a case that I think turns out to be easy

There is an issue in bioethics involving people like Jehovah’s Witnesses (JW), who refuse blood transfusions. According to believers, accepting blood into their body is the same as cannibalism and so will lead them to be damned. Naturally, they want to avoid that outcome and so will not consent to life saving infusions of blood. However, the JW does not go to hell merely be having foreign blood in his body. The issue is not purity but rather volition. If someone else forces the blood into his body, he won’t go to hell as long as he fought as strongly as possible. One can’t help the deeds of others.

The issue from bioethics is: should we treat Jehovah’s witnesses against their will or must we respect their refusals?

Often, the cases that are offered when considering forced treatment involve (1) mistaken beliefs or (2) unorthodox ends. For example, a patient might not believe that their condition is bad. Here’s a case, a woman is told that her gangrenous leg must be amputated in order for to live. She agrees that her goal is to live, but denies that the condition of leg will kill her. She insists that in the past, vaseline has cured her problems and so refuses to lose her leg (this is a real case); she will not consent. She has a false belief about the situation, viz. that death is imminent without an operation. Can we force such a person to undergo treatment?

Another case. There may be situations where patients don’t doubt that they will die, but deny that a recommended treatment will be effective. This same woman might say “Ok, I know I will die without treatment, and I don’t want to die, but I don’t think cutting my leg off will help and I don’t want to lose my leg for nothing, so I refuse treatment.” Can the doctors go ahead anyway?

Finally, there are cases when people don’t have mistaken beliefs but have unorthodox ends. Take the suicidal man who wants to die. That is his goal. We may not like this goal, but what’s to say that it is a wrong goal to have? Another example is an anorexic whose goal is to be skinny. She (it could be a he, guys have eating disorders too) might even believe that this goal conflicts with her desire to live, but simply rate her goal to be skinny as more important. Is there a rationality to deciding the relative values of different goals? Is the goal of being skinny even rational at all?

A minority of people think that no one should ever be able to refuse treatment, but most think that at least some of these cases I listed above cause trouble, but what I want to note in this post is that the case of the Jehovah’s witness is actually easier than all of these hypotheticals. Let’s return to the JW (at least the paradigm JW): he doesn’t have any false beliefs. He knows he will die without a blood transfusion and believes that having one would save his life. He’s also not suicidal and wishes to live if possible. He just also believes that he must resist the blood transfusion with all his might as part of his moral code. Notice though that forcing a blood transfusion on him would not violate that moral commitment because the commitment only references his own state of mind and actions. He is not allowed to accept or condone blood transfusions, but again, as I mentioned above, if someone forces it on him, then his moral probity remains. His morality concerns his actions and not that of the doctors.

Here’s an analogous case. Pretend that I want to live, and need penicillin to do so. I believe that the latter is necessary for the former. However, I have a strange moral belief. I will only accept penicillin that is put into my body despite my best efforts at resistance; nothing else is legitimate. You’re my doctor. Do you force penicillin into me? Of course you do! In fact, I think you are required to. I have a moral belief that restricts what you can do to me in a very strange way, but it’s easily accommodated. Imagine someone who says that they want penicillin to live, but can only accept penicillin out of a red container. By god, you get a red container for the penicillin and then give it to the person. You can satisfy their ends by using means that are acceptable to them.

The reason the JW case appears to be tricky is that he restricts the acceptable means to helping him to treatments that violate his informed consent (he will only “accept” blood that is forced into him against his will). But we don’t have to be fooled into thinking that we violate his rights by treating him against his will because, quite simply, he wants to be treated against his will (though he can’t say that. To escape damnation, he would always have to say to the doctors that he does NOT want the transfusion. In fact, he would, knowing that doctors have to obtain informed consent, probably tell us all sorts of lies to get us to believe that he doesn’t want the transfusion, but we shouldn’t be taken in by this gambit). We have rules about informed consent because we believe encroaching on the lives of others is to be avoided as much as possible (we can put people in jail if they are harming others of course), but in this case, we are not encroaching, but rather respecting the moral code of the person by forcing him to undergo helpful treatment. Not giving him the blood transfusion causes him to die when he could have been saved without contravening his ends, his beliefs, or the restrictions he must place on treatment.

To put it another way, the JW believes that if new blood is put in his body, he will live, which he wants. The state of affairs known as foreign-blood-being-in-his-body is not only unobjectionable (remember tranfusions per se are not wrong, he just can’t accept any of them), but in fact desirable to him. He just has to try and prevent this state from ever being realized. Once the state obtains though, he has no problem. He doesn’t even have an objection to the doctor’s pinning him down and forcing him into the operation. Sure, he thinks such people are evil, but what’s his judgment to the doctors who don’t share his metaphysical commitments?

A final way to think about the case is this: imagine you come across someone unconscious. As far as you know, they don’t oppose blood transfusions and they aren’t suicidal etc. etc. Still, you can’t get consent from the person because they are unconscious. The natural reaction to the case is that you give them blood so they live, because based on what you know about the person and their interests, they would want to live. The JW case is no different. Pretend you find an unconscious JW witness. You know they want to live, and that they believe a blood transfusion will save them. You also know such a person vigorously resists transfusions and is required by their belief system to resist to the utmost. You say to the unconscious JW “I’m going to transfuse you, but against your will.” When the JW wakes up, what can they complain about? They will now live. Sure they have foreign blood in them, but it was forced on them, and so they are not damned. They are both alive and not-damned and not compromised in their belief system.


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