My name is Meg and I am currently a third year medical student. During my surgery rotation in my third year of medical school, one of the patients on our service was a Jehovah’s Witness who became anemic. In my institution’s “Physician, Patient, and Society” course, it was repeatedly emphasized to us that healthcare providers should not force competent patients to accept treatments that they do not want. Respecting patient autonomy is one of the cardinal rules of medicine that should never be violated, even if that means that the patient will not survive. Since the topic of Jehovah’s Witnesses and blood transfusions was covered extensively in this course, I did not expect that this patient would be willing to receive blood products to treat their anemia. So, imagine my surprise when this patient specifically called me to their room to request a red blood cell (RBC) transfusion!
My initial shock was quickly replaced by concerns and questions. Doesn’t this request conflict with the values and beliefs of Jehovah’s Witnesses? Does the patient really understand what a RBC transfusion is, and how receiving one may lead to expulsion and ostracization from their religious community? If the patient did not understand what a RBC transfusion was, should I take the time to fully educate them even though it may cause them to change their mind and refuse this potentially lifesaving treatment?
After extensively debating about ethics and patient autonomy, my team and I decided that telling the patient about the details of a RBC transfusion was the right thing to do to help them make an informed decision. To our surprise, the patient was very knowledgeable about blood transfusions and explained to us that there are many different interpretations and beliefs within the Jehovah’s Witness community. They explained that although many Jehovah’s Witnesses will decline blood transfusions, some will accept individual components of blood like RBCs, clotting factors, and plasma.
This patient encounter really stood out to me because it shattered my preconceived notions of Jehovah’s Witnesses and treatments that we think are incompatible with their values. This episode really emphasized the importance of understanding each individual patient’s beliefs and using them to facilitate shared decision-making. The first step to truly understanding the beliefs of our patients and working with them to develop effective treatment plans is to talk to them. If I find myself in a similar situation in the future, I plan to learn from my patients before I let assumptions determine which treatments are feasible, and I will encourage my peers to do the same. After all, patients know themselves and their beliefs best!
If you want to see more of my narrative comics and funny anecdotes about being in medicine, please check them out on my Instagram: @musings_with_meg.