Conviction in the face of affliction: a case series of Jehovah’s Witnesses with myeloid malignancies

Excerpt

Myeloid malignancies are challenging diseases to treat, and management of Jehovah’s Witnesses (JW) affected by them imposes additional complexities. More than 1.2 million JW lives in the USA, and based on a specific interpretation of several biblical verses, many JW believe that the receipt of blood products is directly against the will of God and thus forbidden irrespective of the clinical indication. Guidance for the receipt of specific fractions of plasma (e.g., cryoprecipitate, albumin, clotting factor concentrates) is unclear and as a result is left up to the individual to decide based on his or her own interpretation [1, 2]. Absence of treatment for the myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) will universally herald disease-related cytopenias and the need for blood product transfusion which if refused often will lead to death. Furthermore, standard therapies for these cancers are myelosuppressive and blood product transfusion is typically an integral component of the therapeutic approach. The optimal approach to such complex and delicate situation begins with respect for the autonomy of competent decision-makers, but also ideally uses therapies which might be less myelosuppressive, yet provide favorable, if not comparable, rates of response and cure. Because of this dilemma, there are no standardized approaches to the care of JW with AML or MDS and many patients will receive suboptimal care including omission of any active therapies. …