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."

"...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 and 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 nonblood 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.:

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:

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 (vaccuuming up the patient's spilled 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. (http://gasnet.med.yale.edu/gta/JehovahsWitness.html )

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:

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?

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.)

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." (

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.

Actual transcript:

Watchtower Blood Policy Changes Again

The June 15, 2000 Watchtower presents a "Questions From Readers" article that represents a historic shift in the Watchtower Society's (WTS) blood policy. We believe that it is imperative that every Jehovah's Witness carefully consider the implications of these changes.

The article presents what appear as subtle changes but upon closer examination reveal very significant reforms. The revised policy continues to prohibit JWs from accepting any of the "primary" components of blood, namely red cells, white cells, platelets and plasma. This policy lacks any meaningful basis for a Christian since the bible does not define what a primary or secondary component of blood is and seems to reflect the fact that blood banks commonly separate blood in this manner. It must be noted, however, that many of the blood components permitted by the WTS are considered to be major or primary by doctors and scientists.

Perhaps most interesting is the fact that the article goes on to state that:

"...when it comes to fractions of any of the primary components, each Christian, after careful and prayerful meditation, must conscientiously decide for himself." (Watch Tower Bible and Tract Society. Questions From Readers. The Watchtower 2000; June 15:29-31. 2 Bailey R)

The statement is subtle and some JWs will initially miss its importance. Nevertheless, it signals an important shift in that JWs may now conscientiously accept any blood product that is fractionated from the WTS list of "primary" components. Previously, JWs had permission from the WTS to accept fractions of blood plasma such as albumin, immunoglobulins, fibrinogen and clotting factors. Research confirms what the WTS previous positions have been on the use of blood components that are now permitted.

The new policy will permit JWs to accept blood fractions of previously prohibited cellular components, namely red cells, white cells and platelets. The article gives examples of interferons and interleukins from white cells and a wound healing factor from platelets. Regarding those fractions, the article states:

"Such therapies are not transfusions of those primary components; they usually involve parts or fractions thereof. Should Christians accept these fractions in medical treatment? We cannot say. The Bible does not give details, so a Christian must make his own conscientious decision before God." (Watch Tower Bible and Tract Society. Questions From Readers. The Watchtower 2000; June 15:29-31. 2 Bailey R)

The careful reader will notice that the above statement implies that the Bible does give details regarding the use of red cells, white cells, platelets and plasma. Clearly it does not. In any event, the new policy will open the door to JWs accepting many additional blood products and eventually blood substitutes that are hemoglobin based.

For any who might question whether or not this is in fact a change in policy, we direct your attention to the comments of Richard Bailey and Tomonori Ariga of the Hospital Information Services of the WTS who in 1998 wrote to a journal for the researchers of blood substitutes as follows[3]:

"Based on this religious understanding, Jehovah's Witnesses do not accept whole blood, or major components of blood, namely, red blood cells, white blood cells, platelets and plasma. Also they do not accept hemoglobin which is a major part of red blood cells....According to these principles then, Jehovah's Witnesses do not accept a blood substitute which uses hemoglobin taken from a human or animal source." (Ariga T. The view of Jehovah's Witnesses on blood substitutes. Artif Cells Blood Substit Immobil Biotechnol 1998;26:571-576.)

We believe this single change in policy could potentially reduce the death toll among JWs by one half once the blood substitutes become commercially available in most countries. It bears noting that the new policy probably raises more questions than it answers. For example, although blood plasma remains banned as one of the WTS "primary" components, what about (FFP) or fresh frozen plasma which is produced after the secondary fractionation of platelet rich plasma then frozen within eight hours. Technically, the process of secondary fractionation, freezing and thawing could qualify FFP as a secondary fraction. To further complicate matters, a new blood product called SD Plasma, the Consumer Reports article, undergoes much more extensive processing in addition to that mentioned above. For example, after secondary fractionation of platelet rich plasma it undergoes solvent detergent treatment, hydrophobic chromatography and filtration. Could a JW accept SD plasma if he were to conclude that it is a secondary fraction of blood plasma, especially in light of the fact that JWs accept albumin, fibrinogen and the clotting factors which are the remaining primary elements of SD Plasma?

