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Jehovah's Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of All Pregnant Women

Published online by Cambridge University Press:  01 January 2021

Extract

The liberty of the woman is at stake in a sense unique to the human condition and so unique to the law. The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. That these sacrifices have from the beginning of the human race been endured by woman with a pride that ennobles her in the eyes of others and gives to the infant a bond of love cannot alone be grounds for the State to insist that she make the sacrifice. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman's role ….

For years, Jehovah's Witnesses have posed a challenge to the medical profession. Bound by religious belief to refuse blood and blood products, they can frustrate physicians who, since World War II, have utilized transfusions when indicated in the course of treatment.

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Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1999

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References

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The author is not aware of such a designation in the literature. However, the development of a doctrine of “fetal rights,” which relies largely on Roe v. Wade, is discussed in Gallagher, J., “Prenatal Invasions and Interventions: What's Wrong with Fetal Rights,” Harvard Women's Law Journal, 10 (1987): 9–58; and Arch, R., “The Maternal-Fetal Dilemma: Honoring a Woman's Choice of Medical Care During Pregnancy,” Journal of Contemporary Health Law & Policy, 12 (1996): 637–73.Google Scholar
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In 1965, the Illinois Supreme Court had determined in In re Estate of Brooks, 205 N.E.2d 435 (Ill. 1965), that an adult Jehovah's Witness had the right to refuse a life-saving blood transfusion. In that case, a married adult woman with no minor children had refused life-saving blood transfusions necessitated by a peptic ulcer. The trial court ordered the transfusions, but the Illinois Supreme Court reversed, holding that an individual's free exercise of religion may be limited “only where such exercise endangers, clearly and presently, the public health, welfare or morals.” Id. at 441. The court further found:Google Scholar
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See id. Despite this fairly strong pattern of paternalism on the part of the responding physicians, none of the respondents was aware of a case in which a doctor had been sued for failure to seek a court order. Id. It is clear, then, that physicians who support coerced treatment do so not for fear of legal liability if they fail to act, but because they believe that their patients should always comply with a physician's prescribed course of treatment. Perhaps, too, well-intentioned obstetricians in particular are prone to this sort of paternalism out of concern for their second patient, the fetus, who is unable to voice an opinion regarding treatment.Google Scholar
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The patient requested a rehearing, but the full panel refused, with five of the nine judges expressing opinions that the matter was moot or that the procedural posture was so inherently flawed as to be incapable of further review. See Georgetown, 331 F.2d at 1016.Google Scholar
See Brief of Amicus Curiae Watchtower Bible and Tract Society at 2–3, In re Fetus Brown, 689 N.E.2d 397 (Ill. App. Ct. 1997) (No. 96–2316). For an excellent discussion of the analysis offered by Judge Skelly Wright, see Davis, D., “Does ‘No’ Mean ‘Yes’? The Continuing Problem of Jehovah's Witnesses and Refusal of Blood Products,” Second Opinion, 19, no. 3 (1994): 3543. Deena Davis points out that there is no official position of the Jehovah's Witnesses that distinguishes the consequences of transfusions that are willingly accepted from transfusions that are forced; both are considered forbidden. She determines that there may be a number of Jehovah's Witnesses who refuse blood but hope to be forced to accept it. They fear that they will die without a transfusion, but worry about the consequences in the afterlife as well as the stigma during this life if they agree to be transfused. Davis concludes that it is dangerous as a policy matter for physicians and hospitals to assume that every Jehovah's Witness who refuses blood is not sincere, even though this approach will save some lives. She warns that encouraging such assumptions will lead to the belief that physicians can ignore the express wishes of other patients. Therefore, Davis argues, to accord individual autonomy the respect it deserves, physicians must place on the individual patient the responsibility to say what she means, for “only she can weigh her religious convictions against the possibility of death.” Id. at 42.Google Scholar
