Durable Power Of Attorney For Health Care Christian: Fill & Download for Free

As you may already be familiar, becoming one of Jehovah’s Witnesses is a very personal and deeply thought out decision that isn’t entered into lightly. One does not simply accept Jesus and his awesome sacrifice then arrange for baptism. It is a much more detailed process… From the way the question is worded, it sounds as if you are working through that process or weighing how to proceed. I commend you for asking a question that demonstrates your interest in truly considering how best to proceed spiritually! After careful consideration, you’ll no doubt have a firmer foundation from which to take your next steps.One might consider fully the following scriptures so as to reason for themselves regarding abstinence from blood:Why do true Christians abstain from blood - both as nourishment in terms of food or through other means?Genesis 9:44 Only flesh with its life*—its blood—you must not eat.Leviticus 17:1111 For the life* of the flesh is in the blood, and I myself have given it on the altar for you to make atonement for yourselves,* because it is the blood that makes atonement by means of the life* in it.Leviticus 17:14“You must not eat the blood of any sort of flesh, because the soul of every sort of flesh is its blood. Anyone eating it will be cut off.”Acts 15:2020 but to write them to abstain from things polluted by idols, from sexual immorality, from what is strangled, and from blood.Perhaps you’ve read these scriptures and know that taking in blood is something God has specifically requested we not do but you are still scared and uneasy? That’s understandable… no one wants to experience death - we were designed to live forever! It is built into our very nature.That being said, there is some very encouraging news you might not be fully aware of! - Did you know that there are whole hospitals now that specialize in alternate treatments and operations which have in many cases better mortality rates as compared to programs that utilize blood transfusion? It’s true! Check out some of the leaps and bounds recently made in medicine on this front:Doctors explore benefits of "bloodless" surgeryBlood Transfusions Still Overused and May Do More Harm Than Good in Some Patients - 04/24/2012Benefits of Bloodless Surgery - Stanford Children's HealthAvoiding and controlling hemorrhage and anemia without blood transfusionThis is by no means a full list. There are so many more articles available to read - ones from widely respected hospitals and universities such as Stanford, Johns Hopkins and Penn. Feel free to do some further research to see just how many options are actually available to you.Additionally, did you know that Jehovah’s Witnesses are also able to accept some blood fractions? These are components found in one’s blood. See How Do I View Blood Fractions and Medical Procedures Involving My Own Blood? for a more detailed explanation of what blood fractions are.Each one of Jehovah’s Witnesses researches on their own and decides which fractions they feel comfortable accepting and then after personal, prayerful consideration, they fill out a durable power of attorney clearly stating which procedures and fractions they are willing to take in the event they are in an accident or are unable to communicate their wishes themselves.So, you see, you are not without options if you want to mitigate your health concerns AND serve Jehovah! We take adherence to scripture seriously so as to remain in Jehovah’s love and to that we each carefully weigh and research each decision that could affect that precious relationship.By all means, if you sincerely have concerns or questions please feel free to ask more questions of any one of Jehovah’s Witnesses and/or more specifically, your bible teacher if you have one currently as they would be able to show you further resources relevant to your concern.Reference:What does the Bible say about blood transfusions?http://Jw.org

Religious and otherworldly convictions and practices are vital in the lives of numerous patients, yet therapeutic understudies, inhabitants and doctors are regularly indeterminate about whether, when, or how, to address profound or religious issues. Doctors in past circumstances were prepared to analyze and treat sickness and had next to zero preparing in how to identify with the otherworldly side of the patient. What's more, proficient morals obliges doctors to not encroach their convictions on patients who are especially helpless when looking for social insurance. Confounding it further, in our country's way of life of religious pluralism, there is an extensive variety of conviction frameworks going from skepticism, free-thought, to a horde combination of religions and profound practices. No doctor could be required to comprehend the convictions and practices of such a variety of varying confidence groups.At first look, the easiest arrangement recommends that doctors maintain a strategic distance from religious or otherworldly substance in the specialist understanding cooperation. Likewise with many issues, be that as it may, the basic arrangement may not be the best. Research demonstrates that the religious convictions and otherworldly practices of patients are effective variables for some in adapting to genuine sicknesses and in settling on moral decisions about their treatment alternatives and in choices about end-of-life mind (Puchalski, 2001; McCormick et al., 2012). This article asks into the likelihood that inside the limits of medicinal morals and enabled with touchy listening abilities, doctors in-preparing and doctors by and by may discover approaches to draw in the profound convictions of patients in the recuperating procedure, and gone to a clearer comprehension of routes in which their own particular conviction frameworks can be represented in exchanges with patients. Research demonstrates that religion and otherworldly existence are related emphatically with better wellbeing and mental prosperity (Puchalski, 2001; Koenig, 2004; Pargament et al., 2004). Late research likewise demonstrates that patients required in "religious battle" have a higher danger of mortality (Pargament et al., 2001). Therefore, doctors need to ask about the patient's deep sense of being and to figure out how religious and otherworldly elements may help the patient adapt to the present disease, and then again, when religious battle shows the requirement for referral to the cleric.How inescapable is religiosity in the United States?Religious conviction and practice is inescapable in this nation, albeit less unavoidable inside the therapeutic calling. Reviews of the US open in the 2008 Gallup Report reliably demonstrate a high commonness of faith in God, 78% and an extra 15% who have confidence in a higher power (Newport, 2009). In a total of 2013 surveys, 56% claim that religion is vital in their own lives and 22% claim it is genuinely critical (Gallup, 2013). Washington State is one of ten states guaranteeing minimal significance of religion, at 52% (Newport, 2009). In 2010, roughly 43.1% of Americans apparently went to religious administrations at any rate once every week (Newport, 2010). 