reprint from the Jan/Feb 1997 issue of the Free Minds Journal

Revisions on the Blood Issue

Does the Watchtower allow blood to be stored?

Does the Watchtower allow blood to be infused?

If your answer is no, think again!

by Gary Busselman and Randy Watters

As most of us know, the Watchtower Bible and Tract Society is continually changing their doctrines regarding acceptable/unacceptable conduct of their followers. This has been true in relation to blood transfusion as well. This is an interview with Gary Busselman, a former Jehovah's Witness who lost his first wife over the blood transfusion and organ transplant issues, and who has spent much time researching their changing positions regarding blood.

Certain key statements in the Watchtower's prohibition on ingesting blood via transfusion are reviewed in preparation for this discussion:

"Questions from Readers" *

"In view of the seriousness of taking blood into the human system by a transfusion, would violation of the Holy Scriptures in this regard subject the dedicated, baptized receiver of blood transfusion to being disfellowshiped from the Christian congregation?"

"The inspired Holy Scriptures answer yes." (The Watchtower, January 15, 1961, p. 63)

 

"Firmly Resolved About Life And Blood "

"Similarly, God's command to `abstain from blood' rules out ingesting it by the mouth as well as through injections into the veins. Furthermore, the Bible makes it clear that the divine law was not to be ignored even during an emergency that could threaten life. (1 Sam. 14:31-35) Many of God's approved servants have been willing to face dangers and even death rather than violate Scriptural principles and their integrity to Jehovah." (The Watchtower, June 15, 1978, p.24)

. . . "So their everlasting destiny is tied up in their faithfulness to Jehovah. This includes their being obedient to what he says about blood." (The Watchtower, June 15, 1978, p.24)

"Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood. Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them." (How Can Blood Save Your Life? 1990, p. 27)

"But Jehovah's Witnesses believe that to be transfused . . . [may] result in eternal damnation." (ibid. p. 31) [brackets theirs]

Gary: As we read above, their principle is this: Blood can not be put into the body either through the mouth or "through injections into the veins." Yet this message is not entirely consistent with what is written in the 1989 and 1995 Watchtower articles that we will discuss.

Randy: What change do you see evident in recent articles in their stance towards receiving blood transfusions?

Gary: First I direct the reader to The Watchtower of August 1, 1995, p. 30. This short article says a lot:

(1) It is reminding Jehovah's Witnesses that there are "circumstances" [note: plural] when a Witness may have his own blood transfused back into him, and viewed by the Watchtower's Governing Body as "unobjectionable." Note:

"...the Center for Bloodless Surgery utilizes alternatives to blood transfusions, including the reinfusion of a patient's own blood - a technique that some Witnesses may find unobjectionable under certain circumstances."

(2) The article is actually an advertisement for the Center for Bloodless Surgery at Cooper Hospital-University Medical Center in Camden, New Jersey, where Jehovah's Witnesses may have surgeries that, in fact, do involve certain blood treatments that have been deemed by the Watchtower writers as "unobjectionable" by them. The Watchtower writers are actually saying that the Witnesses may receive "blood treatment" at the "Center for Bloodless Surgery." Notable indeed! Especially in view of the following statement:

"So, if medical personnel suggest that a Christian permit some of his blood to be withdrawn and deposited in a blood bank for later transfusion purposes, the Christian is not without guidance from the Bible as to the proper course. He can mention that ancient Israelites were told that removed blood was to be `poured out on the ground as water,' to show that it was for God and not to sustain the life of some earthly creature. (Deut. 12:24) And he can refer to the pointed command that Christians `abstain from blood.' In view of this, how could he allow his blood to be collected in a blood bank for later transfusion into himself or another person?" (The Watchtower, June 15, 1978, p.30)

Although the word "blood bank" is used here in a negative sense in regards to the storing of blood, a window of possibility regarding the use of "autologous blood" is noticed in the following question and answer supplied in The Watchtower of March 1, 1989, p. 30, 31:

