This article discusses capacity and consent in Jehovah Witnesses, how to apply the four ethical pillars, and includes a model interview question and answer.

Have a go at answering some of the example medicine interview questions to test your knowledge on the subject.

Jehovah's Witnesses Beliefs Blood Transfusions Medical Ethics Medicine Interviews Medical Ethics 4 Pillars TheUKCATPeople

Jehovah’s Witnesses and Medical Ethics Summary:

Jehovah’s Witnesses are a group of people who believe in Christian religious beliefs. They refuse blood transfusions as they believe that blood is sacred and cannot be administered intravenously.
If a patient has capacity and they decline a blood transfusion, a doctor must respect the patient’s autonomy and choice to refuse.
If the patient lacks Gillick competence, the doctor could consider acting in the patient’s best interests.
Doctors should consider advance directives and a lasting power of attorney to support their decision. Legal advice (from the Court of Protection) can also be used if the doctor has enough time.
Additional factors, like ensuring that the patient has not been coerced, are important to protect the patient’s wishes.

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Beliefs of Jehovah Witnesses on Blood Products:

Jehovah’s Witnesses are a Christian denomination that was founded in the 19th century.

They believe that the Bible is the primary way in which God communicates with humans, and they have their translation of the Bible, known as the New World Translation of the Holy Scriptures.

A distinctive belief of Jehovah’s Witnesses is that they refuse blood transfusions, as they believe that blood is sacred and should not be ingested.

Jehovah’s Witnesses refuse blood transfusions that contain components of :

red blood cells
platelets
plasma
whole blood
white blood cells

It is essential to recognise that each Jehovah’s Witness will have their preferences regarding what they can accept and refuse.

As a doctor, it is crucial to clarify these choices with the patient.

👉🏻 Read more: Medicine Interview Preparation Help

Medical Scenarios And Ethics: Jehovah’s Witnesses

It is important to discuss the ethical pillars when asked about Jehovah’s Witnesses in your medicine interviews and to consider different medical scenarios that you could be asked about.

If the patient has capacity:

If the patient has capacity (i.e., they can understand information and communicate it back to the doctor), they then have the right to refuse the life-saving blood transfusion.

To ensure that the patient has capacity, fully explain the blood transfusion procedure to them and discuss the advantages and disadvantages. Subsequently, give them time to retain this information and ask the patient to communicate this information back to you.

If they express that they have chosen to refuse, as a doctor, it is important to ensure that they have made a fully informed decision.

You must ensure that they have understood the implications of refusing the treatment and that this decision has been made without any coercion from family members or friends.

By accepting their refusal, you are valuing the patient’s autonomy (their right to make their own medical decisions) and you are respecting their choices.

👉🏻 Read more: Capacity in Medicine Interviews

If the patient lacks capacity:

There are many reasons why a patient might lack capacity and cannot express their choice of whether they would accept or refuse the blood transfusion.

Examples are:

If they are unconscious or drowsy
If they have neurodegenerative health conditions (eg, dementia)
If they have severe learning disabilities
If they have mental health conditions (eg, schizophrenia)

NB: Capacity is decision-specific and time-specific so having a condition above does not necessarily mean someone lacks capacity, but may lead to that depending on the situation.

In this case, doctors can refer to the patient’s advance directive, which is a legal document that explicitly states their refusal of blood products. The advanced directive must be in writing, and it must be signed by the patient themselves in order to be accepted. This protects the patient’s autonomy in emergency situations.

Alternatively, the patient may have a lasting power of attorney. This is where the patient has appointed a single person to express their decision to refuse the blood transfusion, in case the patient is unresponsive. The advanced directive and the lasting power of attorney work hand in hand.

However, there are situations where the patient may not have an advanced directive or a lasting power of attorney. In this case, the doctor should talk to the patient’s family to see what their choice would be, which can help act in their best interests.

It would also be worth mentioning in an interview that the doctor should seek advice from the multidisciplinary team and should seek legal advice.