77% of Americans distinguished themselves as Christian, 5% with a non-Christian convention, and 18% did not have an express religious personality (Newport, 2012).One overview in Vermont including family doctors demonstrated that 91% of the patients announced faith in God as contrasted and 64% of the doctors (Maugans and Wadland, 1991). A 1975 study of therapists demonstrated that an even lower number, 43%, claimed a confidence in God (American Psychiatric Association, 1975). These reviews advise us that there is a high frequency of faith in God in the US open. It additionally creates the impression that doctors as a gathering are to some degree less slanted to have confidence in God. Though, up to 77 percent of patients might want to have their profound issues examined as a piece of their restorative care, under 20% of doctors as of now talk about such issues with patients (King and Bushwick, 1994). Obviously, doctors are not asking about most profound sense of being to almost the degree that patients lean toward (Puchalski, 2001; King et al., 2013).Why is it critical to take care of deep sense of being in solution?Religion and otherworldly convictions assume a vital part for some patients. At the point when ailment debilitates the wellbeing, and perhaps the life of a person, that individual is probably going to go to the doctor with both physical side effects and profound issues at the top of the priority list. An article in the Journal of Religion and Health guarantees that through these two channels, drug and religion, people think about basic issues of sickness, enduring, dejection, gloom, and demise, while looking for expectation, which means, and individual incentive in the emergency of ailment (Vanderpool and Levin, 1990).Definitions: Religion is for the most part comprehended as an arrangement of convictions, customs and practices, normally epitomized inside a foundation or an association. Most profound sense of being, then again, is normally thought of as a look for what is holy in life, one's most profound esteems, alongside an association with God, or a higher power, that rises above the self. People may hold intense profound convictions, and could conceivably be dynamic in any institutional religion. Otherworldly existence can be characterized as "a conviction framework concentrating on impalpable components that bestow essentialness and significance to life's occasions" (Maugans, 1996). Numerous in the time of increased birth rates era who assert not to be religious, admit to a feeling of "veneration" forever, like the idea championed by scholar thinker Albert Schweitzer.Numerous doctors and medical caretakers have natural and episodic impressions that the convictions and religious practices of patients have a significant impact upon their existential encounters with disease and the risk of biting the dust. Late research bolsters this idea. At the point when patients confront a terminal ailment, religious and profound considers frequently figure their adapting techniques and impact vital choices, for example, the work of propel orders, the living will and the Durable Power of Attorney for Health Care. Contemplations of the significance, reason and estimation of human life are utilized to settle on decisions about the attractive quality of CPR and forceful life-bolster, or whether and when to forego life bolster and acknowledge passing as suitable and regular the situation being what it is (Puchalski et al., 2009; McCormick et al., 2012; Ai, 2008). Many are support even with a wellbeing emergency with an inward quiet that is established on their profound trust in God's cherishing look after them in all circumstances.Then again, Pargament's examination uncovers that a few patients in comparable conditions are included in religious battle that may have pernicious impacts upon their wellbeing results (Pargament et al., 2001). He distinguishes particular types of religious battle that are prescient of mortality. Patients who feel distanced from God, disliked by God, or rebuffed by God, or credit their disease to the work of the fallen angel were related with a 19% to 28% expanded danger of kicking the bucket amid the 2 year follow up period (on the same page). An investigation of religious adapting in patients experiencing autologous undeveloped cell transplants additionally recommends that religious battle may add to unfriendly changes in wellbeing results for transplant patients (Sherman et al., 2009). Referral of these patients to the pastor, or proper pastorate, to enable them to work through these issues may at last enhance clinical results (Pargament, et al., 2001).Further, the Joint Commission orders that medicinal services foundations guarantee that patients' profound convictions and practices are evaluated and suited (Joint Commission on the Accreditation of Healthcare Organizations, 2003). Handzo, a cleric, and Koenig, a doctor recommend that the doctor's part (as a generalist in deep sense of being) is to quickly screen patient's profound needs as they identify with human services and to allude to the minister (a master in peaceful care), as proper (Handzo and Koenig, 2004).In what capacity would it be a good idea for me to take a "profound history"?Restorative understudies are generally acquainted with the idea of profound request in courses, for example, "Prologue to Clinical Medicine." Medical understudies take in the different segments of the specialist quiet meeting, regularly starting with points, for example, the main protestation, a past filled with the present sickness, a psycho-social history which incorporates inquiries regarding religion and deep sense of being, and an audit of organ frameworks. Understudies in-preparing are regularly reluctant to make inquiries that they view as meddlesome into the individual existence of the patient until the point when they comprehend there are legitimate purposes behind getting some information about sexual practices, liquor, the utilization of tobacco, firearms, or non-professionally prescribed medications. Religious conviction and practice frequently fall into that "individual" class that understudies in-preparing in some cases stay away from, yet when substantial reasons are offered by instructors and tutors for getting an otherworldly history, understudies promptly figure out how to consolidate this line of addressing into the patient meeting.Regularly, the profound history can be joined into what we may now need to call the "bio-psycho-social-otherworldly" patient history. Understudies are educated to make a move by basically expressing something like the accompanying: "As doctors, (or, as doctors in-preparing,) we have found that a significant number of our patients have otherworldly or religious convictions that have an orientation on their impression of sickness and their favored methods of treatment. In the event that you are open to talking about this with me, I might want to get notification from you of any convictions or practices that you would need me to think about as your parental figure." If the patient reacts certifiably, follow-up inquiries can be utilized to evoke extra data. In the event that the patient says "no" or "none" it is a reasonable flag to proceed onward to the following theme, in spite of the fact that it is regularly beneficial to ask before leaving this point if other relatives have otherworldly convictions or practices with a specific end goal to better comprehend the family setting and expect worries of the close family.From years as a clinical t

