Tom Anthony A.

Tonguia MSMT-1 April 27,2020

No Blood – Medicine Meets the Challenge

The title of the documentary is “No Blood-Medicine meets the challenge”. This
was released on 2001 by Watchtower. Notable characters include Professor Charles H.
Baron which is from the Jehovah’s witness. The documentary begins with cases in which
patients needs a life-threatening operation and because of religion, the person subject to
the operation rejects a blood transfusion that could make the operation smooth because
surgery sometimes cause blood loss that the patient really need to be transfused with
blood in order to compensate the loss of blood during the operation. In this documentary,
we will learn some of the medical procedures or alternative strategies that has been
used to compensate or avoid blood transfusion to treat the patient successfully.
These new strategies may soon benefit all patients including persons whose
religion is Jehovah’s witness. The documentary talks about how diverse people are
which includes how people accept different languages, customs, cultures and how they
accept different religious beliefs. Adapting to these may have an effect in the human
society and a singular challenge in the medical community. Professor Oliver Guillod
thinks that the duty of the physicians is not simply to preserve life but the first and
foremost duty of physicians is to respect the patients. It was a challenge for the medical
community especially one religious’ group, Jehovah’s witnesses because of their
avoidance with blood resulting misconceptions in the public.
Eugene Rosam, a spokesperson of the Jehovah’s witness stated a verse in the
bible in Acts 15:20 stating to abstain from blood. They also talked about the right to
choose treatment of the patient especially blood transfusions. According to David Day,
all patients as a general rule have the right to receive treatment or to refuse to receive
that treatment after they’ve had full, open and candid discussion with the treating
physician. Physicians had stamped the standard of being blood as a standard treatment
for blood loss with the idea that blood is the gift of life and that blood is good for you
according to Dr. Peter Carmel. Dr. Avroy Fanaroff said that the refusal of blood
transfusion concerns the physicians because it may jeopardize the life of the patient.
They discussed also how blood functions in the body.
According to Dr. Nicholas Namais, if there’s no blood to bring the oxygen to the
cells, the cells dies and the body dies. There were two urgent priorities if a patient is
suffering a severe blood loss: First, you need to stop the bleeding, according to Dr.
Edwin A. Deitch, it is the most critical immediate need of the patient. Second, is to
restore the volume within the system. If none of these is done, then the patient will most
likely die because there’s no delivery of blood in to the brain and other organs.
Increasing number of patients are opting out blood transfusion for personal reasons.
According to Professor Roland Hetzer, at least 80 percent of the patients would strongly
favor not to have blood transfusions. In the 80s until the present time, concerns about
transfusion transmitted infections or TTIs raised, such as concerns of contracting such
as HIV/AIDS, Hepatitis B, Hepatitis C and etc.
Tranfusion reactions and clerical errors was also believed to be a factor on why
patients are opting out of blood transfusions. Because of these concerns, physicians
have spurred a wide range of alternative strategies that have been acceptable to
Jehovah’s witnesses and to those choosing to opt out blood transfusions. Alternative
strategies have been grouped into four organizing principles: First is to minimize blood
loss. Minimizing or avoiding blood loss is said to be the important technique to control
bleeding. Various instruments have been available to minimize bleeding in surgeries.
According to Dr. Nicholan Namais, there are strategies for interoperatively using
electrocautery instead of scalpels. There is also a recommendation of stopping the
bleeding, usage Argon-Beam coagulator delivers radiofrequency electrical energy to
tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal
hemostasis. Another one is the use of fibrin glue. The fibrin glue is made from blood
fractions that stimulates coagulation upon contact. Second, is to conserve red blood
cells.
There are new technologies that has been used in conserving blood, there is this
hemodilution ad reinfusion. Hemodilution induces macro and microcirculatory responses,
allowing the adaptation of the organism to the dilution-associated reduction in the oxygen
content of the blood. Another strategy used is recovering the lost blood. Dr. Richard K.
Spence stated that we can use cell saver. Cell saver is a technology that uses a cell
salvage technique. In a cell saver machine, it can suction up any blood that’s lost, then it
will be washed up, cleaned, processed, filtered and it goes back to the system of the
human body.
Lastly is we stimulate blood production. One suggests the use of erythropoietin.
Erythropoietin is a natural substance which is formed in the kidneys and other organs as
well but mainly in the kidneys to help our bone marrow to form RBCs (red blood cells)
that is carrying our oxygen. It is considered to be a key element of the body’s ability to
replenish its own blood supply. There are case histories presented in the documentary,
one of them is Leslie which is diagnosed with scoliosis.
It was a difficult surgery because she can’t receive blood transfusion. They look
for alternatives such as hemodilution and the use of cell saver and with careful surgery
minimizing the risk of blood loss, they were able to do the surgery successfully. Another
case was a 75-year-old Dorothy McPhee whose suffering for an abdominal aortic
aneurysm which is a life-threatening condition, that traditionally requires extensive
