Medical Treatment

Jehovah’s Witnesses do not substitute religious faith for medical treatment.1 They accept most available medical and surgical treatments. Other than their refusal of blood transfusion, they are “totally within the mainstream of modern medicine.”2 They refuse blood transfusions for religious reasons, based on the Bible’s command to “keep abstaining from … blood.”3 They believe that the Bible prohibits the ingestion of blood, whether offered as a food or as a transfusion. Expert medical associations recognize that individual congregants “are generally well informed, both about their legal position and the options for treatment.”4

The religious position of Jehovah’s Witnesses on blood became an issue in 1945, when the practice of allogeneic (donor) blood transfusion in the military was considered for use in civilian hospitals after World War II.5 This occurred even though some of the serious hazards of transfusion were already emerging.6 To assist congregants to obtain quality medical care without blood transfusion, Jehovah’s Witnesses established a worldwide network of Hospital Liaison Committees (HLCs), located in major cities worldwide. Upon request, committee members can provide information to clinicians and patients and facilitate patient access to high-quality medical care in accordance with their wishes, values, and religious conscience. Government authorities have acknowledged the value of the HLC network,7 as have expert medical associations.8

In the late 1970’s, published medical reports began to show that complex surgery without blood transfusion was being successfully provided to Jehovah’s Witnesses without an increase in the risk of death.9 Spurred by those medical reports, along with highly publicized tainted blood scandals in Europe and North America, “[b]loodless medicine and surgery centers … emerged and evolved with the aim of raising public awareness, changing attitudes, revising practice standards, and improving outcomes for all patients. Their results have garnered recognition that transfusion avoidance or minimization makes sense for all patients.”10

By the late 1980’s, clinical strategies for avoiding blood transfusion that were initially developed to treat Jehovah’s Witnesses attracted attention from the medical profession and were eventually incorporated in a simplified form into what has become known as Patient Blood Management (PBM). PBM refers to the use of methods to conserve and manage patients’ own blood. Dr. Richard K. Spence (USA) and Professor Jochen Erhard (Germany) summarize:11

“Modern blood management began in the 1980s as a result of three separate and different phenomena: Denton Cooley’s proof that open-heart surgery could be performed successfully in Jehovah’s Witness patients without allogeneic blood transfusion, the emergence of acquired immune deficiency syndrome (AIDS) … and clinical trials with a perfluorocarbon-based oxygen carrier.

“Cooley’s success encouraged others to treat Jehovah’s Witness patients and stimulated the creation of ‘bloodless surgery’ centres around the world … The realisation that AIDS could be transmitted through blood product transfusion shook the medical world … Trials with perfluorocarbon-based oxygen carriers … offered an alternative to blood transfusion. … Although the blood ‘substitute’ was never approved for general use, the experience in treating these patients was a milestone to many in recognising that blood transfusion was not always a necessity … As the practice of ‘bloodless surgery’ gained popularity, it gained a national voice through governmental agencies and new societies.”

By 2010, the World Health Assembly, which is the main decision-making body of the World Health Organization (WHO), published a resolution encouraging all countries worldwide to promote the availability of transfusion alternatives and PBM programs, which were “found to be associated with improved clinical outcome and reduced costs.”12

In 2021, the WHO issued the policy brief “The Urgent Need to Implement Patient Blood Management,” which encourages wider use of medical and surgical strategies that make optimal use of patients’ own blood to preempt allogeneic blood transfusion. The document emphasizes that the systematic use of such strategies is associated with excellent clinical outcomes (lower mortality, shorter hospital stays), improved quality of health care (anemia management, reduced surgical blood loss, and reduced iatrogenic blood loss), better patient safety (decreased postoperative infection rates, avoidance of transfusion-transmitted disease, avoidance of transfusion complications), equivalent or lower costs, and respect for patient rights.13

Leading doctors and medical institutions worldwide confirm the benefits of treating patients (adults and children) without blood transfusion. A sampling of 45 expert medical opinions, by key opinion leaders worldwide, is posted on this website (Expert Opinions > Expert Medical Opinions). The following are extracts of just a few of those expert opinions:

“Peer-reviewed medical studies show that after patients received blood transfusions, their immune systems are significantly weakened, and cancer recurrence risk can be higher. On the other hand, the results of patients who did not receive blood transfusions fare obviously better than those of patients treated with blood transfusions … Our experience with bloodless operations, together with scientific studies showing the risks of blood transfusions, has in turn helped us to provide better medical care to all of our patients.”—Professor Yuichiro Doki, Osaka University Hospital, Osaka, Japan