Re your query: Do Jehovah's Witnesses know that 4.5 million lives are saved each year by blood transfusion? Would God want the equivalent of half the JW population to die each year because he views life as sacred?I appreciate your query but please note the following comments by well know surgens:Please note the following comments from well known Surgens on the matter of ‘Blood Transfusions’TRANSFUSION ALTERNATIVE HEALTH CAREMeeting Patient Needs and RightsNarrator: Each year in this new millennium, pressures on health-care systems mount. The growing number of patients, particularly the elderly, challenges health-care providers’ ability to meet patient needs with available resources. At the same time, legal and ethical voices increasingly advocate that patients be permitted a greater role in choosing their treatment. These developments especially affect one major sector of health care.Prof. Neil Blumberg: There’s a growing concern on the part of physicians that our approach to blood transfusion needs to be reevaluated.Prof. Roland Hetzer: Today at least 80 percent of the patients would strongly favor not to have blood transfusions.Narrator: News headlines show this, both physicians and patients are faced with transfusion complications, supply shortages, and concerns about blood product safety. As just one example, the world health organization calculates that around the globe unsafe transfusion and injection practices cause some 5,000,000 Hepatitis-C virus infections each year. Increased efforts by national health-care systems to achieve a safer blood supply have caused the cost of blood to spiral upward.Dr. Guy Turner: Two years ago it cost us about 63 euros per unit of transfused blood. It now costs us 142.Narrator: Treating transfusion-related side effects has incurred additional costs.Dr. Aryeh Shander: These costs, which are indirect and delayed, are enormous and clearly would raise the cost of the unit of blood substantially.Narrator: The same holds true for compensation totaling billions of euros or dollars that have been paid to recipients of tainted blood and to their surviving families. As society faces these issues—transfusion risks and costs—is there a better approach? Might transfusion-alternative health care meet patient needs and rights? Professors Earnshaw and Hetzer and countless other clinicians have responded to the requests of patients and of parents of minors. Consider three examples of complex surgeries performed without transfusion. Open-heart surgery is consistently a major challenge. In Berlin, Professor Roland Hetzer explains why he had to operate on the tiny heart of a ten-month-old baby girl.Prof. Roland Hetzer: This child has a congenital heart defect, which is relatively rare. It means there is a direct communication between the left ventricle and the right atrium, which creates a continuous abnormal flow between the left heart and the right heart.Narrator: The defect was corrected with a heart arrest time of only 26 minutes, and the blood flow normalized. No transfusion was given—in fact, there was virtually no blood loss. Another example: Liver surgery usually involves considerable donor transfusion. In Jena, Germany, at the University Clinic, Professor Johannes Scheele here removes the cancerous portion of the liver from an elderly man.Prof. Johannes Scheele: How much was the blood loss today? ...250 CCs.Narrator: No donor blood was given, and 18 hours later, the patient is chatting with the doctor in the ICU. Now an example of orthopedic surgery: In London, Royal College fellow Peter Earnshaw successfully performs a total knee replacement on an elderly woman, typically a high-blood-loss operation. All three successful operations were accomplished by surgical teams committed to respecting the patient’s or parent’s preference that donor blood not be given. Were these experimental operations by three pioneering surgeons? There are more than 100,000 physicians and surgeons in 150 countries who routinely treat patients without donor transfusion. Some experts feel…Dr. Linda Stehling: Every anesthesiologist and surgeon should be interested in blood-conservation strategies because it’s good patient care.Narrator: When physicians who turn to transfusion-alternative health care are asked why, they often cite as a major reason—respect for their patient’s decision. Professor Blumberg, director of a transfusion medicine unit and blood bank:Prof. Neil Blumberg: Well, I think there are a growing number of patients who are interested in being treated with either no transfusion or the minimum amount of transfusion possible, and there are some folks who strictly don’t want to be transfused under any circumstances.Narrator: Another area motivating physicians and surgeons to change their approach is the growing evidence of inconsistent practices leading to unnecessary transfusions. Everyone concerned with improving health care or protecting the individual patient should consider some revealing studies on blood use. First, the Sanguis Study. As part of a concerted action by the European Commission Medical Research Program, transfusion rates in 43 major teaching hospitals across Europe were analyzed. The ramifications of the Sanguis Study are staggering—for the same type of operation, there were enormous variations in the number of units transfused, depending on the hospital! In 1998 in Brussels, Professor Baele published a follow-up study.Prof. Philippe Baele: All types of hospitals were included in the Belgium Biomed Transfusion Study for Surgery. And we found exactly the same range of variability.Prof. Lawrence T. Goodnough: So we are left with the conclusion that variability implies that a lot of these blood transfusion components are being given unnecessarily.Narrator: A comparison of the two studies revealed another significant fact.Prof. Philippe Baele: There were two centers which participated both in the Sanguis Study and in the Biomed Study.Narrator: Based on their findings in the Sanguis Study:Prof. Philippe Baele: They had somehow managed to reduce their blood consumption for major surgery. The mortality was the same before and after the changes. The hospital stay was shorter. The new procedures they adopted weren’t very difficult to adopt, although they took time and took a considerable educational effort, but they didn’t result in increased costs.Narrator: Soon after, in Canada, Dr. Hebert did a large-scale study of critically ill patients in intensive care. Professor Spahn evaluates the results.Prof. Donat R. Spahn: I talk about the Hebert paper, where they showed in more than 800 patients that less transfusion results in an improved outcome.Narrator: The obvious conclusion is that unnecessary transfusion translates into unnecessary labor and unnecessary cost. Besides patient demand and overtransfusion, many physicians cite as motivation to implement transfusion-alternative health care the desire to avoid medical risks.Prof. Lawrence T. Goodnough: There’s the risk of bacterial contamination in a stored unit of blood.Narrator: Bacterial contamination, whether occurring at donation or subsequently from improper storage, can cause infections having fatal consequences. In another arena, despite improved testing viral infections continue to pose a serious threat. Experts are concerned about what the future holds.Dr. Howard L. Zauder: Will existing viruses mutate and produce disease? There’s no reason to believe that they won’t.Prof. Peter H. Earnshaw: The problem with contamination of transfusions, it always seems to be one step ahead of us.Prof. Donat R. Spahn: In addition, blood transfusions induce a immunosuppressive state with the recipient, and that results in increased postoperative infections as well as earlier and more often recurrence of tumors.Prof. Neil Blumberg: We’ve estimated that, approximately, in the United States, we can expect that 10,000 to 50,000 patients a year may be dying from transfusion-immunomodulation related causes.Narrator: Likely the most surprising and least recognized medical risk is human error—giving blood of an incompatible type can cause a reaction ranging from mild to fatal. Professor Spence, a director of surgical education, acknowledges:Prof. Richard K. Spence: We can mix the blood up and cause catastrophe. Patients have died and do die from getting the wrong blood.Narrator: In fact, reports indicate that human error causes up to one half of all