Ectopic Pregnancy and the Jehovah's Witness It is important to be aware of cultural and religious beliefs within a community, especially as a health care provider, because when dealing with patients from within that community there can be tensions that arise if the treatment violates a principle of the cultural/religious community. This would be the case were a member of Jehovah's Witness community to come into the hospital with the symptom described in the case study in which the woman has ectopic pregnancy. Because it is a tenant of the Jehovah's Witness community to reject blood transfusion, it is important that a hospital have a back-up plan for such cases so as to be able to practice "bloodless medicine" in order to save the lives of patients like the 25-year-old woman in the case scenario (Ratcliffe, 2004). This paper will discuss the impact of treating Jehovah's Witnesses when the treatment requires blood transfusion.

It is a belief of Jehovah's Witnesses that one should not ingest blood or allow blood transfusions, based on their interpretation of the Bible. This belief is based on passages within the Bible that relate to the blood and the sacredness of life. These passages include Genesis 9:4 ("But you must not eat meat that has its lifeblood still in it"), Acts 15:29 ("You are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals ... "), and Leviticus 17:10 ("I will set my face against any Israelite or any foreigner residing among them who eats blood, and I will cut them off from the people"). Moreover, the official publication of the Jehovah's Witnesses, The Watchtower, elaborates on the principles on this belief and the practices that should be observed by all the faithful -- such as, abstention from the eating or transfusion of blood (even in medical emergency. Therefore, acceptance of a blood transfusion by a Jehovah's Witness who does not repent is liable to be excluded from his church and viewed as a pariah by former friends and members (Muramoto, 2001). Thus, the belief has both "spiritual" and social ramifications.

To understand the position of the Jehovah's Witness and to be able to provide a more ethical standard of care to such a patient, it is helpful to have a sense of the general beliefs as well. For instance, the general beliefs of the Jehovah's Witness regarding birth are that "life begins at conception," that life is sacred, that abortion is sinful and should never be practiced even to save the mother's life (DuBose, 2002, p. 6). Moreover, birthdays are not occasions of celebration for the Jehovah's Witness as there is no Bible basis for such celebrations and it is their belief that the Bible recommends celebrating only those days that are related to the glory of God because everything else has pagan roots (DuBose, 2002).

The general beliefs relating to death stipulate that the final days of the earth are approaching, that Armageddon as depicted in the Bible will soon be here. Yet, their views about what happens when one dies are unique: they believe that "death means only the termination of conscious existence. Hell is not eternal torment," but rather a separate existence apart from those who are called to Jehovah. Death prior to Armageddon is simply like a sleep. Nonetheless, life is still deemed as precious, since it is a gift from God, and therefore Witnesses do not support suicide, as this is a rejection of the gift of life, which no one has the right to refuse as God has obviously willed it or else it would not be. This is reconciled to the idea of refusing medical treatment such as blood transfusions that could potentially assist in saving lives because the spiritual or Biblical principle upon which that rejection is based supersedes the principle of embracing life, as it is believed that it is better to die with a pure conscience and soul than to die having defiled it through the breaking of one of God's commandments. Thus, life is to be preserved so long as it can be preserved without offending God.

Their general beliefs related to illness and disease are that disease is primarily the effect of a "degenerative process that began with Adam's fall from grace and would not be reversed until after Armageddon" -- thus, there is a certain amount of fatalism intertwined within the Jehovah's Witness

2). At the same time, the founder of the religion expressed his belief in a psychosomatic trend in moderns, asserting that "one half of the people in the world are sick because they think they are" (Dubose, 2002, p. 2). For this reason, one can discern the reason Jehovah's Witnesses did not set up their own health care facilities, as Christian denominations have throughout history. It is their belief that operating health care facilities would be a waste of time since Armageddon is fast approaching and time is better spent preaching and spreading the word of Jehovah than in attempting to fix or heal physical maladies that will really only be healed by God post-Armageddon (DuBose, 2002).
Jehovah's Witnesses are not averse to receiving medical treatment; they simply do not view it as being as important as living for Jehovah. Their view is that one can receive health care so long as it does not violate any of their principle religious tenets or practices.

With this knowledge in mind, the medical team might consider responding after hearing the couple's concerns (as presented in the case study) by developing a conceptual framework that is respectful of the couple's religious beliefs. This is the ethical standard of practice that has been adopted in similar cases (Tannsjo, 2015). Care should be taken, however, to examine alternative means of providing care -- for example, "bloodless medicine," as noted in the study by Ratcliffe (2004). As Ratcliffe (2004) notes, "bloodless medicine is quality medical care employing alternative nonblood medical management as well as minimizing blood loss" and has been an established practiced since the 1980s, as a result of "organized efforts of Jehovah's Witnesses" in Canada and then in the U.S. (p. 405). A bloodless medicine care plan would need to be provided and practiced by the health care team or else the patient would need to seek out this -- but as part of the care provision, this alternative procedure should be discussed and the couple should be educated about their options rather than pushed into a decision that no one wants to be forced to make. This is the most ethical approach considering the patients, their beliefs, and the problem at hand.

To see how this approach applies to this specific problem, one should understand what is causing the pain and suffering in the ectopic pregnancy. The most common symptom that occurs is abdominal pain and bleeding, as a result of the ectopic pregnancy, which is the attachment of the fertilized egg attaches and develops outside the endometrial lining of the uterus. As the embryo begins to grow, bleeding and heavy cramping can occur. There can also be lightness of the head, dizziness, fainting, depending on how the woman's body responds to the stress.

The health of the woman, of course, is of primary concern, though ethical standards support the notion that a "competent adult has a 'paramount right' to refuse" treatment that would violate religious beliefs" (Mirza, Gyamfi, 2010, p. 42). In terms of whose life is more important, the mother's or the baby's -- this question is not one that can or should be asked to the Jehovah's Witness, as the Jehovah's Witness believes that all life is a gift from God and that one should not respect one life any more than another life. Moreover, it should be apparent that all that can be done to save a life should be done so long as that procedure does not violate a tenet or principle of that person's belief system.

At the same time, it should be acknowledged that an ectopic pregnancy is a life-threatening case for the mother, who may die from blood loss if, for instance, her ovary, where implantation has occurred, should burst from being stretched too far by the growing baby. The danger of proceeding with an ectopic pregnancy is well-known by researchers in the medical field. But this does not mean that ectopic pregnancies cannot be delivered by Caesarean -- which has occurred before (though without knowledge of the doctor or the mother that the child was ectopic) (Ertelt, 2008). Nonetheless, reactions to this news from within the medical field were that such cases have the odds of a million to one of actually ending without loss of life. So this is not a common experience and should not be relied upon in order to instill hope in the patient. Instead, alternative measures should be provided and discussed.

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