Attempting to Honor Beliefs of Jehovah’s Witnesses at the Edge of Viability in an Infant Born at 23 Weeks’ Gestational Age
Management of emergency care, Clinical situation which can not be reproduced for ethical reasons, Rare co-existance of disease or pathology
Charles W. Sauer, Krishelle L. Marc-Aurele
(Department of Pediatrics, University of California, San Diego, CA, USA)
Am J Case Rep 2016; 17:375-378
Infants born at 23 weeks’ gestation have a poor prognosis and require intensive care, including blood transfusions, to survive. Generally speaking, the decision to forgo life support is acceptable. Jehovah’s Witnesses believe that life is sacred and want lifesaving interventions except for blood transfusions. Therefore, an ethical dilemma exists when a baby is born on the edge of viability to parents that are Jehovah’s Witnesses. In this case, if parents and healthcare professionals disagree on the best interests of the child, the medical team should obtain a court order from the state to intervene.
CASE REPORT: We present the case of an infant born at 23 weeks’ gestation to parents who are Jehovah’s Witnesses. The parents wanted full life-support, except for blood transfusions, to be given. The clinical team obtained a court order to transfuse the infant. The infant unfortunately died despite all efforts.
CONCLUSIONS: Currently, it is nearly impossible to honor the beliefs of Jehovah’s Witnesses to provide lifesaving treatments without blood transfusions for infants born at the border of viability. If the goal is to prolong life, the standard of care for a premature infant is for a doctor to obtain a court order to override the beliefs and wishes of Jehovah’s Witness parents and transfuse blood products as medically indicated. Although bloodless techniques for high-risk surgeries are under development, care for premature infants at 23 weeks’ gestation necessitates red cell transfusions.
Keywords: Fatal Outcome, Erythrocyte Transfusion - legislation & jurisprudence, Gestational Age, Hemoglobins - analysis, Humans, Infant, Newborn, Infant, Premature, Jehovah's Witnesses, Male