transfusion-triggered deaths! In the light of such realities—patient decision, unnecessary transfusions, medical risks, as well as shrinking blood inventories and soaring blood costs—Professor van der Linden summarizes what many experts have concluded:Prof. Philippe van der Linden: In view of the potential for a better patient-care and a reduced health-care cost, blood conservation is not an option, it’s a must.Narrator: The good news is that safe, practical, and cost-effective therapies already exist.Dr. Aryeh Shander: The best medical care can be delivered without the use of allogeneic blood.Prof. Peter H. Earnshaw: There are some very simple, very cheap things you can do, which would help the majority of people, and this could be done in the smallest of hospitals.Prof. Johannes Scheele: Blood conservation is a very simple method, which make things rather smooth, less expensive, and with a better outlook for the patient.Narrator: The transfusion-alternative techniques used by these surgical teams can be grouped within one of three basic principles, or pillars. The first is “tolerance of anemia.” Racing through the arteries, red cells carry life-sustaining oxygen to all parts of the body. The anemic patient has a low number of red cells in relation to his blood volume. If a person suffers extensive blood loss during surgery or as the result of an accident, the body can tolerate anemia to a considerable degree. Professor Moore, an acknowledged pioneer in trauma surgery:Prof. Ernest E. Moore: Studies have shown, physiologically, that the human being can tolerate much lower hemoglobin levels than previously assumed safe.Dr. Aryeh Shander: The medical community is starting to realize that tolerance of a significant anemia is doable for patients.Narrator: However, anemia is tolerable only when the body has sufficient circulatory volume to continue to function.Prof. Richard K. Spence: We also know that with that anemia, we can compensate with volume, because volume is the critical component here to maintaining blood pressure.Narrator: With low-cost blood volume expanders being available, current medical opinion increasingly abandons the arbitrary rule, proposed back in 1942, that a hemoglobin level of 10 was the transfusion trigger, or the lowest acceptable figure before administering a transfusion. Thus, Professor Earnshaw notes his first step in implementing a transfusion-alternative program:Prof. Peter H. Earnshaw: I halved our transfusion rate by simply saying, ‘could we lower our triggers from 10 to 8?’ And just taking a little more control over the decision. That was very easy. That cost nothing.Narrator: Simply implementing the first pillar would cut out millions of transfusions and save billions of euros or dollars annually! The second important principle in transfusion-alternative strategies involves stimulating red-cell production in the patient’s body. This is important for an anemic patient before surgery, and it can speed recovery after extensive blood loss. Studies directed by Professor of Obstetrics Albert Huch have shown:Prof. Albert Huch speaking German: Sufficient iron supplementation can already normalize the blood count to a large extent and at relatively little expense.Narrator: In selected cases, the genetically engineered drug erythropoietin, commonly called epo, can be used. Professor Mercuriali, a director of transfusion services, explains:Prof. Francesco Mercuriali: Stimulated by the administration of erythropoietin, there is an acceleration of production of new red blood cells.Narrator: The third principle, or pillar, is to minimize blood loss.Prof. Johannes Scheele: The most important technique to control bleeding is to avoid bleeding.Narrator: Meticulous surgery is practical and cost-effective. A variety of tools can be used to assist. For example, electrocautery devices enable surgeons to cut rapidly and to seal blood vessels immediately. There are also modern drugs that can reduce bleeding. Some are applied directly to the bleeding area. Here a fibrin glue pad is used to stop blood from oozing out of a dissected liver. Professor Baron notes about the cost-effectiveness of such agents:Prof. Jean-François Baron: The decrease in the intraoperative bleeding and the decrease in the use of blood products compensates for the cost of the drug.Narrator: Another effective technique to minimize loss in instances of heavy bleeding is to salvage the patient’s own blood. Recovery of as much as 50 percent of the blood otherwise lost has become a reality. This technique also meets the ethical needs of many who absolutely refuse donor transfusions. For instance, some of Jehovah’s Witnesses have allowed cell salvage to be used. There are even such machines designed for small children.Prof. Donat R. Spahn: Cell salvage is a very important technique because when you use cell salvage, the blood lost by the surgeon is not lost for the patient.Narrator: Many other beneficial strategies are available. All assist in avoiding the risks and societal costs of millions of transfusions. To illustrate the impact of properly combined techniques, consider the task faced by the medical team of four-year-old Luana in Modena, Italy. She was born with a serious heart defect. Her team, headed by Professor Marcelletti, chief of cardiovascular surgery, had to perform a series of complex operations. As requested by Luana’s parents, the first operation was successfully done without donor blood. Once again, for the second procedure, there were both skilled personnel and the appropriate equipment, including a cell-salvage machine. The meticulous surgery, utilizing electrocautery, took two hours, and Luana lost only 100 milliliters of blood! Her parents were delighted, and the medical team was pleased with the outcome.Prof. Carlo F. Marcelletti: We have performed the operation without the use of a blood transfusion, as we try to perform with all of our children.Dr. Nicoletta Salviato: I think all these little babies deserve not to be transfused and not to take the risk of a blood transfusion.Narrator: Further proof of the effectiveness of heart surgery without transfusion is provided by Dr. Rosengart:Dr. Todd K. Rosengart: When we looked at a series of 50 Jehovah’s Witnesses patients and 100 patients in the general population, we found a shorter length of stay and a lower cost using our blood-conservation strategy.Narrator: While many clinicians would hold that some situations absolutely require blood, what is the view of those experienced in the use of transfusion alternatives in life-threatening emergencies? First, an anesthesiologist’s perspective:Dr. Aryeh Shander: The cessation of bleeding, whether surgically or by other means, must be the first principle. It’s important to act quickly, and to keep in mind that modalities are still available even in a trauma situation.Narrator: Next, a surgeon’s perspective:Prof. Johannes Scheele: In any trauma patient with a significant blood loss, I would always prepare the cell-saver system.Narrator: In one of the busiest trauma centers in the United States, Professor Cohn, chief of Trauma and Surgical Critical Care, notes about patients declining donor blood:Prof. Stephen M. Cohn: We see more than 3,000 patients a year here that are Jehovah’s Witnesses, and we do about 250 to 275 major operations on them each year. And what we have seen in our population is no increased length of stay, no increased mortality. In fact, it appears to be somewhat decreased.Narrator: On the basis of such experience, many physicians conclude that, overall, transfusion-alternative health care is cost-effective:Prof. Richard K. Spence: One of the beauties of transfusion alternatives is that the most effective alternatives