"But what about using autologous blood (1), a term used regarding a number of procedures? Some of those procedures are unacceptable to Christians because of being clearly in conflict with the Bible, but others lead to questions." (The Watchtower, March 1, 1989, p. 30, 31)

(1) The above-mentioned Watchtower also defines the blood related medical terms for readers as: "homologous blood (coming from another person) and autologous blood (the patient's own blood)." (p. 30)

Next, the writers go into a lengthy explanation of the Scriptural basis for their opinions on blood treatment and non-blood treatment, primarily using the Mosaic law (which they insist is no longer in effect). Finally they concur:

"This clearly rules out one common use of autologous blood - preoperative collection, storage, and later infusion of a patient's own blood. In such procedure, this is what is done: Prior to elective surgery, some units of a person's whole blood are banked or the red cells are separated, frozen, and stored. Then if it seems that the patient needs blood during or following surgery, his own stored blood can be returned to him. Current anxieties about blood-borne diseases have made this use of autologous blood popular. Jehovah's Witnesses, though, DO NOT accept this procedure." (ibid., p. 30, italics mine)

In my opinion, the key words in the above paragraph are "preoperative" and "this." On page 31 of the same article they say:

"What about induced hemodilution? Some surgeons believe that it is advantageous for a patient's blood to be diluted during surgery. Thus, at the start of an operation, they direct some blood to storage bags outside a patient's body and replace such with non-blood fluids; later, the blood is allowed to flow from the bags back to the patient. Since Christians do not let their blood be stored, some physicians have adapted this procedure, arranging the equipment in a circuit that is constantly linked to the patient's circulatory system. Some Christians have accepted this, others have refused. Again, each individual must decide whether he would consider the blood diverted in such a hemodilution circuit to be similar to that flowing through a heart/lung machine, or he would think of it as blood that left him and therefore should be disposed of." (italics mine)

While the Governing Body has ruled out preoperative storage of blood, they are allowing for an intraoperative procedure that allows blood to travel outside of the body and later be infused back into the patient, and as we shall see, even if it is temporarily stored outside the body.

How does this process, called hemodilution, work? Note the description by Peter E. Keipert, Ph.D.:

"A related technique, acute normovolemic hemodilution (ANH), entails the collection of a portion of the patient's blood (e.g., 2-4 units) in the operating room just prior to surgery. As it is withdrawn, the blood is replaced with a crystalloid and/or colloid plasma expander to maintain constant circulating blood volume. The result of ANH is a diminished net loss of red cells in surgery, since the shed blood is more dilute. The patient's whole blood is re-infused during the surgery, if required, or at the end of surgery to raise the hematocrit to a safe level. " (USE OF OXYGENT, A PERFLUORO-CHEMICAL-BASED OXYGEN CARRIER, AS AN ALTERNATIVE TO INTRAOPERATIVE BLOOD TRANSFUSION. Peter E. Keipert, Ph.D. Alliance Pharmaceutical Corp., 3040 Science Park Road, San Diego, CA, 92121

Anna L. Harris, M.D. and Thomas P. Engel, M.D. present the following summary of hemodilution in relation to the Jehovah's Witness patient:

"Anesthetic Management" "Acute normovolemic hemodilution (ANH) is a method that reduces, or may even eliminate, the need for blood transfusion during surgery.... ANH may be done with either arterial or venous blood and should be completed prior to surgery since surgical blood loss during hemodilution may result in acute hypovolemia.... "Jehovah's Witnesses will not accept stored or banked blood under any circumstances; however, adapting the hemodilution process to effect a continuous system of blood withdrawal and reinfusion has been acceptable to some Witness patients. (37) This adaptation is accomplished by phlebotomizing the patient from a central catheter or a large bore peripheral catheter via gravity drainage into an appropriate blood storage bag; appropriate in the sense that the patient is secure in the belief that their blood is still part of their circulatory system." (Anesthetic Challenges and Considerations Presented by the Jehovah's Witness Patient, Anna L. Harris, M.D. and Thomas P. Engel, M.D. Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA.

