Appellants
President and Directors of Georgetown College
Appellee
Jessie E. Jones
Appellants' Claim
That the school's hospital should be able to administer a blood transfusion to Mrs. Jones despite the Jones' refusal to permit the transfusion based on religious principle.
Chief Lawyers for Appellants
Peter R. Taft, Harold Ungar, Edward Bennett Williams
Chief Lawyers for Appellee
Ralph H. Decker, Bernard Margolius
Judge
J. Skelly Wright
Place
Washington, D.C.
Date of Decision
3 February 1964
Decision
Ruled in favor of Georgetown that all necessary blood transfusions to sustainlife should be administered.
Significance
The decision supported the hospital's ethical concern in saving lives of patients admitted under their care despite the patient's and family's immediate wishes. Despite the expansion of civil liberties by the courts in the 1960s, the judicial system refused to recognize any right to refuse medical treatmentfor purely religious reasons.
One of the many Christian religious sects is a group called the Jehovah's Witnesses. The modern group by that name was founded in Pittsburgh, Pennsylvaniain the 1870s by Charles Russell. By the late 1990s membership numbered 4.5 million people worldwide. Followers of the sect believe in the imminent end ofthe world, and in strictly following the literal words and commands of the Bible. One of these biblical commands is contained in Genesis chapter nine, which states that the consumption of blood is forbidden:
In keeping with their literalist approach, the Jehovah's Witnesses traditionally would not eat blood sausages or blood puddings. They had few serious conflicts with the medical profession until the 1940s, when blood transfusions and the technology of blood storage in blood banks became standardized and commonplace. In 1945, a Jehovah's Witness publication called The Watchtower issued the ruling that blood transfusions were akin to consuming blood. Consequences to the individual who violates the prohibition are significant including excommunication from the church and forfeiting the prospect of eternallife.
Crisis Develops at Georgetown Hospital
In September of 1963, a young man named Jessie E. Jones brought his wife intothe hospital operated by Georgetown College in Washington, D.C. Georgetown College, later known as Georgetown University, and the Georgetown University Hospital are world-famous institutions. Mrs. Jones, age 25 and mother of a 7 month old child, had suffered a ruptured ulcer and lost two-thirds of her blood. The Joneses were both Jehovah's Witnesses. When Dr. Edwin Westura, the chief medical resident, said that Mrs. Jones would die unless given a blood transfusion, Jones refused to permit it.
Georgetown went to court for permission to give the necessary blood transfusions without Jones's consent. On 17 September 1963 the attorneys went to JudgeEdward A. Tamm's chambers at the U.S. District Court for the District of Columbia and asked for an emergency order allowing the hospital to save Mrs. Jones's life. Judge Tamm refused. At 4:00 p.m. on the same day, the attorneys next went to the chambers of Judge J. Skelly Wright of the U.S. Court of Appeals for the District of Columbia Circuit, asking for an immediate review of Tamm's decision.
Judge Wright telephoned the hospital, and Dr. Westura confirmed that Mrs. Jones would die without a blood transfusion. Wright then went to the hospital with the attorneys, where he met Mr. Jones. Jones remained firm in his refusalto grant consent. Father Bunn, Georgetown's president, even came to plead with Jones to no avail. Westura and other doctors assigned to the case tried without success to explain that a transfusion is very different from drinking blood. At 5:20 p.m., Wright signed the legal orders prepared by Georgetown, andMrs. Jones received blood transfusions that saved her life.
On 14 October 1963, Jones's attorneys, Ralph H. Decker and Bernard Margolius,filed a petition for rehearing before the full court of appeals to quash Wright's order. On 3 February 1964, the court of appeals denied Jones's petitionbecause Mrs. Jones had long since recovered and left the hospital. There wasa spirited dissent, however, by Circuit Judge Warren Burger, who subsequently became chief justice of the U.S. Supreme Court. Burger felt that the fact that Jones had signed a release upon bringing his wife to the hospital took the case out of the court's jurisdiction. In effect, the college had the release for legal protection without court help.
Also on 3 February 1964 Wright issued his written opinion concerning his actions, which recited various legal precedents permitting courts to act in preservation of human life, and ended by stating:
Jones appealed to the U.S. Supreme Court, but his petition was denied withoutcomment on 15 June 1964.
Impact
Even though the 1960s was an era of increasing civil liberties, the Supreme Court under Chief Justice Earl Warren refused to overturn the court of appeals' de facto approval of Judge Wright's actions to save Mrs. Jones's life. Although the Supreme Court and the judicial system were increasingly sensitive to the rights of religious minorities, they drew the line when religioussensibilities meant that modern medical technology would be denied to a person in need. Later in 1986, the New York Supreme Court awarded damages to a Jehovah's Witness patient given blood products against wishes. The Court in Randolph v. City of New York ruled a Jehovah's Witness could legally refuse treatment even if detrimental to his health.
Conflict between physicians and patients' religious beliefs led to several forms of response by health care teams. Two alternatives included coercion often in treating young patients and deception by not revealing the treatment administered when possible. The more increasingly common option was cooperationbetween the patient and staff in reaching a mutual understanding of the situation and the medical options available. Since the Georgetown decision,use of coercion and deception became accepted as ethically wrong in denyingthe autonomy of the patient, long respected in medical ethics. In fact, somefeared such medical tactics would actually deter Jehovah's Witnesses from coming to hospitals at all, thus endangering lives where blood transfusions would not be a factor. The right of a patient to refuse blood transfusions basedon religious reasons became well accepted ethically and legally, though stillintroducing additional stress on hospital staff in such situations. Some hospitals began asking Jehovah's Witnesses to sign waivers relieving hospitals of the threat of lawsuits. Most Jehovah's Witnesses began carrying medical directive cards expressing their refusal of blood transfusions under all circumstances.
