Tuesday, December 22, 2015

What Do Blood Transfusions and Christmas Trees Have in Common?

Four years ago, Claudia, a woman I occasionally hired to clean my house, revealed to me that she and her three daughters were living in a homeless shelter after she had fled her abusive husband in the night.  Horrified by this turn of events in her life I offered to let her and her daughters move into my guest bedroom until she could save up enough money to put a deposit down on an apartment.  

About a month after Claudia and her daughters had moved in it was time to put up the Christmas tree.  The little girls were gleefully placing glass baubles on the branches of the Douglas Fir and singing along to Top 40 Christmas covers when the seven-year-old said that this was the first time they had ever decorated for the holidays.  It took me aback and I thought perhaps economic hardship had prevented them from enjoying the Christmas season in the past.  However, I had completely misread the situation.  I had stereotyped and assumed that as a Mexican-American family they were Roman Catholics and if not practicing members of the faith they surely celebrated Christmas as a secular holiday. 

As it turned out Claudia was a practicing member of the Jehovah’s Witness faith and for those who are not familiar, Jehovah’s Witnesses do not celebrate Christmas or birthdays.  When Claudia got home later that day I talked to her about her level of comfort with me baking angel cookies with the girls and decorating the house for the holidays.  She assured me she was comfortable with tree trimming and setting up the nativity scene because she knew that interfaith relationships, whether romantic, platonic or professional were a part of life and she wanted the girls to learn respect for my love of Christmas.  However, this was not the feel-good end of the conversation you might be expecting.  There were bigger and less pleasant issue still to address.

Because I am a bioethicist by profession another more uncomfortable conversation immediately formulated in my head.  In my professional experience I have been no stranger to the belief espoused by the Jehovah’s Witness faith that blood transfusions are to be avoided. Actually the Jehovah’s Witness refusal of blood transfusions is one of the text book examples of religious refusals of healthcare that you learn about in your professional training. There are several passages in the Bible, ranging from Leviticus 17:10,14 in the Old Testament to Acts 15:28,29 in the New Testament that Jehovah’s Witnesses interpret as directives to avoid blood transfusions.  This practice can prove ethically problematic when in the course of the the delivery of healthcare a person requires blood to save their life.  Thus, there are countless cases of individuals who have been brought to the emergency room, bleeding to death following a traumatic injury and the only way to save their life is through a blood transfusion…but because of their religious belief the patient has refused the life-saving measure and bled to death.  This is particularly problematic for women who hemmorhage during labor and delivery, victims of any blunt force trauma and of course hemmophiliacs.

Now Claudia’s personal religious beliefs and healthcare choices were certainly none of my business and I would never step beyond taking an intellectual curiosity in them.  What she did with her body was her prerogative and I respected that.  However, what her expectations were regarding what I would do with her children when they were in my care definitely required further conversation.

I started what I was concerned would be an uncomfortable conversation by asking her if she would approve of her children having blood transfusions if it was medically necessary to save their lives.  She gave me an unequivocal no as her response.  I approached the next stage of the conversation delicately.  Claudia would frequently leave the girls in my care while she was at work.  If something had happened with the girls along the lines of a freak accident while playing in the driveway, a slip of the kitchen knife while slicing through cookie dough, a high fall out of the big tree in the backyard or anything that might cause major blood loss for that matter, and the girls needed to be rushed to the emergency room then I would need to act as the agent for their medical care.  In an emergency situation I may be asked to give consent to medical professionals to move forward with a blood transfusion to save the girl’s lives.  If this horrible scenario ever were to manifest itself as reality I would feel ethically compelled to say yes to a blood transfusion. 

I explained to Claudia that I was happy to continue watching the girls.  However, if she left them in my care, then she needed to know that should something happen to them and I had to act as their guardian in an emergency situation, I would have to honor my personal ethical beliefs and always opt for the blood transfusion.  She did not feel comfortable with this owing to her belief that receiving the blood of another was a sin, and so we agreed that the girls and I could continue to decorate, but that going forward she would not leave the girls alone with me where I could possibly be placed in a situation where I may have to make a decision regarding the girls’ healthcare.

In our increasingly diverse society there is a strong possibility that the person caring for your child may not be of the same ethical or theological tradition as you and there are a lot of questions we simply don’t ask. Had it not been for the relatively innocuous activity of decorating a Christmas tree I don’t know how much time may have passed before I learned of Claudia’s religious beliefs. I had thought to ask about all of the girls’ food allergies and whether or not she wanted the girls to stick to vegetarian, gluten-free, sugar-free pescatarian or paleo diets but not to delve into Claudia’s theology.  Thankfully nothing ever happened with the girls.  But it stayed in my mind all these years that while we are comfortable asking people about every aspect of their parenting ideology and whether or not we can give their kids candy that may have trace elements of peanut in the nougat we aren’t always mindful of the fact that there are profound issues of faith that it is not only OK, but meaningful and essential to discuss.