understand completely that by refusing blood transfusions, I might die. That is the choice I have made, and I am very comfortable with that choice. I have faith that things will go just as they are meant to go."

Now, on the operating table two weeks later, things were not going as well as I had hoped. The muscles had been difficult to separate cleanly from the superficial surface of the thyroid gland. The limited space between the bone of the spine and the bone of the sternum was completely filled by the mass.

As I repeatedly advanced my finger into the unyielding space, I was aware of the firm pressure pushing back at me. I continued to second-guess myself: What had I so quickly agreed to operate on him?

Again I pushed. Then again. Suddenly, something deep and unseen gave way and the goiter noticeably moved upward into the palm of my right hand. I filled the space behind it with surgical sponges.

Then I carefully removed the sponges one by one. A pool of blood appeared in the cavity. I held my breath and stared for several seconds, finally convincing myself that nothing was welling up from below. I began to breathe again.

What emergency course of action might I have recommended if he had experienced a massive hemorrhage during the operation? Would I have tried to force his family to consider a lifesaving transfusion? I was still not certain.

Advice: Express your moral and religious values clearly to your doctors.

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Thanks to Dr. Bruce Campbell for the source article in the Feb. 27 issue of the Journal of the American Medical Association.