One must wonder how quickly the WTS will move to update their blood brochure, medical power of attorney forms and advance directives. How many Jehovah's Witnesses will end up rejecting potentially life saving therapies due to confusion over this extremely complex blood policy. Where does this leave the average JW who will give little thought to these complex issues up until such time as an emergency arises?

There are new ethical issues to be considered as well. With more and more Jehovah's Witnesses accepting blood products one must wonder how the WTS can continue to justify a policy that effectively prohibits JWs from donating blood or blood plasma. The combined demands of a group of six million people on the blood supply must be staggering, even if they are only accepting blood components or fractions.

We will be pursuing various means to advise the medical community, the JW community and the general public of these changes and their implications. Additionally, we will continue to advance our agenda of reform so that eventually all Jehovah's Witnesses will have a free choice in their medical treatment without controls or sanctions from the WTS or member congregations.

(Speaker Sten Bostrup):

Jehovah's Witnesses are now permitting their members to receive blood during operations and doctors estimate that it will save human lives.

(Female speaker):

As late as in 1996 a 24 year old woman died because she refused to receive a blood transfusion during a delivery. The woman was one of Jehovah's witnesses and according to her belief, she was not allowed to receive any blood. A similar situation can be avoided in the future. Now, it is possible to derive fractions from blood and Jehovah's witnesses will leave it up to each individual Witness to decide whether they will receive transfusions with this or not. Consulting physician Henning Sorensen believes that it is going to save human lives.

(Consultant physician Henning Sørensen):

People have died because they were not allowed to receive blood transfusions. Some have died because of hemorrhaging and similar cases will probably be prevented with the aid of these substances. Yes, it will be possible to save human lives.

(Female speaker):

According to the Bible, Jehovah's Witnesses are not allowed to receive blood from another person, but a new product derived from the hemoglobin from the red blood cells has been accepted by the religious community, anyway. The red blood cells are important because they are aiding the oxygen to circulate inside the body and now it is also up to each individual Jehovah's witness to decide if they will receive treatment with this product. Jehovah's Witnesses do not wish to decide whether it is real blood or not.

(TOMMY JENSEN, WATCHTOWER SOCIETY, HOLBÆK):

AS A RELIGIOUS COMMUNITY, JEHOVAH'S WITNESSES DO NOT DECIDE ON THE MATTER OF WHETHER HEMOGLOBIN WHICH IS DERIVED FROM THE RED BLOOD CELLS AND IF IT IS BLOOD IN THE BIBLICAL SENSE AND THEREFORE INCLUDED IN THE BIBLICAL COMMANDMENT, BUT IT IS A QUESTION FOR EACH INDIVIDUAL TO DECIDE.

(Female speaker):

Jehovah's witnesses do not consider it to be bending any of the biblical rules, when the members are now allowed to decide for themselves whether they will receive treatment with this new product or not.

(TOMMY JENSEN, WATCHTOWER SOCIETY, HOLBÆK):

YES, IT IS DERIVED FROM BLOOD AND BLOOD CONSISTS OF SO MANY THINGS -WATER, SALTS AND MINERALS, ETC.; AND WHEN WE ARE MAKING FRACTIONS OUT OF IT OR SEPARATING IT DOWN TO VERY SMALL ELEMENTS, SO BIT BY BIT, IT IS NOT BLOOD ANYMORE, AND WE CANNOT AS A RELIGIOUS COMMUNITY DECIDE WHETHER IT IS BLOOD OR NOT.

(Consultant physician Henning Sørensen):

It is splitting hairs, BUT IT IS HEMOGLOBIN AND IT IS A PART OF THE BLOOD, and it originates from blood when it is taken out, SO IT IS BLOOD; and this is the manner in which we detect blood by detecting the hemoglobin.

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