Email Rolf J. Furuli:
As a member of the hospital liaison committee in Oslo, Norway for the last ten years the question
about medical ethics and the use of blood is very important for me. When I stand at the bed of a
critically ill person who has called for my assistance, I feel strongly the responsibility for building on a
firm Biblical foundation - life is not something with which to play. Dr. Muramoto's article presents
several facts regarding Jehovah's Witnesses, but its setting has a certain twist which may harm the
relationship between the doctor and the Witness patient. Every researcher knows the importance of
seeing the subject of research from the inside, and the fact that his informants are opposers, and
that he lacks personal experience from inside the Witness organization, can perhaps explain why the
article sends several wrong signals to doctors. There are also several misunderstandings in the
comments to Muramoto's article in BMJ, so allow me to present the ground on which I stand.
PROPHETS VERSUS TEACHERS AND PRESSURE VERSUS INFLUENCE
I and my fellow Witnesses believe that each person should decide which ethical values he or she
wants to follow without being pressed by others. However, it should be stressed that in all areas of
life, our choices are very much influenced by others; this is simply unavoidable! If we want to use the
Bible as our sole ethical foundation, still we are dependent upon knowledge accumulated by other
human beings: We are dependant upon those who wrote the autographs, that they did a faithful job,
we are dependent upon those who copied the text, and upon those who made the modern critical
editions of these text copies. Further, we are dependent upon those who made lexical and
grammatical studies of the Greek and Hebrew text, and we are dependent upon those who
translated the Bible into our modern tongue.
But this is not all. In connection with any subject which has to be learned, there is a need for teachers
to guide us through the knowledge which is accumulated by others, and to point out important data
for us. Similarly, there is a need for guidance when we are going to work out our ethical principles on
the basis of our English translations of the Bible. And here is one area where Muramoto errs: the
responsible persons among Jehovah's Witnesses who organize the world-wide community are
portrayed as prophets who force their arbitrary decisions upon the individual Witness, while they are
no more than teachers, whose teaching can be checked by the individual Witness. There can be two
reasons why the individual Witness is very receptive to what is written in the literature from the
Watchtower society and what is said in the congregation: 1) Each member is brainwashed and does
not use his or her thinking ability, or 2) what is written and said accords with his or her Christian
conscience and viewpoints based on the Bible. As an example why I advocate 2) I will point to an
incident some years ago: At a gathering of members of many hospital liaison comittee members a
particular understanding of a side of the blood issue was presented, and my reaction was: �This
simply is not correct, and it cannot be accepted!� Fortunately it turned out to be a mistake. So it is
possible to be sympathetic to a source which I have experienced allways has given true information
without being slaves of men!
TO TAKE OR NOT TO TAKE BLOOD
As a linguist I am painfully aware of the fact that language is ambiguous. One reason why teachers of
the Bible are needed, is that most people do not master lexical semantics (word meaning),
particularly not as far as Greek and Hebrew are concerned. To illustrate why I see our standpoint
regarding blood as consistent and not arbitrary, I will use an example as to word meaning from a text
where blood is also mentioned.
Acts 15:29 in the New Testament gives the law �to keep abstaining from things sacrificed to idols
and from blood (Greek haima) and from things strangled and from fornication (Greek porneia)�. A
person who wants to base his ethics on the Bible may logically ask: �What is the meaning of the
Greek word porneia which is translated by the English word fornication? Any lexicon will show that
immoral sexual practices are involved, but this is rather vague. The word evidently involves sexual
intercourse between a married person and one who is not one's mate, but does it involve sex
between persons who are unmarried? And does it include homosexual acts and bestiality? The
sexual drive of some persons may influence their answers to the questions, so it is not guaranteed
that we can get a good answer just by reading definitions in lexicons.
Witnesses who knew the Biblical languages struggled with the word porneia for a long time; it can
seem strange for non-linguists, but sometimes it is extremely difficult to pinpoint the semantic range
of a single word. The study concluded that 'fornication' is an immoral use of another person's (or an
animal's) sexual organs, and it includes all the four areas mentioned in the last paragraph. Apart
from this, there may be 'grey' areas, such as how unmarried persons will show affection for one
another, but such cases are a matter of the individual consciences, where each person must bear
his or her own responsibility.
Just as the ethical interest of Jehovah's Witnesses in the law 'to abstain from fornication' revolves
around the question �What is included in the concept porneia?�, similarly the ethical interest in the
law 'to abstain from blood' revolves around the question �What is included in the concept haima?�
Thus what Muramoto calls a 'policy change' which allows 'a wider selection of acceptable blood
products' (p. 38) is hardly more than a clarification of the important ethical question of what the Greek
word haima really includes in a situation where ever more new products are manufactured from
blood.
