On Wednesday, November 4, 1998, on the well-known medical drama Chicago Hope, CBS presented an episode about a fictitious character, an 18 year-old member of Jehovah's Witnesses desperately needs surgery to save his cancerous leg. The young man, "Kevin," agrees to the surgery only after being assured that no blood will be used. However, in a well-meaning attempt to save Kevinís cancerous leg, the surgeon, "Dr. McNeil," violates his patientís right to self-determination and gives him a transfusion of packed red blood cells.
This program is a work of fiction. But television dramas like this one have a great impact on forming an opinion in the minds of the viewing public. As the Bloodless Medicine and Surgery Network, the NoBlood! web siteís primary mission is to promote public awareness of the new standard of excellence in health careónonblood medical management. Education is the key to advancing medical treatment that respects the patientís right to quality care and treatment without blood or blood-based products. NoBlood! Editors are concerned that Chicago Hopeís fictitious dramatization misleads health-care providers and the general public regarding a patientís decision to refuse a blood transfusion. We consulted with numerous representatives of the bloodless community, including physicians, nurses, bloodless-program coordinators, and attorneys. These experts contributed a wealth of information from statements to case studies. The following information clarifies patientsí rights and alternatives to blood transfusions.
Physicians and Nonblood Medical Management
Although the drama portrayed a non-elective circumstance, it should be noted that numerous clinicians have treated osteosarcoma (cancer of the bone) without resorting to blood transfusions. They do this by employing surgical techniques, utilizing high-tech surgical instruments, and using the most modern biotechnological medications. Doctors who keep up-to-date with blood conservation techniques find that they do not need to administer blood for a procedure that their colleagues insist requires blood. Such progressive surgeons do not expose their patients to the dangers of blood transfusions. In his 1995 article "Anesthetic Management of the Patient Who Refuses Blood Transfusions" from The Cancer Bulletin, Doctor J Dupuis1 reports a case of a successful hemipelvectomy surgery for osteosarcoma of the femur, performed without blood on one of Jehovah's Witnesses. This procedure, done at one of the finest cancer hospitals in the United States, MD Anderson, is many times more difficult than the one done at the fictional Chicago Hope.
We contacted Dr. Dupuis regarding the condition of osteosarcoma. He indicated that further information will be published in the near future regarding the successful treatment of more extreme cases that were operated on without administering blood transfusions. It should also be noted that according to the May 1985 issue of the Journal of Clinical Oncology, "A significant increase in the incidence of tumor recurrence and decrease in survival were associated with the receipt of blood transfusions at the time of definitive surgical therapy of the sarcoma." Subsequent medical articles have demonstrated the immune suppression effect of blood transfusions. For instance, Professor Neil Blumberg stated in the September 1996 issue of The American Journal of Medicine, "If as little as 10% of the association between allogeneic transfusion and increased postoperative infection and cancer recurrence is causal, the number of deaths annually due to these causes would be 2,150."
Dr. Aryeh Shander, Chief Anesthesiologist and Medical Director of The New Jersey Institute for the Advancement of Bloodless Medicine and Surgery in Englewood, New Jersey, shared the following observations:
This past year we performed the identical surgery on a 15 year old Jehovah's Witness girl without requiring any blood. Although the anticipated blood loss was large, blood harvesting in the operating room as well as preparation of the patient preoperatively would obviate the necessity for transfusion in any established Bloodless Surgery and Medicine Program. There are many modalities that are currently available as alternatives for transfusion and those should have been offered to "Kevin." We at Englewood Hospital Medical Center have performed much more complex surgery in the past four years with anticipated larger blood loss on both Jehovah's Witnesses as well as non-Witness patients without the use of banked blood products.
The concern for transfusion goes beyond the religious concerns that were addressed in the show. The multiple risks associated with transfusions are a deterrent for the Witness as well as the non-Witness patient.
As the complexity of the surgery increases, experienced "bloodless" centers should always be considered for patients who cannot receive allogeneic blood for religious and medical reasons. The operating room scenes in Chicago Hope raise multiple questions in addition to the transfusion issue. As an example, it appeared that the surgeon had complete disregard for the licensed professionals in the operating room. Contract with the patient extends to all the professionals caring for the patient in the operating room, including the other surgeon, the anesthesiologist and the blatantly absent nursing staff. Lastly, when patients are assaulted, one of the responsibilities of the institution is to provide psychological and emotional support to the patient while other appropriate steps to educate the medical staff are taken.