Then there is the Watchtower's consideration of the medical practice of picking up blood that has actually spilled from the circulatory system into an open wound, scavenging the spilled blood, cleaning that blood and transfusing or "reinfusing" it "through injections into the veins." The following are their comments relating to a possible use for spilled blood, and the medical explanations of the process called "autologous blood salvage," or "cell-saver scavenging."

"Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood. Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them." (How Can Blood Save Your Life? 1990, p. 27)

They are discussing "predeposited blood" and its use as being wrong for the Witness, but by the use of "intraoperative" appear to be saying that the storing of all blood, etc. is ruled out during the operation. Yet in the March 1, 1989 Watchtower they actually allow for blood scavenging and reinfusion (vacuuming up the patient's pilled blood and reinjecting that blood into the patient), as well as allowing a "brief interruption" of the blood flow, a form of storage (since the blood is contained in a bag and in the tubes of the machine, and briefly stored there for some time during the operation):

"A final example of autologous blood use involves recovering and reusing blood during surgery. Equipment is used to aspirate blood from the wound, pump it out through a filter (to remove clots or debris) or a centrifuge (to eliminate fluids), and then direct it back into the patient. Many Christians have been very concerned whether in such salvage there might be any brief interruption of blood flow. Yet, as mentioned, a more Biblical concern is whether the blood escaping into a surgical wound is still part of the person. Does the fact that the blood has flowed from his circulatory system into the wound mean that it should be `poured out,' like the blood mentioned at Leviticus 17:13? If an individual believes so, he would probably refuse to permit such blood salvage. Yet, another Christian (who also would not let blood flow from him, be stored for some time, and later be put back into him) might conclude that a circuit with recovery from a surgical site and ongoing reinfusion would not violate his trained conscience." (The Watchtower, March 1, 1989, p. 31)

  Anna L. Harris, M.D. and Thomas P. Engel, M.D. describe how this happens with the Jehovah's Witness patient:

  Anesthetic Management

"Under usual circumstances, standard preoperative preparation would also include the practice of storing the patients blood for use during surgery; however, Jehovah's Witnesses will not accept autologous transfusion of pre-deposited blood. (30) Alternatively, in order to maximize hemoglobin levels, the patient can be placed on a regimen of oral iron therapy for 3-4 weeks before surgery. (31) Intraoperatively, the minimization of oxygen consumption and the maximization of oxygen delivery are factors which help reduce transfusion dependency. To that end, techniques that may be employed include acute normovolemic hemodilution, cell-saver scavenging devices as a form of autotransfusion, hypotensive anesthesia, and deliberate hypothermia. No technique will be satisfactory, though, unless the surgeon pays scrupulous attention to minimizing operative blood loss and securing hemostasis." (Anesthetic Challenges and Considerations Presented by the Jehovah's Witness Patient, Anna L. Harris, M.D. and Thomas P. Engel, M.D. Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California.

While the above-mentioned doctors refer to the "cell-saver scavenging devices as a form of autotransfusion," The Watchtower carefully avoids using the word "autotransfusion" when referring to the procedure that they refer to as a "personal decision" matter. They avoid referring to the blood scavenger device by name, apparently preferring to say, "Equipment is used to aspirate blood from the wound" (The Watchtower, March 1, 1989, p.31) Apparently they do not want the reader to see the irony that they are allowing a form of "blood transfusion" after all!

Randy: So what types of "blood transfusions" are actually allowable?

Gary: They are still saying pre-operative autologous blood collection and storage for transfusion is not accepted. However, in the same article that pre-operative blood collection is defined as a procedure that is not accepted, the Watchtower publishers are saying that intra-operative autologous blood collection and storage for later reinfusion may be "unobjectionable" to the individual Witness.