The Encyclopedia Britannica, Micropedia II (1974) p. 89 defines the major blood components as
�plasma, red blood cells (erythrocytes), white blood cells (leucocytes), and platelets
(thrombocytes)�. I can see no reason to exclude any of these components from the concept haima,
and therefore, from the second World War1 when blood transfusions bacame common, Jehovah's
Witnesses have abstained from whole blood and from any of the mentioned components. However,
in the last few decades fractions and extracts have been synthesized from the aforementioned
components, and naturally questions have arisen: Immunglobulins, coagulation factors, albumin,
stem cells, interleucines etc, are they included in the concept blood (haima)? We cannot answer this
question with certainty because these factors did not exist as products in Biblical times, and
therefore the answer has been that the use of these components is a matter of conscience. This
does not mean that the Watchtower Society or a group of humans has authorised the use of these
components, but rather that they have pointed out that they represent a grey area where each
Christian conscience must decide.
There has been a steady development of the use of blood from vaccines to the transfusion of whole
blood, and to the extraction and synthesizing of components from blood which occur at present.
Because the witnesses all the time have been continually faced with new products and new uses, a
continual study of the blood issue has been necessary. In the course of the study several roads have
been explored, such as which components of blood can be said to be nutrients, the role played by
particular blood components in the body2, and whether we can differentiate between erythrocytes
and hemoglobin when 95 % of the dry weIght of an erythrocyte is hemoglobin3. The answer to such
questions may influence some person's choice of using or not using a particular component, but the
fundamental position has all the time been the same: What clearly is blood (haima) we do not
accept! So the conclusion of the study which was published in The Watchtower June 2000 June
15:29-31 is in my view logical and consistent; everything except the major blood components is a
matter of conscience.
A THIRD PARTY CAN HARM THE RELATIONSHIP BETWEEN THE DOCTORS AND THE WITNESS
PATIENT
To abstain from blood is deeply rooted in Jehovah's Witnesses; so deeply that even many persons
who no longer are Witnesses stick to it in situations of crisis. Because of this and because of actual
experience, my estimate is that less than 1 % of the Witnesses would accept blood in a situation of
crisis.4 Thus the situation paitned by Muramoto of Witnesses who will accept blood in secrecy is
virtually nonexistent.
A good relationship between doctor and patient is mandatory for a good outcome of the treatment. It
is fine that the doctor should ask the patient about his or her decision to refuse blood, in order to be
sure that this is the final decision on the part of the patient. However, Muramoto's suggestions that
the signed card expressing the patient's decision should not be accepted, and that the doctor should
try to make the patient accept blood bacause this is what many Witnesses want but are afraid to do,
may really harm the patient. First, the signed medical document is a legal document which should be
accepted by doctors. Second, the standpoint of the patient is an example of the principle of 'informed
consent', and it is not the duty of the doctor to try to change the will of the patient.
The standpoint to abstain from blood was reached when the patient was fit and well, but the Witness
patient will defend this decision when he or she is weak from blood loss or pain as well. But it is my
experience that there is one thing the patient wants more than anything else in such a situation,
namely, an assurance from the doctor that blood will not be used and that the best possible
treatment will be given. Such an assurance will help the patient get mental strength which will
contribute to his or her recovery. Suggestions from a third party work against the patient achieving
this feeling of security, because the doctor unnessesarily can become suspicious about the motives
of the patient.
CONCLUSION
Bloodless surgery is standard procedure in many hospitals, and the Witness patient in most cases
does not pose a challenge for the doctor. The realisation that infusion of blood components may be
dangerous, and the work of the hospital liaison comittees in conveying information to doctors and
assisting the Witness patient when they are called to do so, have contributed to a cordial relationship
between the Witnesses and many doctors. Third party articles such as the one written by Muramoto,
do not represent the interests of Witnesses but rather those of the opposers, and may harm this good
relationship.
My hope is that doctors will respect the autonomy of each patient, not by trying to breach the
relationship between the patient and fellow believers and by asking cunning questions, as Moramoto
suggests. But instead: ask the patient clear questions to make sure that the standpoint regarding
blood is his or her own. And then, assure the patient that blood will not be given, thus giving the
patient the feeling of security that he or she is seeking.
1 Even before World War II the sanctity of blood was stressed in connection with vaccines. One
reason why vaccination was not recommended was that a great part of those vaccines which were
administered in the 1920s and 1930s was blood.
2 The blood system of a pregnant woman is separate from that of the fetus in her womb. The fact that
the mother's major blood components do not under normal conditions cross the placental barrier
into the fetus' blood, while some protein fractions including albumin do move naturally into the blood
system of the fetus (albumin moves less efficiantly), has led some Christians to believe that only the
major components represent haima.
3 It should be noted that only 35 % of the erythrocyte is dry weight, so depending of the point of view it
can be said that either 95 or 33 % of the red blood cell is hemoglobin.
4 The experience of a professor at one of the University hospitals in Oslo was that 1 % of the Witness
pateients accepted blood (personal communication).