“… I have had the privilege of caring for hundreds of patients who decline blood transfusion for personal or religious reasons … Our patient population has ranged from pediatric patients to those of very advanced age. … The clinical outcomes in the population of patients who declined allogeneic blood transfusion were so positive that we adopted these clinical pathways for all patients. … A large number of medical studies confirm that patients treated using BMS [bloodless medicine and surgery] strategies, both adults and children, often do as well as, if not better than, patients treated with reliance of allogeneic blood transfusion therapy. Use of such strategies is also associated with significant cost savings to the health care system.”—Professor Aryeh Shander, Englewood Health, Englewood, New Jersey, USA

“Over the past two decades, we have learned much about effective methods of treatment that result in excellent clinical outcomes, while avoiding transfusions. In fact, these methods of blood conservation are so beneficial they are being used even for patients who accept blood, to reduce avoidable transfusions, thus saving blood and money. … In summary, we recognize through experience and from published findings, that patients can be successfully managed without transfusions when they decline them, and that both adult and pediatric patients have excellent outcomes when cared for properly. This field is no longer new, and the methods of blood conservation are being used and perfected across the world.”—Professor Steven M. Frank, Professor Linda M.S. Resar, Professor Emeritus Paul M. Ness, and Professor John A. Ulatowski, Johns Hopkins Medicine, Baltimore, Maryland, USA

“To date, our transfusion-free JW program has over 2500 complex cases performed in JW without major blood products. These include adult and pediatric heart, liver, kidney transplantations and complex tertiary surgeries … Results have been equal or superior to those outcomes in non-JW patients for comparable patient types. … The only barrier that remains to broad adoption of a transfusion-avoidance practice is the closed-mindedness of medical practitioners who seem incapable of learning and adopting transfusion avoidance strategies.”—Professor R. Rick Selby and Randy Henderson, Keck Medical Center, University of Southern California, Los Angeles, California, USA

“… millions of patients worldwide have benefited from the contribution that Witness patients have made to medical knowledge, which has led to a dramatic drop in the average blood usage in patients undergoing cardiac surgery … our health care system has been improved significantly by embracing the treatment of the patients of Jehovah’s Witness faith. Our trainees have benefited, and they are better surgeons as a result of this experience. …”—Professor Fraser D. Rubens, University of Ottawa Heart Institute, Ontario, Canada

“… my clinical and research experience has taught me that blood transfusion is rarely needed even during major surgery and that many alternatives are available, and that patients often have better outcomes if blood transfusion is avoided. In fact, our Jehovah’s Witnesses patients have had the best outcomes of any patient group and I am always happy to consult with and look after them and their children if they need surgery.”—Professor Andrew A. Klein, Royal Papworth Hospital NHS Foundation Trust, Cambridge, England

“Having worked with [Jehovah’s Witness patients] on a regular basis for the past 15 years, these patients are compliant and accept all our therapeutic approaches, as long as we do not involve blood transfusion as part of the therapeutic protocol … treating Jehovah’s Witnesses does not represent an additional risk compared with the general population …”—Professor Alain Pigné, Hôpital Privé Geoffroy Saint Hilaire, Paris, France

“There is a compelling need to implement PBM [Patient Blood Management]. Any review of the literature on allogeneic (donor) blood transfusion and patient outcomes is sobering. In non-bleeding patients, evidence for the benefit from blood transfusion is scant – even in critically ill patients. … It is needless to say that we recommend that physicians accept this group of patients and their beliefs. Especially in view of the recent advancements in medicine, we cannot accept that physicians refuse to provide treatment to Witness patients because of a lack of skill or perhaps a mindset of not wanting to implement PBM. Using all options in PBM, patient safety and outcome is better. Therefore, we use the PBM strategy for all our patients.”—Professor Kai Zacharowski, University Hospital, Frankfurt, Germany

“I have 30 years of experience in alternative medical strategies to blood transfusions… I definitely have found a faster recovery, less pulmonary involvement and also a statistically proven reduction in infections by avoiding transfusions … Jehovah’s Witnesses parents are always well informed about the possibilities of avoiding blood and blood products, and they also know what are the most advanced techniques to be able to ensure a success of intervention on their children, while not using blood transfusions.”—Professor Paolo Cimato, Villa Torri Hospital, Bologna, Italy