In other words, The Watchtower is saying that "brief" storage is (in certain cases) acceptable. Consider the following quote:

"Actually, the Biblical emphasis is not on the issue of continuous flow. Even aside from surgery, a person's heart might stop briefly and then resume. His circulatory system would not have to be emptied and his blood disposed of just because blood flow had stopped during the cardiac arrest. Hence, a Christian having to decide whether to permit his blood to be diverted through some external device ought to focus, not primarily on whether a brief interruption in flow might occur, but on whether he conscientiously felt that the diverted blood would still be part of his circulatory system.-Galatians 6:5." (The Watchtower, Mar. 1, 1989, p.30)

Dr. Aryeh Shander testifies regarding how this applies in the JW patient:

"When the cell-saver is used for Jehovah's Witness patients, the red cells are shunted off to the plastic pouch and are held out of circulation during surgery. They are replaced with `volume expanders' plasma like fluids that fill the blood vessels during surgery. `That way if the patient bleeds, not as many red cells are lost,' said Dr. Aryeh Shander, the medical center's chief of Critical Care Medicine." (Gale Scott, The Star-Ledger, Newark, N.J., June 24, 1996, p.15)

Randy: What, then, is the main point you feel most Jehovah's Witnesses and Watchtower watchers have missed in the language of their new ruling?

Gary: Many don't recognize that there are two autologous blood treatment procedures acceptable to Jehovah's Witnesses: (1) acute normovolemic hemodilution and (2) the autologous blood salvage procedure. Ironically, both procedures are for the benefit of "sustaining life," a use for blood distinctly ruled out by The Watchtower as an acceptable use for blood! (The Watchtower, 1/15/95, p. 6 says, "In his inspired Word, the manual for keeping humans alive, our Maker forbids the use of blood to sustain life.") Additionally, they both utilize "ingesting blood through injections into the veins," another procedure completely ruled out. (The Watchtower, June 15, 1978, p.24)

Randy: How then, in summary, could this newer ruling be considered a milestone in their policy?

Gary: The point is, under certain circumstances the following questions can be answered as follows:

Do the publishers of The Watchtower demand that no blood be removed from the Witness? No!

Is all blood to be poured out that has left the body? No!

Can blood actually be infused into a Witness patient at all? Yes!

Can the Witness allow blood to be removed from the body? Yes!

Can his/her blood be temporarily stored in bags for later reinfusing? Yes!

Can blood be "ingested through injections into the veins"? Yes!

Can blood be ingested by Witnesses to sustain life? Yes!

Can many blood treatments be a matter of personal conscience? Yes!

The most significant principle, I believe, is that blood can be stored outside the body. (Time frame notwithstanding.)

Other Recent Developments

In addition to the issues raised in the 1989 and 1995 Watchtowers above, they have ruled that blood from another human being, in the form of its components, can be used.

"However, Witnesses' religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these.2" (How Can Blood Save Your Life? p. 27)

These exceptions do involve other people's "stored" blood and "ingesting it by injections into the veins." The justification for the exception is that it is only a small amount of blood that is injected into the veins. If this is the principle, then one would think that a small amount of fornication, adultery, or heroin would be okay with them, as would the worship of a small idol, or having a small Christmas tree!

Randy: Why do you feel this is significant, and where might they be going with this thread?

Gary: The principles now at issue with the Watchtower's Governing Body are no longer whether blood can be removed, stored, treated, and reinfused. Those issues are all accepted by them in various contexts. The principle is no longer whether another's "blood" can be infused into the Witnesses. Under certain circumstances this, too, is seen as a personal decision. The only issue left is properly defining the words "blood" (what it consists of) and the word "brief." Presently, these are ambiguous terms in their literature. If blood does not equal its components, then what does it equal? And how long is "brief?" One minute? Two minutes? Two hours? Eight? More? How long is an "intraoperative" session? How long does surgery last? How long is postoperative?

Additionally, every change in an enforced compliance doctrine such as alternatives to military service or blood treatment is really simply a change in the shunning doctrine. What will the Watchtower leaders tolerate of their followers? What will they shun them for doing? These are the main questions.