are generally the cheapest.Prof. Stephen G. Pollard: There’s no doubt that blood is a costly product. We’ve been able to reduce our blood-transfusion bill for the liver-transplant program here by 70 percent since we started adopting new techniques. And that equates to hundreds of thousands of pounds in a year, and it’s far more than the cost of the drugs and the other therapies we use and the mechanical methods we use for reducing blood loss.Prof. Philippe Baele: It takes more dedication than technical means. Similar results can be achieved without the use of costly machinery.Narrator: And transfusion-alternative health care has a benefit beyond saving money and meeting patients’ physical needs. There is an ethical benefit. This care honors the patient’s freedom of choice to accept or reject a certain treatment.Prof. Neil Blumberg: One of the primary principles of good medical care is being concerned about what the patient wants.Narrator: Professor Harding, who teaches ethics to medical and law students:Prof. Timothy W. Harding: Today one would link that ethical duty not to do harm, to seek the best possible outcome for one’s patient, with another duty, which is to respect the autonomy of the patient, to respect the patient’s own views and decisions.Narrator: At Glasgow University, Professor of Law and Ethics in Medicine Sheila McLean summarizes:Prof. Sheila A. M. McLean: Doctors have virtually an absolute obligation, both legally and ethically, to respect the patient’s choice.Narrator: Concerning the advancing legal view generally designated “patient rights,” Professor Guillod, founder of the Health Law Institute at Neuchatel University:Prof. Olivier Guillod: I believe the basic element of patients’ rights is the right of self-determination, that is, the right of any patient to decide what shall be done with his or her own body.Prof. Sheila A. M. McLean: Patients have a right to be told that there are alternatives and, more than that there are alternatives, what are the respective risks and benefits expected to be associated with those.Narrator: Concerning the evolution of patient rights, Professor Weissauer explains:Prof. Walther Weissauer speaking German: Earlier, the doctor determined how to proceed and thereby shouldered the entire responsibility. In the course of time, the relationship has changed more and more into a partnership, doctor and patient meeting each other with full equal rights.Narrator: Recognizing patient rights accords with the UN’s universal declaration of human rights. In fact, these legal issues have become so important that in 1997 the Council of Europe formulated the Convention on Human Rights and Biomedicine. Article 5 proclaims: “An intervention…may only be carried out after the person concerned has given free and informed consent to it.”Prof. Olivier Guillod: The doctrine of informed choice says that it is up to the patient to accept or to refuse any kind of medical act, for instance, a blood transfusion.Narrator: Addressing a sensitive issue, Article 6 states: “The opinion of the minor shall be taken into consideration as an increasingly determining factor in proportion to his or her age and degree of maturity.”Prof. Timothy W. Harding: There’s no doubt that minors, in a legal sense, can and very often are able as adolescents to take decisions about their own treatment and their own health.Narrator: How does freedom of choice for patients and parents work out in practical terms?Prof. Olivier Guillod: Well, if the physician cannot think of finding a way of accommodating a patient’s desire about alternatives to blood transfusion, he should try to refer the patient to one of his colleagues or to another institution or health-care facility where this alternative is really practiced.Narrator: But what about emergencies where the victim may not be able to speak, to convey personal conviction?Prof. Timothy W. Harding: It’s now recognized that people have the right to indicate treatment choices in advance. And this takes the form of a written document where the patient shows that they have considered certain situations and they have taken a clear position about a treatment choice.Prof. Walther Weissauer speaking German: In an emergency, one would always also search for an advance directive or a durable power of attorney, for instance, in the wallet of the patient.Narrator: Respecting patient rights also has health-care benefits.Prof. Sheila A. M. McLean: There is empirical evidence that patients who feel engaged in their treatment are likely to get better quicker.Narrator: Consider, for example, a case at St. Richard’s Hospital in Chichester in southern England.Dr. Vipul Patel: Mrs. Whittington had arthritis of her hip, which was so advanced that she required a total hip replacement. She is a Jehovah’s Witness and therefore declined to have a blood transfusion.Mrs. Whittington: Well, I do believe that God’s word is against taking blood, and we should appreciate that God’s word is the truth. Mr. Patel was quite happy to do it without blood.Dr. Guy Turner: It is the doctor’s responsibility to listen to patients’ demands, listen to what they have to say, and give them an informed choice of alternatives.Narrator: In frank dialogue between physician and patient, the question of whether she would accept cell salvage arose:Mrs. Whittington: When I knew more about the machine and it was explained to me, I said I would accept having the machine.Jo Light: The relationship between the patients and the medical staff is excellent here. We have a very open culture and a good learning environment.Narrator: What was the outcome of this cooperative approach?Dr. Vipul Patel: The strategies that we used intraoperatively during Mrs. Whittington’s operation were meticulous hemostasis, salvage of blood using a cell-saver system, as well as using a cemented hip replacement. She tells me that she is delighted with the operation in terms of the pain relief.Narrator: As earth’s population continues to grow and age, their medical needs will be a greater challenge to health-care structures, many of which are already struggling. In this regard, transfusion-alternative health care offers a promising direction.Prof. Philippe van der Linden: A well-adopted blood-conservation program means a decrease in the total cost for the patient but also a decreased cost for society.Narrator: While all medical interventions involve risks, transfusion-alternative health care uniquely meets both patient needs and rights.Dr. Vipul Patel: I can foresee that in the future, patients will almost expect that any surgery which is necessary is carried out without blood transfusion.Prof. Olivier Guillod: Patient empowerment is important, not only to better respect autonomy but to promote good medical treatment.Prof. Roland Hetzer: The various steps to reduce the need of blood transfusion, nowadays, are very well established, well tested, and they are certainly safe.Dr. Aryeh Shander: This is universal, can be practiced in any institution, in any part of the world.Prof. Philippe van der Linden: Blood conservation is safe, effective, and progressive medicine.Dr. Aryeh Shander: This is the best way of treating patients and clearly should be a standard of care._____________________________________________________________________________________More examples of peoples thoughts about Blood Transfusions:NO BLOOD - Medicine Meets - the ChallengeNarrator: Dorothy McPhee has a life-threatening medical problem. An artery that could burst at any time.—"The normal way of doing this operation is, generally through the abdomen, a long vertical incision . . . "Leslie is a young girl with a serious spinal deformity.