“The implementation of PBM in clinical routine translates into a significant decrease in transfusion rates, a better postoperative outcome, and a shorter length of stay … No child has suffered any harm as a result of their parents’ refusal to receive a transfusion and it has never been necessary to take the matter to court. … Today, Jehovah’s Witnesses’ desire to receive “transfusion-free” care is no longer an eccentricity but a desirable model of care for the entire population.”
—Professor Antonio Pérez Ferrer, Hospital Universitario Infanta Sofía, Madrid, Spain

“All these years I had the opportunity to cooperate with many Jehovah’s Witnesses while practicing surgeon oncology. My impressions are, all in all, excellent. … implementation of [PBM], as proved by numerous scientific studies, has contributed significantly to a shorter hospitalization period, reducing post-operative complications and generally improving all the parameters connected with the patient.”—Professor Ioannis G. Kaklamanos, General Oncological Hospital of Kifissia “Oi Agioi Anargyroi,” Athens, Greece

“For 30 years I have been successfully performing operations on congenital heart defects without blood transfusions in children of Jehovah’s Witnesses and others. … The results … clearly show that children who were not given blood recover faster, stay shorter in the intensive care unit and have fewer postoperative complications. … From my many years of contact with Jehovah’s Witness parents, I can say that they are wise and caring parents who raise their children well.”
—Dr. Marek M. Wites, Upper Silesian Children’s Health Center, Katowice, Poland

As the above expert opinions confirm, the choice of Witness parents to seek quality medical care without blood transfusion for their children is not parental “neglect.” Rather, it is a sincere choice based on religious conscience that, in addition, has a sound medical basis. Professor Emeritus Shibutani explains: (Expert Opinion by Hideki Shibutani)

“… the World Health Organization (WHO) explicitly states that “evidence from all regions of the world shows considerable variation in the use of clinical blood between different hospitals, between different clinical specialties, and even between clinicians on the same team. This suggests that blood and blood products are often used inappropriately. [Reference omitted.14] Clearly, just because a physician considers blood transfusion “necessary” does not mean that blood transfusion is actually necessary, as the World Health Organization (WHO) clearly states.

In addition, the World Health Organization (WHO) recommends that all countries (and by extension all physicians and hospitals) use a method called Patient Blood Management to avoid or minimize blood transfusions. The World Health Organization (WHO) explains that this is due to medically serious “transfusion risks”. [Reference omitted.15] Thus, it is clearly not “child abuse” for a parent to ask a physician to use alternatives to blood transfusion.

… it is widely known that when their own children become ill or sick, parents of Jehovah’s Witnesses take their children to doctors and hospitals for treatment. On the rare occasion that the doctor believes that a blood transfusion may be necessary, the parent asks his or her doctor to consult with an experienced physician who is familiar with bloodless treatment. This is not neglect of the child; rather, it is an exercise of the parents’ sincere religious beliefs, protected by Article 20 of the Constitution.

If a physician determines that a blood transfusion is urgently needed, the physician may, by law, notify the Child Guidance Center and request its intervention. If, after hearing the parents’ opinion, the Child Guidance Center determines that the transfusion is necessary and that no alternative medical treatment is available, the Child Guidance Center would be able to intervene on their behalf. Again, this is not a neglect situation. In such a case, the child would remain in the hospital and receive whatever treatment is objectively deemed necessary.”

“… the various reasons listed by the [father] [about the beliefs and practices of Jehovah’s Witnesses] cannot be accepted, and the issue of blood transfusion is a decision to be made by the doctor, so it cannot be said that the belief of the [mother] about refusing blood transfusions endangers the life of the [child].”—Tokyo High Court, October 19, 1975, case number 1979 51 (La) No. 26

“Regarding the problem of blood transfusions, it would appear that there are currently non-blood products available to circumvent this difficulty, and that in any case, in the event of an emergency, this can be overridden by a court decision. In any case, this consideration alone cannot lead to any suspicion that [the mother] is not interested in her daughters’ health.”—Court of Appeal of Douai, France (1999)

“The mother’s firm opposition to blood transfusions and favoring of alternative treatment methods in the decision-making process is not opposed to the child’s welfare.”—Berlin Court of Appeal, Germany (2022)

“… the parents’ mere refusal of blood transfusions in accordance with religious beliefs cannot be considered as a basis for an assessment of inadequacy to exercise parental responsibility.”—Court of Appeal of Milan, Italy (2020)

All of the above confirms that Jehovah’s Witnesses endeavor to seek the best medical treatment available, both for themselves and for their children. They are caring and loving parents.