JW patient for THR

PIG Meeting: 13th May 2021

Male patient 70+ for THR.

Issues:

  • Jehovah’s Witness
    • Initial surgeon declined to operate due to JW status (acceptable ethically as long as the clinical refers the patient to an alternative practitioner)
    • Patient required an advanced care plan which included specifics of blood products. Sent from pre-anaesthetic clinic with advice to speak with his church for assistance.
    • Local JW church declined to be involved due to patient’s lack of ongoing formal involvement with the church.
    • GP declined to advise on ACP due to lack of knowledge in this field.
    • Face-to-face consultation arranged in clinic
      • Full list of available blood products discussed
      • NSW Health ACP used to guide discussion, with additional caveats included regarding blood products.
      • Patient revealed that in case of life-threatening haemorrhage, he certainly WOULD accept life-saving blood products. He still identifies as a JW.

Discussion

  • Church figures may not always be helpful in assisting the patient to make decisions, as they have their own strong beliefs which they will encourage the patient to follow.
  • Even a JW patient who comes prepared to the consultation may be unaware of many available products, may request products which are not available in Australia, and may not understand the consequences (death) of avoiding blood products in critical bleeding.
  • Models at other institutions include an MDT with the patient, haematologist, JW-liaison officer, surgeon and anaesthetist.
  • Current best practice in our clinic is (for surgeries with a material risk of haemorrhage – e.g. those requiring G&S) to review the patient, then encourage them to speak with their church and review all available blood products, then to re-review the patient in clinic/by phone to formally document all of their wishes.
  • Ongoing project in the Peri-operative department regarding blood product documentation for JW patients.