—"The patient is a Jehovah's Witness, and in a procedure of this magnitude, it's unavoidable that some blood loss will occur.Both patients need surgery, yet, both patients have religious beliefs that preclude their accepting a blood transfusion. Medical science is now providing doctors with alternative strategies to treat successfully patients who, for various reasons avoid blood transfusions. These new strategies may soon benefit all patients.NO BLOODMedicine Meets the ChallengeAt the dawn of the 21st century, society is becoming increasingly diverse. People everywhere are being exposed to different languages, customs, cultures, and religious beliefs. Adapting to these differences is a challenge to all strata of human society. It is a singular challenge for the medical community.Prof. Timothy W. Harding: "We're living in a pluralistic society, and the doctor has one set of values. But, he or she will meet patients who have their own values and their own position about certain issues."Eileen Yost, R.N: "There's a lot of different cultures out there, and they have entities specific to their own cultures, that we as health-care workers need to understand."Prof. Oliver Guillod: "I think the duty of physicians is not simply to preserve life, but the first and foremost duty of physicians is to respect the patient."Narrator: In the past the medical profession found it difficult, at times, to respect the health care need of one religious group, in particular—Jehovah's Witnesses. This was because of their avoidance of blood transfusions.Alexis: "That was the easiest decision, because there was. . . under no circumstances would I accept blood. . . "Jessica: "One thing I heard; he said: 'blood transfusion,' and immediately I said: 'No! No!' . . . "Wayne: "I just couldn't live with myself if I turned my back on my beliefs, and my God, and . . . I wasn't going to accept a blood transfusion."Narrator: Their abstaining from blood transfusions was often misunderstood by the public.Prof. Roland Hetzer: "There was certainly a time, years back, when Jehovah's Witnesses were looked at by physicians, and especially surgeons, in a negative way."Jamie Pollard, R.N.: "I think that before I ever met a Jehovah's Witness, I had a certain mind-set, that they were maybe a religious fanatic-type person."Prof. Charles H. Baron: "Part of it, I'm sure, is prejudice, about a religious sect, which the physician, or the judge, or the lawyer, . . . about which they may know next to nothing."Gene Smalley—JW spokesman: "Á lot of people nowadays have heard of dangers, or diseases, that might be contracted from blood and blood transfusions. But frankly, for Jehovah's Witnesses, central to their avoiding blood transfusions, is because the Bible highlights the preciousness of blood."Eugene Rosam—JW spokesman: "It's a very clear statement, by the way. It isn't something that takes a lot of theological study to determine, or work out. It says very plainly in the Christian scriptures:"Abstain . . . from Blood."—Acts 15:20.Prof. Charles H. Baron: "From the point of view of someone who is not a believer, it seems an irrational act."Prof. Edward Keyserlingk: "For some people, it seems to be anti-medicine. It seems to be, somehow, putting the patient in jeopardy."Diane Mitchell C.C.M.: "I think that some of us, myself included, was under the impression that maybe Jehovah's Witnesses didn't want the best medical treatment, that they were sort of against medical care."Alec: "There's no question, it mattered to me whether she lived or died. I brought her to the hospital in the first place, to help her recover."Cynthia: "I didn't want her to die, and I don't think anybody wants that to happen."Dr. Mark E. Boyd: "It's not some sort of suicide pact that they want to enter into with you. They want to live, they want to have good health care, and I think that you can work with them."Diane Mitchell, C.C.M.: "I realized that they wanted the best medical health care, but they just wanted it without blood."Prof. Edward Keyserlingk: "I think the effort has to be made to remove the perception that Jehovah's Witnesses are somehow in a category by themselves."Dr. Aryeh Shander: "Clearly, you can point to many religions, they all have one issue or another, with which you may or may not agree, but that's not the issue."Dr. Peter Carmel: "If this is a religious precept, this is not illogical stubbornness. This is a religious belief. And just as I respect the religious beliefs of many other religions, I think I have to respect that."THE RIGHT TO CHOOSE TREATMENTDavid C. Day, Q.C.: "All patients, as a general rule, have the right to receive treatment or to refuse to receive that treatment, after they've had full, open, and candid discussion with the treating physician.Prof. Oliver Guillod: "I believe that the basic element of patient's rights is the right of self-determination. That is, the right of any patient to decide what shall be done to his or her own body."Narrator: Patients' rights not withstanding, some have claimed that declining, what they say, is 'life-saving medical treatment,' is irrational.Prof. Timothy W. Harding: "It's wrong to equate a refusal of treatment with suicide, which is a conscious choice to end one's life."Prof. Edward Keyserlingk: "There is always a legitimate question about a patient's competence. But just the mere refusal of blood, in itself, is not any kind of such indication."Dr. Stephen M. Cohn: "I don't believe that refusal of treatment is irresponsible or irrational. I think that just because one person chooses to not to take this pill, or that fluid, this kind of solution, is their own personal choice."Dr. Nicholas Namais: "We have patients who say that they don't want to be on a mechanical ventilator, they don't want a breathing tube."Dr. Mark E. Boyd: "It's an everyday even, for a patient who has a malignancy or cancer, to refuse some treatment of other. They don't want to have chemotherapy, they don't want to have radical surgery, so the idea that patient's refuse treatment, is something that I work with, not take it . . . I don't take it as a personal insult."Narrator: These facts are often obscured by news stories claiming that someone died because he refused a blood transfusion.Dr. Aryeh Shander: "To say that one has died because of refusal of blood, I think is a very general misleading statement."Dr. Mark E. Boyd: "That's an oversimplification of the . . . of the tragic event."Dr. Peter Carmel: "It's rarely, if ever, the case that a patient refused a blood transfusion and therefore died."Dr. Aryeh Shander: "People die because of either a medical disease, or a consequence of trauma, or surgery where there has been complications."Dr. Hooshang Bolooki: "I can tell you I have done over 200 Jehovah's Witness patients. I have never lost a patient because I could not give the patient blood."Narrator: Why then does blood transfusion remain the standard treatment for serious blood loss?Dr. Peter Carmel: "I think that physicians have been brought up with the idea that blood is the 'gift of life,' and that inherently, blood is good for you."Dr. Avroy Fanaroff: "The refusal to accept a blood transfusion bothers and concerns many physicians because they're worried that without the transfusion, the well-being of the patient is jeopardized."Narrator: To appreciate fully why physicians feel this way, one needs to understand a little about blood and why transfusions are given.THE FLUID OF LIFE—BLOODBlood circulates through the body by means of an amazingly intricate system of conduits called veins and arteries. Arteries carry oxygenated blood away from the heart, eventually branching into tiny vessels called capillaries. These deliver the oxygen-rich red blood cells to every part of the body. Nutrients and oxygen