Patients who seek quality medical care without the use of blood or blood products can now access treatment by physicians who specialize in nonblood medical management, sometimes termed "Bloodless" or "Transusion Free" Medicine and Surgery. This field of medicine is expanding and is being well received by growing numbers of health-care professionals. Over 78 Bloodless Centers exist throughout the United States and 195 across the globe. Some 90,000 health-care professionals demonstrate a willingness to treat patients without administering blood transfusions.
Jan Castro Graziani, manager of one of the bloodless centers in the Chicago area, commented:
Right here in the Chicago area, we have the expertise to take care of these patients. We have had a Center for Bloodless Medicine and Surgery program at Our Lady of the Resurrection Medical Center since 1987. We are equipped to handle almost all the medical needs of the Jehovah's Witness community. There is no reason today for a patient to experience the spiritual and physical abuse that this patient was subjected to.
Sharon Vernon from the National Association for Bloodless Medicine and Surgery2 (NABMS) shared this observation:
The episode depicted on Chicago Hope highlights the educational gap that continues to exist within both the medical community and society at large. NABMS has addressed this issue through national medical conferences focusing on the alternatives to blood and blood products. This is not just a religious issue. The health and welfare of all patients are involved. The hidden cost of treating individuals who have contracted blood-borne disease, or who have developed immunological complications as a result of
unnecessary homologous transfusions, is affecting all areas of health care today. The National Association would like to encourage physicians, to avail themselves of the new technologies and alternatives available,
and we would like to encourage all patients to seek, for their health care needs, hospitals that have developed bloodless medicine and surgery programs. For the Jehovah's Witness Patient
We contacted the headquarters of the Jehovahís Witnesses. We were told that for patients such as Kevin, as well as for his parents, the Watchtower Society established a department in 1988 known as Hospital Information Services3 (HIS). They in turn established Hospital Liaison Committees in 120 major cities throughout the United States. These committees are available 24 hours a day, seven days a week. They serve as intermediaries between Witness patients and health-care communities, helping Witness families to locate cooperative doctors and helping interested doctors to keep up-to-date with the latest developments in bloodless medicine and surgery. The liaison committees also help arrange consultations between physicians at one medical center and those at other medical centers who may have more experience in treating the problems in question without blood.
According to Chicago Hope, Kevinís parents were as responsible as Kevin for the decision not to accept a blood transfusion. In real life, Kevinís decision would suffice for the hospital and surgeon to respect his choice of treatment, as he is a competent adult who is about to enter college. Chicago Hope further dramatizes his medical condition by making the patient one of Jehovah's Witnesses who will not accept blood transfusions. Chicago Hope portrays the Witnesses as having no knowledge of medical alternatives to blood. To the contrary, Jehovahís Witnesses are generally aware of the alternatives to blood transfusion. In real life, Jehovah's Witnesses are encouraged to carry an Advance Medical Directive/Release and an executed Durable Power of Attorney (DPA). These legal documents outline acceptable nonblood methods of treatment in case of an emergency. For example, a DPA could list the following alternatives or additional methods of treatment: Cell Saver--a device used during surgery that circulates the blood outside the body, washes it and returns it in a continuous circuit Hemodilution--a process whereby the blood is diluted Erythropoietin--a synthetic hormone that stimulates the body to create more red blood cells to increase the blood oxygen-carrying capacity In the event that the use of blood becomes an issue, Jehovah's Witness patients like Kevin would contact an HLC through their local congregation. HLC representatives would be available to assist Kevin and his family and provide information to the medical staff, whether at a bloodless center or not.
Administering unwanted medical treatment is illegal, which was certainly noted in this story line, and should be noted by those physicians and surgeons who feel it necessary to take it upon themselves to administer blood despite the patient's firm conviction to "abstain from blood," for whatever reason that may be, religious or otherwise. A Message to Chicago Hope Producers There are over 70 hospitals in the United States that use proven nonblood alternatives to treat patients. These hospitals perform every type of medical procedure from open-heart surgery and heart transplants to liver transplants and very complicated cancer surgeries all without blood. Quite often patients are transferred to these facilities by surgeons who in all modesty feel unprepared to treat them without having blood as a safety net. Patients seeking treatment without the use of blood appreciate a medical center that is committed to caring for the whole patient physically, mentally, and spiritually. The Chicago Hope episode in question focused mainly on a legal and ethical mistake made by the surgeon. We are convinced that had the writers taken the time to portray the situation in a more honest and realistic light, it would have been just as dramatic or even more so, and the general public would have gained a deeper, more insightful understanding of patientsí rights, alternatives to blood transfusions, and the beliefs of Jehovahís Witnesses. All information is from: http://www.noblood.com/