I see the Society in the unenviable spot of trying to change it's teaching regarding blood treatment just as it eventually changed its archaic medical advice guidelines, while trying to keep its business empire from collapsing at its feet. The Watchtower is currently supporting both sets of guidelines. The confusion this tactic causes must be incredible. The tactics to force compliance of the blood treatment tenet must demand tremendous persuasion and continuous reinforcement. I can envision the day when The Watchtower will just leave it at this, without the word autologous:

"As we can see, there is a growing variety of equipment or techniques involving autologous blood. We cannot and should not try to comment on each variation. When faced with a question in this area, each Christian is responsible to obtain details from medical personnel and then make a personal decision." (The Watchtower, March. 1, 1989, p.31)

I am not condemning the Governing Body for their changing tolerance and leniency towards blood treatments. Quite the contrary! I applaud them for the wisdom they have shown thus far in this most difficult of change for them, and I encourage them to continue to search their hearts and their scriptures.

Gary Busselman


Summary of Blood Revisions
Watchtower Blood Acceptance Guidelines

by Gary Busselman

The Watchtower reports on three ways for a Witness patient to receive his own blood to "sustain his life" by simply moving the "right / wrong" choice from The Watchtower guidelines to the conscience of the Witness patient.

(1) The Witness patient can have his blood removed from his body, pumped by a pump, oxygenated, filtered, "briefly" stored in a non-circulating state (WT 3-1-89 p.30), and returned to him "through injections into the veins" by a heart / lung device, as long as the Witness patient "conscientiously reasoned that the blood is flowing continuously and that the external circuit might be viewed as an extension of the circulatory system." (WT 6-15-78 p.30) In 1989 The Watchtower effectively removed the word "continuously" from this condition. (WT 3-1-89 p.30)

(2) The Watchtower clearly rules as "a personal, conscientious decision" matter the use of reinfusion of the intraoperative collection, "brief" storage, and later reinfusion of a patient's own blood (Acute normovolemic hemodilution, or ANH), WT 3-1-89 p.31, "through injections into the veins," with the test being that the Witness patient "believes" that the tubing attached to his arm represents a part of his circulatory system.

(3) The use of "autologous blood salvage" (ABS) techniques involve suctioning the blood lost from the circulatory system in the intraoperative and postoperative contexts "and subsequently reinfusing the recovered red cells into the patient" (Peter E. Keipert, Ph.D., Alliance Pharmaceutical Corp.) "through injections into the veins," and such is an individual's decision (WT 3-1-89 p.31). Witness patients may "utilize alternatives to blood transfusions, including the reinfusion of the patient's own blood... a technique that some Witnesses may find unobjectionable under certain circumstances." (WT 8-1-95 p.30)

"As we can see, there is a growing variety of equipment or techniques involving autologous blood. We cannot and should not try to comment on each variation. When faced with a question in this area, each Christian is responsible to obtain details from medical personnel and then make a personal decision." (The Watchtower, March. 1, 1989, p.31)

In addition to this, the Witnesses may take stored human and animal blood "ingesting it by the mouth as well as through injections into the veins" to "sustain life" (WT 6-15-78 p.24) as "a personal, conscientious decision" in five ways:

(1) The Witness patient may take other people's stored blood in the form of serum made from the stored blood of other people, "through injections into the veins." (WT 6-15-78 p.30)

(2) The Witness patient may take other people's stored blood in the form of albumin made from the stored blood of other people, "through injections into the veins."*

(3) The Witness patient may take other people's stored blood in the form of immune globulins made from the stored blood of other people, "through injections into the veins."*

(4) The Witness patient may take other people's stored blood in the form of hemophiliac preparations made from the stored blood of other people, "through injections into the veins."*

(5) The Witnesses may eat animal blood, including un-koshered meat and food products made without the careful consideration for blood avoidance that is required by The Watchtower publishers for medical treatment, as a "conscience" decision, "to sustain life" and "ingesting it by the mouth" with virtually no dietary guidelines from the Society. (WT 6-15-78 p.31)

. . .* "Witnesses' religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these." (How Can Blood Save Your Life? p. 27)


RELATED ARTICLES:

Is Blood FORBIDDEN Among Jehovah's Witnesses?
Revisions on the Blood Issue
Blood and the Law of God
Critique of Transfusion-Free Medicine
Jehovah's Witnesses and the Rh Factor
Shunning:”A Part of the Faith of Jehovah’s Witnesses”
Just Up the Hill A Ways by Gary Busselman

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