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Representatives of the Watchtower organization state that Jehovah’s Witnesses respect the autonomy of patients. The same representatives demand that others should do the same thing.
According to the Watchtower organization, what does it mean to respect a patient's autonomy?
1987 — May Need to Report It
In 1987 Watchtower published an article that sanctioned conduct of Jehovah’s Witnesses for choosing to breach laws of patient confidentiality by reporting a supposed “sin” to a third-party. Under Watchtower doctrine, among such sins is the conscientious acceptance of blood transfusion.[1-2]
In response to Watchtower’s 1987 sanctioning of illegal conduct, legal and medical sources identified the problem and issued warning.[3]
1990 — Submit to Written Requests
In 1990, Watchtower asserts the view of professor Daniel Anderson[4] by writing:
In terms of respecting patient autonomy, this 1990 Watchtower position requires submission to written statements of a patient.
In developed societies when patients enter medical systems they are asked to put in writing who has permission to see, use and share details of their medical decisions and treatment. Hence, at face value, in its 1990 presentation Watchtower proposes that respect for patient autonomy would preclude the illegal conduct sanctioned in its 1987 presentation because such illegal activity would not be submitting to a patients written request.
So does Watchtower sanction illegal breaching of written privacy agreements, or not?
1998 — You Tell or I Will!
In 1998 David Malyon, a Watchtower representative wrote two articles published in a prestigious medical journal addressing its position on blood transfusion and Jehovah’s Witnesses.[5] Malyon had some interesting things to say about Watchtower's 1987 article approving of illegally breaching medical privacy law.
Among other things, Malyon said he “would not have reached the same decision as ‘Mary””. (“Mary” is the hypothetical Jehovah’s Witnesses spoken of in Watchtower’s 1987 article.) What does Malyon mean saying he would “not have reached the same decision as Mary”?
In Watchtower’s 1987 article Mary decided she should do something about the confidential medical information she was privy to. She decided to speak personally with the patient in an effort to coerce her to confess her sin to Watchtower appointees known as congregation elders, and this is what she did with her goal achieved. Malyon, though, says he would not have made the same decision. So what would he have done?
In his 1998 article Maylon cites the hypothetical sin of a fellow believer he would be privy to and says he would confront this fellow believer by saying “Are you going to tell them or shall I!”
As it turns out, the choice espoused by Malyon would be to give the “sinner” an ultimatum, and that ultimatum would include a direct threat to reveal private information. What makes this remarkable is that David Malyon is a member of Watchtower’s Hospital Liaison Committee network and he was writing in that official capacity.
Despite Watchtower's earlier 1990 language that would preclude illegal breaches of written patient confidentiality requests as a means of respecting patient autonomy, in 1998 Watchtower’s representative expresses a contrary notion. Watchtower representative and Hospital Liaison Committee member David Malyon makes no bones about it. He would confront Witness patients he knew had conscientiously accepted blood transfusion with threat of ‘Either you will report your sin to the elders or I will!’
Oddly, David Malyon’s bold admission that he would engage in threatening behavior in the context of discussing medical issues is made in an article he titles “Respecting the Autonomous Patient's Rights”. A fundamental right of every patient is the right to privacy. Malyon admits he would treat this right with contempt. Hence we have an article’s title conveying one message and its text containing a contrary message.
Today
Watchtower’s teaching that its members should report the “sin” of accepting blood transfusion remains as mainstay teaching. In its 2010 manual provided to congregation elders the teaching is well embodied in the succinct question, “Did he voluntarily confess, or did the matter come to light by other means?”
Two Standards
Of medical providers, Watchtower’s position on respecting patient autonomy would, as an ethical standard, require submission to a patient’s written requests, which requests include who they give permission to access, use and share their private medical decisions and treatments.
Of Jehovah’s Witnesses working in the medical field, Watchtower’s position on respecting patient autonomy would, as an ethical standard, not require submission to a patient’s written requests, which requests include who they give permission to access, use and share their private medical decisions and treatments.
It is for good reason that in year 1988 author Courtney Campbell warned the medical world that “Jehovah’s Witnesses employed as health care workers may be obligated to violate institutional, professional, or legal requirements protecting patient confidentiality of fellow Witnesses.”[3]
Marvin Shilmer
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References:
1. The Watchtower, September 1, 1987 pp. 12-15.
2. Media release by Jehovah's Witnesses Public Affairs Office out of Watchtower's headquarters in Brooklyn, New York, dated June 14, 2000.
3. Courtney , S. Campbell, The pure church and the problem of confidentiality, The Hastings Center Report Feb-March 1988 v18 n1 p2(1)
4. How Can Blood Save Your Life?, published by Watchtower, 1990 p. 18
5. Malyon, D, Transfusion-Free Treatment of Jehovah's Witnesses: Respecting the Autonomous Patient's Rights, Journal of Medical Ethics, Vol. 24, No. 5 (Oct., 1998), pp. 302-307
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