Medical professionals had to accept and respect the patient's rights to refuse treatment and the patient's values and beliefs, even if death could result.A cooperative relationship between the medical profession and the sect evolved by the end of the 1990s. Jehovah's Witnesses divide blood products into two main categories. They will not accept transfusions of whole blood, red blood cells, plasma, white blood cells and platelets. Acceptable are immune globulins, vaccines, serum, hemophiliac preparations, and organ transplants. As aresult, treatment of Jehovah's Witnesses often presented difficult situationsfor health care specialists, but new approaches in treating diseases such asleukemia were explored and shared in the medical profession.
The case also raised issues concerning ethical and legal responsibilities ofhospitals and physicians who accept patients under their care. A physician'srelationship with a patient is a voluntary one with no requirement to accepta particular person. But once a relationship is established, the doctor is legally responsible to provide medical treatment and can be held liable for notproviding treatment. The case of Cruzan v. Director, Missouri Departmentof Health (1990) highlighted hospital employees' apprehensiveness to passively allow death without clear legal footing. In Cruzan the Court essentially ruled that the hospital was compelled to sustain life with whatevermeans available regardless of the desires of the immediate family when the wishes of the patient were not clear, either due to his current incapacitated state or lack of prior guidance.
Related Cases
Refusal of Treatment
When it comes time to choose a cure for a medical problem, members of faith-healing religions will turn to prayer rather than conventional medicine. Thesereligions believe that faith in the healing power of God, not medical procedures, will heal them.
Over the years, court cases have been brought against those who believe in faith healing to force them to accept medical treatment and procedures, especially if the health of a third party, such as a fetus, is at stake. In the situation where a woman refuses medical treatment that could save the health of her child, the court must weigh the rights of the mother against the unborn child. Court-appointed advocates for the third party contend that the rights ofan unborn child must be ensured, even if this means forcing a pregnant womanto undergo unwanted medical treatment.
But those in favor of a patient's right to refuse treatment counter that theConstitution provides a right to privacy and the free exercise of religious beliefs. It would be a breach of the Constitution, proponents say, to make someone undergo conventional medical treatment when that is against the tenets of his religion.
Sources
Crawford, Jan. "Caesarean Case Appeal is Rejected." Chicago Tribune, 17 December 1993.
President and Directors of Georgetown College
Appellee
Jessie E. Jones
Appellants' Claim
That the school's hospital should be able to administer a blood transfusion to Mrs. Jones despite the Jones' refusal to permit the transfusion based on religious principle.
Chief Lawyers for Appellants
Peter R. Taft, Harold Ungar, Edward Bennett Williams
Chief Lawyers for Appellee
Ralph H. Decker, Bernard Margolius
Judge
J. Skelly Wright
Place
Washington, D.C.
Date of Decision
3 February 1964
Decision
Ruled in favor of Georgetown that all necessary blood transfusions to sustainlife should be administered.
Significance
The decision supported the hospital's ethical concern in saving lives of patients admitted under their care despite the patient's and family's immediate wishes. Despite the expansion of civil liberties by the courts in the 1960s, the judicial system refused to recognize any right to refuse medical treatmentfor purely religious reasons.
One of the many Christian religious sects is a group called the Jehovah's Witnesses. The modern group by that name was founded in Pittsburgh, Pennsylvaniain the 1870s by Charles Russell. By the late 1990s membership numbered 4.5 million people worldwide. Followers of the sect believe in the imminent end ofthe world, and in strictly following the literal words and commands of the Bible. One of these biblical commands is contained in Genesis chapter nine, which states that the consumption of blood is forbidden:
And God went on to bless Noah and his sons and to say to them: "Be fruitful and becomemany and fill the earth. And a fear of you and a terror of you will continueupon every living creature of the earth and upon every flying creature of theheavens, upon everything that goes moving on the ground, and upon all the fishes of the sea. Into your hand they are now given. Every moving animal thatis alive may serve as food for you. As in the case of the green vegetation, Ido give it all to you. Only flesh with its soul--its blood--you must not eat."
In keeping with their literalist approach, the Jehovah's Witnesses traditionally would not eat blood sausages or blood puddings. They had few serious conflicts with the medical profession until the 1940s, when blood transfusions and the technology of blood storage in blood banks became standardized and commonplace. In 1945, a Jehovah's Witness publication called The Watchtower issued the ruling that blood transfusions were akin to consuming blood. Consequences to the individual who violates the prohibition are significant including excommunication from the church and forfeiting the prospect of eternallife.
Crisis Develops at Georgetown Hospital
In September of 1963, a young man named Jessie E. Jones brought his wife intothe hospital operated by Georgetown College in Washington, D.C. Georgetown College, later known as Georgetown University, and the Georgetown University Hospital are world-famous institutions. Mrs. Jones, age 25 and mother of a 7 month old child, had suffered a ruptured ulcer and lost two-thirds of her blood. The Joneses were both Jehovah's Witnesses. When Dr. Edwin Westura, the chief medical resident, said that Mrs. Jones would die unless given a blood transfusion, Jones refused to permit it.
Georgetown went to court for permission to give the necessary blood transfusions without Jones's consent. On 17 September 1963 the attorneys went to JudgeEdward A. Tamm's chambers at the U.S. District Court for the District of Columbia and asked for an emergency order allowing the hospital to save Mrs. Jones's life. Judge Tamm refused. At 4:00 p.m. on the same day, the attorneys next went to the chambers of Judge J. Skelly Wright of the U.S. