Jehovah’s Witnesses Won’t Take Blood Transfusions. They Need a Shabbes Goy.

Health and medicine explained.
June 25 2013 10:45 AM

How I Treat Patients Who Refuse Blood Transfusions

Why can’t Jehovah’s Witnesses have a Shabbes goy make medical decisions for them?

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All of these, and more, were discussed with our patient. But she had another idea. “I want,” she said. “I want my cousin to be my deputy.” Her cousin was not a Jehovah’s Witness. In the event that the patient lost consciousness, she wanted her cousin to make her choices. She was very precise: Her cousin was not her health care proxy. A health care proxy, a more usual legal arrangement, would appoint a deputy who has to make the decisions the patient would make herself if she were able to do so. No—she delegated the cousin to make the decisions he wanted to make at the time of her inability to speak, rather than her own. It seemed to her team that she was very clearly choosing someone who was not a Jehovah’s Witness, someone who would not make a Jehovah’s Witness choice. Someone who would allow us to save her life.

As a former student of Talmud, this scenario felt very familiar. In Jewish law, because you are forbidden to turn on the light on Shabbat, a friendly gentile can perform that service—the Shabbes goy. If you own forbidden yeast or leavened products at the time of Passover, you can temporarily sell them (even though they stay within the walls of your house) to another friendly gentile. In its own way, it’s a markedly pluralistic way of seeing the world: It’s not wrong to do these things, it’s just wrong for me. Enter the legal wranglings and complicated contracts that then make it possible for the light to be turned off, and the bread to be intact, and society to function, all without sin.

During the conversation with this patient, I thought: Of course. She needs a blood equivalent of a Shabbes goy. She needs … a transfusion atheist.

I thought: This is brilliant. This is brilliant! This is a way out. All the Jehovah’s Witnesses could choose a transfusion atheist—I’ll do it for the whole hospital, even though I’m Jewish. Nobody would need to die, or be shunned, or have to face this terrible choice between their God and their life, between their community and their self, ever again.

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I tried bringing this idea up with the next Jehovah’s Witness patient I had, and I was met with a gentle “No” and more than a bit of confusion. I tried to ask a few Jehovah’s Witness ministers (I got their numbers through my institution’s chaplain), but nobody returned my calls. I spent a long while on the phone and sent several very carefully composed follow-up emails to the Jehovah’s Witness media center, and was sent repeatedly to this page, which I found completely inadequate. I meant all my inquiries with the utmost respect but also the utmost urgency: Could we solve this?

After reaching out to several of those Jehovah’s Witness leaders and failing to have a serious conversation with them, I still don’t know. Right now I’m left with the thought that maybe the reluctance to talk around, to negotiate, to manage this rule is the true and deep cultural divide here. For me, the refusal of blood transfusions is a problem, a problem that I want to solve. I am willing—more than willing, in fact, eager—to walk backward around this rule and tie it up in knots and call that “keeping it” because a maternal death is the worst news I have ever had to break to a family.

And maybe that’s the point. For the truly devout among Jehovah’s Witnesses, the refusal of transfusion is not a problem; perhaps it is a divine command. In that setting, all my machinations, even on their behalf, may appear woefully inadequate, and perhaps—although meant with respect—insulting, compared with gracious acceptance. Getting out of the problem is not the point for them; it is not, perhaps, a problem to be solved.

And that is where we cannot agree. Because I will always believe that debate and manipulation, and even falsification, in pursuit of the life of a woman are sacred things, indeed.

Chavi Eve Karkowsky is a specialist in high-risk pregnancy, also known as maternal-fetal medicine, in New York City.