Here, you could mention the medical ethical pillar of justice and how, if the family is refusing the option of a blood transfusion, urgent applications to the Court of Protection can be issued.

This all depends on how much time the doctor has and the urgency of the patient’s case.

If the patient is a child:

If the patient is 16 or 17 years old and they have capacity, they are technically able to consent or refuse the blood transfusion procedure.

However, their refusal of life-saving treatment can be overridden by the court and parents' consent can also be used to authorise treatment in this age group.

If the patient is under the age of 16, you must assess them for Gillick competence.

This is similar to testing for capacity as you would assess if they can understand the procedure, if they can weigh up the advantages and disadvantages of the procedure, and can understand the consequences of not receiving the procedure.

In the case of a life-saving situation, where those with parental responsibility have refused the treatment, a doctor can seek an emergency court order to administer the blood transfusion in the patient’s best interests.

This considers the ethical pillar of beneficence and describes how the doctor is taking action to save the young patient’s life. The rationale behind overriding this decision must always be documented in the patient’s medical notes.

👉🏻 Read more: Gillick Competence & Fraser Guidelines

Medical Ethics: The 4 Pillars When Considering Jehovah’s Witnesses and Blood Transfusions

Autonomy: The doctor should always endeavour to support the patient’s choices. If the patient has capacity, the doctor should respect the patient’s choice of refusing the blood transfusion. Advanced directives and a lasting power of attorney further protect the patient’s autonomy.

Beneficence: The doctor should aim to act in the patient’s best interests to promote their survival and health. The doctor could also seek alternative treatments to the blood transfusions.

Non-maleficence: Not administering the blood transfusion could lead to the patient’s health deteriorating further. However, administering the blood transfusion to a Jehovah’s Witness goes against their religious beliefs, and this could harm their mental or spiritual health.

By going against their wishes, this could risk damage to the patient-doctor relationship. The doctor must balance both of these risks when making the decision.

Justice: The doctor should ensure that the patient is being treated fairly and in accordance with the domains of the GMC guidelines. The doctor should aim to seek legal advice, especially in urgent situations, from the Court of Protection.

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Jehovah’s Witnesses' Alternate Treatments & Dilemmas:

The NHS has adapted to utilise alternative treatments for Jehovah’s Witnesses, if they are losing large volumes of blood. Examples include:

Volume expanders: This can be used to replace and maintain internal fluid volume. Substances like albumin and saline can be used
Medication: Erythropoietin can be used to stimulate the production of a greater number of red blood cells.
Blood clotting medication: Tranexamic acid and clotting factors can be used to reduce the amount of bleeding occurring in the patient.

How to answer MMI Medicine Interview Questions on Jehovah’s Witnesses:

Jehovah’s Witnesses' questions are common ethical questions during interviews and can often be presented within the context of a medical scenario. These are important tips that you can remember when answering these questions:

Always remember to refer to the 4 pillars of medical ethics! Go through each of the pillars and justify how your answer to the question supports the pillars. This also provides your answer with a nice structure.
Remember the use of a lasting power of attorney and advance directives. Mentioning this to your interviewer indicates that you have researched this topic.
Discuss capacity and Gillick competence. Discuss what you would do if the patient does or does not have capacity (depending on the context of the question)
In your answer, consider other additional factors that would impress your interviewer, like best interests, coercion, and how much time the doctor has.
Remember that the interviewer may present counter-arguments or may push you on certain points! This is normal for ethical stations- just stay calm and fully justify and explain your points.

👉🏻 Read more: Answering Ethics Medical Interview Questions

Jehovah’s Witness Medical Interview Model Question and Answer:

There is a 6-year-old child who is unconscious and requires a blood transfusion to save their life. Her parents are Jehovah’s Witnesses and state that their child cannot have a blood transfusion. Discuss what action you would take and explain the ethical implications of this.

Answer: This is an incredibly distressing situation for everyone involved, and my first thoughts would be for the child who is critically unwell, and for her parents who are facing a terrible conflict between their faith and their child's life. My approach would have to be calm, methodical, and compassionate.