are exchanged for carbon dioxide and other wastes at the cellular level. Veins then transport the oxygen-depleted blood back to the heart which pumps it to the lungs. There the carbon dioxide is exchanged for oxygen and the cycle begins anew. This cycle is absolutely essential to life.Dr. Nicholas Namais: "If there's no blood to bring the oxygen to the cells, the cell dies—the body dies!Narrator: When someone suffers severe blood loss, Doctors have two urgent priorities.Dr, Edwin A. Deitch: "The most critical immediate need is to stop the bleeding."Dr. Nicholas Namais: "Everything takes 'backseat' to stopping the bleeding."Dr. Stephen M. Cohn: "And number 2, is to restore the volume within your system."Narrator: "What can happen when a patient looses too much blood volumeDr, Edwin A. Deitch: "Then you don't deliver blood to the brain or the other organs and a person can die."Dr. Nicholas Namais: "And what you need to do is restore volume, restore profusion, and restore oxygenation."Dr, Edwin A. Deitch: "A way of correcting that decrease in blood volume is by giving other fluids intravenously. This can be done using any one of a number of fluid types, and doesn't necessarily require blood."CHANGING ATTITUDESNarrator: Increasing numbers of patients are opting to avoid blood transfusions for personal reasons.Prof. Lawrence T. Goodnough: "If you've ever had a conversation with a patient the night before surgery, and you were to ask them if they had a preference, would they prefer to avoid a blood transfusion, the answer is always, 'Yes.'"Prof. Roland Hetzer: "I would say that today, at least 80 percent of the patients, would strongly favor not to have blood transfusions."Prof. Francesco Mercuriali: "Blood transfusion, traditionally considered a normal adjunct to surgery, presently is considered something that has to be avoided."Dr. Willem de Groot: "There are real risks as far as transfusions are concerned."Dr. Gerard A. Kaiser: "There are concerns about blood bore pathogens, and certainly the concern about AIDS."Dr. Richard K. Spence: "It's a biological product. It can have diseases, etc. We screen for most of them, but there are some there we just don't know about."Prof. Neil Blumberg: "We've certainly seen some horrendous new diseases in the form of HIV come along that probably didn't exist in the past. Whether the next disease will come along in ten weeks, ten years, or a hundred years, nobody can say."Dr. Concha Lewand: "We have Hepatitis C, Hepatitis B, transmitted, and the social costs of that are very high."Dr. Todd K. Rosengart: "There are transfusion reactions that occur, they are very rare, but they can potentially dangerous or even life-threatening."Dr. Richard K. Spence: "We could mix the blood up and cause a catastrophe. Patients have died and do die from getting the wrong blood."Prof. Donat R. Spahn: "It is interesting to realize now, that during the late 90s or early 2000s that the blood transfusion, to a certain extent, does not do what we always used blood transfusions for."Prof. Neil Blumberg: "We've become persuaded, over the years, that many of the bad things that happen to patients after surgery, are in fact, not bad luck, are not a lack of surgical skills, but are in fact, the complications of transfusions."ALTERNATIVE STRATEGIESNarrator: These concerns have spurred a wide range of alternative strategies, treatments that are acceptable to many of Jehovah's Witnesses, an others who also choose to avoid blood transfusions. Alternative strategies can be grouped around four organizing principles.[Minimize Blood Loss;Conserve Red Blood Cells;Stimulate Blood Production;Recover Lost Blood]Prof. Donat R. Spahn: "That involves an aesthetic factor, it involves the use of certain substances, and certainly involves also the surgical technique."MINIMIZE BLOOD LOSSProf. Johannes Scheele: "The most important technique to control bleeding is to avoid bleeding. . . . so that with less bleeding during surgery, the result of that is better, and the outcome is more likely to be smoother."Dr. Richard K. Spence: "Careful surgery means preventing blood loss. Age is no factor. We have operated on newborns, we have operated on people in their 90s."Dr. Mark E. Boyd: "The surgeon who operates without losing large amounts of blood, is almost invariably a good and careful surgeon. One who loses large amounts of blood is most often, the reverse."Narrator: A variety of instruments are now available to help surgeons minimize bleeding.Dr. Nicholas Namais: "There are strategies for inter-operatively using electrocautery instead of scalpels."Prof. Johannes Scheele: "If there is some bleeding persisting, there are coagulation techniques. The best of which is, at the moment, Argon-Beam Coagulator."Narrator: There are non-invasive tools that enable the surgeon to see inside the body, minimizing surgical incisions.Dr. Richard K. Spence: "You can use drugs, topical application of different products that will help prevent blood loss."Prof. Roland Hetzer: "We have now, several methods available, like the 'fibrin glue' . . .Narrator: Fibrin glue made from blood fractions stimulates coagulation upon contact.Prof. Johannes Scheele: "The fibrin tissue adhesive is certainly very, very useful because it does not harm the tissue."Dr. Nicholas Namais: "In a Jehovah's Witness, where the blood loss is so, so, so critical, I think you have to be very, extremely meticulous not to lose even a drop of blood."CONSERVE RED BLOOD CELLSDr. Peter Carmel: "There are new technologies of hemodilution and reinfusion, that make the operation easier, and which are acceptable to people who have a religious precept against blood transfusion."Dr. Linda Shehling: "The principles of hemodilution, in terms of reduction of blood loss, are really quite simple."Dr. Concha Lewand: "Basically, we do the closed circuit on the patient. We draw off blood from the patient—keep it in contact with the patient—and substitute it with fluids."Prof. Donat R. Spahn: "That results in a diluted blood, and therefore, the patient looses only diluted blood, rather than native, or concentrated blood."Dr. Linda Shehling: "When the patient bleeds interoperatively, the red cell lose is less."Dr. Herbert Dardik: "It would be like taking a quart of milk and turning it. . . or adding water so that you have 3 gallons of it now, but the original quart is still in there. But if you were to spill it into something, it would be a lot of water—and a fraction of the milk—then at the end, you get rid of the water, and then you're back where you started."Dr. Aryeh Shander: "And we use that routinely in this institution, especially for those patients who have anticipated significant blood loss."Dr. Concha Lewand: "I think that's nowadays, besides—I think that for Jehovah's Witnesses it’s a pretty good standard of care for large volume loss surgery."RECOVER LOST BLOODDr. Richard K. Spence: "If we do loose blood, this is the kind of case where we'll use a cell saver. We will suction up any blood that's lost—we wash it, we clean it, we process it, we filter it—and then we'll give it back to you."Prof. Donat R. Spahn: "Cell salvage is a very important technique, because when you use cell salvage, the blood lost by the surgeon is not lost for the patient."Prof. Johannes Scheele: "In any trauma patient with a significant blood loss, I would, always, prepare the cell saver system."STIMULATE BLOOD PRODUCTIONNarrator: "A key element in stimulating the body's ability to replenish its own blood supply is a hormone called erythropoetin.Dr. Blair Siefert: "Erythropoetin is a natural substance. It is formed in the kidneys, other organs as well, but primarily the kidney, to help our bone marrows to form the red blood cells