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Id. at 458. The court's order was not enforced, and Ms. Jefferson vaginally delivered a healthy baby without complications. See supra note 7.Google Scholar
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The Illinois Court of Appeals is not alone in upholding a pregnant woman's right to refuse invasive treatment. In 1990, the District of Columbia Court of Appeals decided the much discussed case of In re A.C., 573 A.2d 1235 (D.C. 1990). In that case, a twenty-seven-year-old cancer victim was forced to undergo a cesarean section at twenty-five weeks' gestation in an attempt to save the fetus before A.C.'s death. After the death of both mother and child, the appellate court found that the trial court had erred in balancing A.C.'s rights against those of the fetus. The appellate court ruled that A.C.'s wishes should have been ascertained and that, absent “a situation extraordinary or compelling enough to justify a massive intrusion into a person's body,” the mother's wishes should prevail. Id. at 1252. Also underpinning the court's holding was its observation thatGoogle Scholar
Crouse-Irving Memorial Hospital, Inc. v. Paddock, 485 N.Y.S.2d. 443 (N.Y. Sup. Ct. 1985). The brief opinion does not mention whether the defendant was a Jehovah's Witness; it merely refers to her religious beliefs.Google Scholar
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In fact, the recent opinion of Stamford Hospital v. Vega, 674 A.2d 821 (Conn. 1996), made precisely the opposite finding in hearing the case of a hospital that had petitioned the court for the forcible transfusion of a young mother. It noted: “The hospital's interests were sufficiently protected by Vega's informed choice, and neither it nor the trial court was entitled to override that choice.” Id. at 832. Similarly, the court in In re Dubreuil, 629 So. 2d 819 (Fla. 1993), held:Google Scholar
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Although some patients will accede to treatment once a court issues an order, many will not. See, for example, In re Fetus Brown, 689 N.E.2d 397 (Ill. App. Ct. 1997). Citing In re A.C., 573 A.2d 1235, 1244 (D.C. 1990), the Doe court noted: “We simply cannot envision issuing an order that, if enforced at all, could be enforced only in this fashion.” Doe, 632 N.E.2d at 335.Google Scholar
In at least one case, the pregnant woman left the hospital before her court-ordered transfusion could be accomplished. See Nelson, Buggy, Weil, supra note 7, at 763 n.229, describing Raleigh Fitkin-Paul Morgan Memorial Hospital v. Anderson, 201 A.2d 537 (N.J. 1964). In addition to the ethics of court-ordered treatments, there is the question of their effectiveness. As the Brown court observed: “We question the efficacy of a court order requiring a blood transfusion for someone who is facing death.” Brown, 689 N.E.2d at 406. Presumably, the court was referring to efficacy of the court order in convincing the patient to accede to the transfusion: The patient's fear of God's retribution for accepting the transfusion would outweigh her fear of being held in contempt of court for refusing.Google Scholar
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It seems that a majority of even the nonpregnancy refusal of transfusion cases concern women rather than men. It is possible that women tend to refuse blood more often than men. Alternatively, men may refuse blood as often as women, but are less likely to be challenged by physicians regarding their decisions. For an exception, see In re Osborne, 294 A.2d 372 (D.C. 1972). An examination for, and substantiation of, the reasons for this tendency is beyond my scope here, but it should be noted that Osborne arose in 1972, before Cruzan and before the case law in most states had established the right of a competent adult to refuse treatment.Google Scholar
Even though it is the patient's duty to inform the physician of any religious beliefs that may bear on treatment modalities, the careful physician will ask patients in order to avoid the situation that occurred in Brown, where the physician was unaware that his patient was a Jehovah's Witness until a blood transfusion became necessary.Google Scholar
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See, for example, Doe, 632 N.E.2d. 326. When the patient was examined at thirty-five weeks, her obstetrician/gynecologist recommended either immediate induction of labor or a cesarean section. Two weeks later, he advised that a cesarean section was the only option for a safe delivery. By the time he appeared in court, Dr. Meserow testified that the fetus's chances of surviving a natural labor were almost zero percent. Id. at 327–28.Google Scholar
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