My absolute first priority would be the child herself. Alongside my team, I would do everything possible to stabilise her using methods that don't involve blood products. This means securing her airway, breathing, and circulation with things like saline or other volume expanders, and using any medications that could help reduce bleeding. This is the immediate practical application of my duty of care.

Simultaneously, it would be crucial to have a senior, experienced clinician speak with the parents. This conversation needs to be handled with immense empathy. We need to acknowledge their faith and their distress, making it clear that we respect their position. The goal isn't to argue, but to explain calmly that we've reached a point where we believe blood is the only remaining option to save their daughter's life.

This is where the formal process must begin, and it has to happen very quickly. I would immediately escalate to my consultant and the hospital’s on-call management to engage our legal team. As doctors, we can't simply override a parental refusal, but we also cannot stand by and allow a child to die when a life-saving treatment exists.

The established legal pathway in the UK for this exact scenario is to apply for an emergency court order. This is a rapid process designed for out-of-hours, life-or-death situations. The hospital lawyers would apply to a judge for what’s known as a Specific Issue Order, authorising the transfusion. The courts almost invariably grant these orders because the law is very clear: in any conflict, a child's right to life is held as the paramount consideration.

So, in summary, my role is to provide all possible immediate care, ensure the family is treated with compassion, and, crucially, to initiate the official legal process that allows us to act in the child’s best interests. The decision to transfuse is ultimately authorised by the court, allowing us to fulfil our primary ethical duty of preserving the life of our vulnerable patient.

Jehovah’s Witnesses: Medical Interview Questions

A patient refuses a life-saving blood transfusion. Discuss the ethical issues here.
An 85-year-old patient with dementia refuses an emergency blood transfusion. She is a Jehovah’s Witness. What action would you take here?
How do you manage conflict between a patient’s medical needs and their religious beliefs?
What is the role of autonomy in Jehovah’s Witnesses who refuse blood transfusions?
What is the role of beneficence in Jehovah’s Witnesses who refuse blood transfusions?

Harder questions - less likely to come up!

How would you respect Jehovah’s Witnesses’ religious beliefs while also providing effective care?
What is the role of informed consent for Jehovah’s Witnesses who refuse blood transfusions?
Which skills are required to navigate a situation where a Jehovah’s Witness is refusing blood products?
How would you manage disagreements between the patient’s family and the medical team?
Describe a situation where you had to manage conflict.

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Jehovah’s Witnesses FAQS

What are Jehovah’s Witnesses?

They are a group of people who follow Christian beliefs that date back to the 19th century. A crucial characteristic of Jehovah’s Witnesses is that they refuse blood transfusions and those with components of white blood cells, plasma, and platelets.

Why do Jehovah's Witnesses refuse blood?

They believe that blood is a sacred substance and that it should not be ingested. It cannot be administered intravenously.

What should a doctor do if the patient refuses the blood transfusion?

The doctor should assess the patient for capacity, and if they have capacity, the doctor should respect the patient’s autonomy and right to refuse the blood transfusion and should seek alternative treatments.

Which ethical pillars should be considered?

The patient’s autonomy or right to make choices should be respected. Beneficence should be considered, and which actions would be in their best interests. Non-maleficence and avoiding causing harm to the patient should be considered. Also recognising that justice has a role in ensuring that the patient is treated fairly.

What is done if the parents of a child refuse the blood transfusion?

In this case, assess the child for Gillick competence. If the child is too young and is not competent, the doctor can override the decision and provide the blood transfusion in the patient’s best interests.

What is the role of advanced directives and a lasting power of attorney?

Advance directives are legal documents that specifically state the patient’s wishes. A lasting power of attorney is a trusted person that states the patient’s choices if they are unconscious.

How can disagreements between the patient’s family and medical team be handled?

The doctor should consider seeking advice from the multidisciplinary team and a consultant. In urgent cases, the doctor can apply for advice from the Court of Protection to ensure that the patient will be treated fairly.

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