that are going to carry our oxygen."Narrator: Blood cell production takes place primarily in the sternum, the ribs, the vertebra, and the pelvis. Recombinant Erythropoetin boosts the body's natural production of red blood cells.Dr. Nicholas Namais: "So if I know the patient is going to be in the hospital a long time, I may start them on some recombinant erythropoetin so they can start building up their own blood storage."Prof. Francesco Mercuriali: "This can be a very cost effective strategy, to reuse the utilization of allergenic blood transfusion."Dr. Richard K. Spence: "One of the most exciting things about this whole field, is that the majority of things that we talk about is within the reach of physicians and hospitals around the world."Dr. Peter Carmel: "There are now available, techniques in almost every sub-specialty of surgery and medicine that allow bloodless treatment."Major Spry—JW spokesman: "Alternatives, like any other therapy, are not necessarily, free from risk. So a patient, a Witness patient in particular, may want to become informed about the benefits and the risks that are associated with any particular treatment."Dr, Edwin A. Deitch: "They should be a prudent consumer."Narrator: How effective are these alternative strategies in helping doctors treat patients who do not want blood transfusions?CASE HISTORIESLeslie Lacks had just begun elementary school when it became apparent that she had a degenerating spinal deformity. Doctors diagnosed Leslie's condition as a severe form of Scoliosis.Dr. Tarek Mardam-Bey: "Scoliosis is a curvature of the spine, so we have to correct it as much as the spine's flexibility allows us."Narrator: After a brace failed to correct her condition, doctors recommended an extensive surgical procedure.Dr. Tarek Mardam-Bey: "We used essentially a series of hooks and metal rods made out of stainless steel, that are implanted in the patient's back, and are used essentially to distract the spine and achieve alignment."Narrator: The Lacks wanted the surgery performed without a blood transfusion. So they found a surgical team that had experience using bloodless techniques. Before the surgery, Leslie's doctors boosted her blood through the use of iron and recombinant erythropoetin.Dr. Tarek Mardam-Bey: "So it was essential that we do the surgery without excessive blood loss. The way that we were able to achieve this is using two techniques basically. One of them is called the cell saver. The other technique we used is called hemodilution. It is safer in that, it's the patient's own blood and its has remained in continuous circulation with the patient, so there's no chance for contamination or blood transmitted diseases.Narrator: The surgery was a success, and no blood transfusion was administered! Within days, Leslie was up and walking.Bobbie Lacks: "She's so happy. She can completely stand, now she says, 'Mommy, I'm almost as tall as you now!'Narrator: Although Leslie will have to wear a brace for a while—doctors are confident she will lead a normal life.Leslie Lacks: "I'd like to skate, and skateboard, maybe learn how to snowboard, . . .stuff like that!"Narrator: Sometimes alternative strategies involve new surgical techniques to reduce blood loss in patients that don't want a transfusion. 75 year-old Dorothy McPhee suffered an abdominal aortic aneurysm, a life threatening condition, that traditionally requires extensive surgery.Dr. Herbert Dardik: "The normal way of doing this operation is, generally through the abdomen, a long vertical incision from the lower chest down to the pubic area, having to work around and behind the entire intestinal tract. Hospitalization ranging—at best, days, 4 or 5 days, to averaging a week or even more—presuming that there are no operative complications."Narrator: Since Dorothy is one of Jehovah's Witnesses, her physicians used a surgical technique that minimizes bleeding.Dr. Herbert Dardik: "What we did today is called endovascular aortic surgery. Essentially that's; Endo—meaning we are working within the artery. Through that artery we place our catheters, our wires, all the instruments that we steal right up to where the aneurysm is. And then we can visualize the aneurysm by doing coroscopy, x-ray technology.Narrator: Dorothy's doctors inserted a wire mesh called a stint, and were thus able to repair her aorta without a large surgical incision that would have caused a lot of bleeding.Dr. Herbert Dardik: "A small incision through the groin, all the manipulation through that—a virtually pain-free, complication-free, in post-operative, of course—home, generally in 24-hours—so, everybody's a winner!Dorothy McPhee: "I feel fine! I never would have believed it, but I do!"Narrator: Two days after her surgery, Dorothy was sent home. She recovered nicely!A NEW STANDARDA growing number of health care providers are willing to meet the challenge of treating patients who avoid blood transfusions.Prof. Roland Hetzer: "With the development of all those techniques, there's nothing really specific about Jehovah's Witnesses anymore. We know that they don't want blood transfusions and we have the technology to follow their wish."Dr. Stephen M. Cohn: "The belief that you don't want a blood transfusion should not in any way . . . that should be a tiny part of the whole medical care environment. That should be acknowledged—put over to the side, fine—now to the other 99 percent of your care!"Major Spry—JW spokesman: "I guess it could be likened to a patient who is allergic to penicillin. You wouldn't expect the physician to say, 'Well, I'm sorry, I can't treat you because I can't administer penicillin.' No, he simply says, 'We'll give you a medical alternative. We'll give you another antibiotic.' Then he gets on with treating the patient."Narrator: This enlightened approach to patient care has exciting implications for the public at large.Dr. Stephen M. Cohn: "The fact that we couldn't use blood in Jehovah's Witnesses, we learned how we didn't have to use blood in many other situations. So, it has actually propelled us in the right direction."Dr. Richard K. Spence: "Transfusion alternatives clearly, are good medical practice. Sound practice—safe practice, for a patient."Dr. Linda Shehling: "Indeed it is a standard that should be available to all patients."Dr. Peter Carmel: "What we're talking about here is going to be a mute point, because bloodless medicine and surgery will become in the next 5 to 10 years, so widespread that, it won't be novel anymore."Eugene Rosam—JW spokesman: "Jehovah's Witnesses have had the unique privilege, because of their religious position on the matter, of helping doctors learn better ways to treat patients without subjecting them to the risks of blood transfusions."Prof. Charles H. Baron: "What I have seen in my own experience is that they have turned the medical profession around, where the gold standard, is to treat people without blood."Narrator: Already some 100,000 physicians worldwide, are making bloodless medicine and surgery available to anyone who does not want a blood transfusion. Many experts agree that in the new future medicine and surgery without the use of blood transfusions will become the standard of care for all patients."There are now available, techniques in almost every sub-specialty of surgery and medicine that allow bloodless treatment, so that we are getting away from blood transfusions in general.""As a heart surgeon, I guess it's unusual for a guy not to like blood, he should like blood, but I don't—I'm very proud when my patient comes out of the operation room, and has not received any transfusion.""I can see within the next few years, us getting to a point of where we do not have to even think about getting blood."