The Watchtower Society redefines the guidelines for use of blood products

by Osamu Muramoto, M.D.

In the June 15th 2004 issue of the Watchtower, the Watchtower Bible and Tract Society featured two articles on the use of blood products by Jehovah's Witnesses. The first article is titled "Rightly value your gift of life" and reiterated the long-held tradition of the scriptural interpretation to support the religious doctrine to prohibit medical use of blood products. The second article is titled "Be guided by the living God", which details the rules regarding which blood products are "unacceptable" and which are a matter of personal decision. This issue of the magazine also included the reprint of the previous landmark article published on June 15th 2000 titled "Questions from readers: Do Jehovah's Witnesses accept any minor fractions of blood?", confirming the then new policy permitting any fraction of a "primary component" of the blood. The circumstances under which this new policy was promulgated in 2000 clearly showed that it was the preparation for allowing Jehovah's Witnesses to receive full benefit from the newly developed hemoglobin-based blood substitutes.

While the two articles of June 2004 showed no substantial changes in the policy promulgated in June 2000, there are several interesting points which are worth discussing. First, the second article now depicts a new chart showing a clear horizontal line dividing the "unacceptable" and the "Christian to decide".

The latter category include fractions from red cells, from white cells, from platelets, and from plasma. While there is nothing new in this chart compared to the "Questions from readers" article of June 2000, this chart now explicitly indicates the "fractions of red cells" as an acceptable fraction. This is an important emphasis, because until recently there have been no "fractions of red cells" which can be used medically. With the emerging technology of hemoglobin-based blood substitute in late 1990's, the Watchtower Society quickly paved the wide road for Jehovah's Witnesses to receive this "minor" fraction of the red cells, which in reality comprise 97% of the red blood cells.

The other interesting point is the explanation for the refusal of the "primary component". After the lengthy biblical discussion and meticulous justification for refusing to "take in" blood for medical reasons, the article quickly concludes this:

The 2001 textbook Emergency Care under "Composition of the Blood," stated: "The blood is made up of several components: plasma, red and white blood cells, and platelets." Thus, in line with medical facts, Witnesses refuse transfusions of whole blood or of any of its four primary components. (page 22)
In essence, the article states that the reason for refusing "four primary components" is that it is "in line with medical facts" which is stated in "Emergency Care." While everybody agrees that there is no biblical reason to define the "four primary components" that must be refused, most readers would have expected that such a classification is based on well-established and sound "medical facts." Very interestingly, the book this article cites here is not an authoritative medical textbook. It is a textbook used by the students of the emergency medical technician courses. Why did the Watchtower Society not cite a more authoritative medical textbook or scientific source to base this critically important classification? The simple reason is that such a classification is not at all scientific, but it is simply a tradition in medicine. To use a parallel analogy, our food is traditionally classified into "major components" such as protein, carbohydrate, fat, minerals, etc. Is this classification the only classification considered as a medical fact? Of course not. This is only one of many ways to classify our food. We can also use such a classification as grains, meat, vegetable, fish, etc. This is another way to classify our food, which is equally valid. These classifications are just traditional and convenient tools to understand the various components of our food. Depending on the method of classification, what is considered a "primary component" is different. The same is true for the classification of the blood components.

In case of the classification of the blood components, there are many different ways to classify. It is true that the classification that blood banks most frequently use is the four components this Watchtower article states. However, medical textbooks use many different classifications. Often times, the blood is separated into "two major components", red blood cells (45%) and plasma (55%), because other smaller components such as platelets are usually taken as a fraction from one of those major fractions. Another classification which is frequently used in textbooks of anatomy and physiology is based on chemical composition. With this classification, the major and primary components of the blood are water (80%), hemoglobin (15%), albumin (2-3%), and globulin (1-2%).

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While the Watchtower Society adopted the classification of red cells, white cells, platelet, and plasma, as the "primary components" and specified those to be refused, what would happen if the Society adopted a different classification which is equally valid with "medical facts"? For example what would happen if the classification of hemoglobin, albumin, globulin as the primary components were adopted? This classification would have prohibited the use of hemoglobin-based blood substitutes and albumin as a plasma expander, which are now permitted to be used for Witnesses. What does this difference tell us?

It tells us that what is "unacceptable" in the Watchtower doctrine has nothing to do with the biblical doctrine cited in the article. It only depends on what classification of the blood components the Watchtower Society adopted among several different classifications available in medical literature. Under one classification of the components (red, white cells, platelets and plasma), most of the currently available blood products in medical practice are in the category of "Christian to decide", or the matter of conscientious decision. This is because the current technology no longer uses those crude fractions in pharmaceutical products. On the other hand, under the other classification based on chemical components (hemoglobin, albumin, globulin, besides water), most of the currently available products become unacceptable, because this classification is more consistent with the current biochemical technology for producing blood-based pharmaceutical products. Under this alternative classification, however, the use of platelets may be acceptable because it is not considered a primary or major component under this classification. In other words, if the Watchtower Society had adopted the chemical classification of the primary components of the blood, which is more consistent with the current biotechnology, hemoglobin, albumin, and globulin, are all prohibited, but platelets and perhaps white blood cells may have been permitted.

Which classification of the blood components the Watchtower Society adopts makes such a huge difference in terms of what is acceptable and what is unacceptable, and thus who can survive and who must die from catastrophic blood loss. This difference has nothing to do with the biblical doctrine, or not even with the current medical science. It only hinges upon the Watchtower Society's decision regarding which classification of the blood components they adopt. The cold reality of Jehovah's Witnesses is that their life-and-death decisions are after all not directly based on any of the biblical arguments these articles discuss, because such biblical doctrines have no relevance to the classification of the blood components. And it is this classification that determines all the "unacceptable" components and thus the life-and-death decisions. It is ironical that the rules promulgated in this article titled "Be guided by the living God" are simply guided by the human decisions and old tradition. Should they adopt an alternative classification, which is more in line with the current medical technology, life and death of Jehovah's Witnesses would have been totally different.

References

Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses. British Medical Journal 2001; 322: 37-39 [Full Text]

Muramoto O. Recent developments in medical care of Jehovah's Witnesses. Western Journal of Medicine 1999; 170: 297-301 [Full Text] About the author

Dr. Muramoto is a staff neurologist, lead physician, and a member of the Regional Ethics Council, Kaiser Permanente Northwest Division, Portland, Oregon. His views and opinions are his own and do not reflect those of Kaiser Permanente and Northwest Permanente P.C.