surgery. Dorothy is a Jehovah’s Witness, in which she can’t have a blood transfusion.
They used a surgical technique that is called endovascular aortic surgery which can
minimize blood loss during surgery, then she also recovered from the successful
surgery.
With this development, we can truly say that this issue is not limited to the
Jehovah’s witnesses but with these advances I think I should say that it raised the bar
high for physicians to do bloodless surgery. Major Spry, a Jehovah’s witness spokesman
quoted “I guess it could be likened to a patient who is allergic to penicillin. You wouldn’t
expect the physician to say, ‘Well I’m sorry I can’t treat you because I can’t administer
penicillin. ‘No, he simply says, “We’ll give you a medical alternative. We’ll give you
another antibiotic.’ Then he gets on with treating the patient.” Dr. Richard K. Spence
believed that transfusion alternatives clearly are good medical practice.
If I were to evaluate the movie, I think it presented some good points and things
that I could agree on. I would agree that we humans are diverse, we have different
cultures and religious beliefs. One religion stood out from the movie and that Jehovah’s
Witnesses. Without the concern of opting out blood transfusion, we won’t be able to
really look upon alternatives in compensating blood loss. Truly this is an advancement in
medicine. I think the documentary is pointing out that rejecting blood transfusion is not
only sole for Jehovah’s witnesses, it proves that we have a right to decide whether we
want this blood transfusion or not. I would agree to Professor Oliver Guillod that the duty
of physicians is not simply to preserve life but the first and foremost duty of physicians is
to respect the patient.
Which is why I say that we have the right to choose treatment. I have a question
regarding the Jehovah’s witnesses, why do they reject blood transfusion? According to
the documentary, Eugene Rosam, a Jehovah’s witness spokesman quoted a scripture in
the bible saying to “Abstain from blood” (Acts 15:20). Based on the book “Jehovah’s
Witness and Question of Blood by Watchtower (1977), Jehovah’s witnesses cherish and
deeply respect life. They also believe in the bible verse found in Genesis 9:3,4 stating “A
human is not to sustain his life with the blood of another creature”. Another verse from
Leviticus 17:13,14 stating “When an animal life is taken the blood representing that life is
to be poured out, given back to the life giver”.
Do science really consider the facts of this? no it does not but merely if we are for
example a physician treating a Jehovah’s witness patient, we want to have respect for
the beliefs of the patient. Blood is a gift of life, but I believe that blood is not the only
treatment that can be done in treating severe blood loss. What matters is that we value
the life of the patient, we do the best that we can do and we respect them as they
respect us. One factor also on why do people refuse to have transfusions including
Jehovah’s witnesses is the fear of having infected blood. In the 80s, AIDS come out. In
the movie “And the Band Played On”, there was a concern of the blood banks having
contaminated blood.
No testing was done in that time, only the blood product is filtered and separated.
Study shows in the movie that most of the donors are HIV positive that caused to passed
on to immunocompromised patients in particular hemophiliacs. HIV/AIDS is not the only
transfusion transmitted infections occurring, one of them also is your Hepatitis B,
Hepatitis C, Syphilis, HTLV, malaria, Trypanosoma cruzi infections and etc. Concerns
about this includes also your transfusion reactions and clerical errors in the blood facility
or in the hospital based on testing example of that is mixing of the blood, wrong blood
given and false positives results in crossmatching. In this present time, we have
developed different kinds of alternatives and approaches in dealing with this situation. In
minimizing blood loss alternatives such as electrocautery instead of scalpels, the use of
the Argon-Beam Coagulator and the use of fibrin glue. Another alternative used is using
hemodilution technique and using cell saver that salvages the cell and bought back to
the body. The use of erythropoietin can be also used, it is an enzyme that promotes
blood production to compensate the lost blood.
To conclude, I believe that medicine is very diverse and deep. We as medical
healthcare professionals can also contribute to discoveries of various advancements in
medicine. I believe that advancement in medicines is still a lot that we are to discover in
the future. I totally agree with the documentary because it tells us that treatment is has
its own choice. I was really amazed of what turn out this issue into developing
advancement in the field of medicine. Dr. Stephen M. Crohn quoted that “the belief that
you don’t want a blood transfusion should not in the way, that it should be a tiny part of
the whole medical care environment, that should be acknowledged, put over to the side”.
Transfusion alternatives is really a good practice not only in treatment but also ideas that
can be utilized by physicians all over the world.

References:
Watchtower (1977). Jehovah’s Witnesses and Question of blood. Watchtower Bible and
Tract Society of New York, Inc.

Harmening, D. (2005). Modern Blood Banking and Transfusion Practices (5th ed.).
Philadelphia, Pennsylvania: F.A Davis Company.

https://www.sciencedirect.com/topics/medicine-and-dentistry/hemodilution
https://www.ncbi.nlm.nih.gov/pubmed/1920562
https://www.ncbi.nlm.nih.gov/pubmed/20879634
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307508/
https://my.clevelandclinic.org/health/drugs/14573-erythropoietin-stimulating-agents
https://wol.jw.org/en/wol/d/r1/lp-e/202004447
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096856/
https://www.youtube.com/watch?v=QJkI4jdBxgA
https://www.fandango.com/and-the-band-played-on-104514/plot-summary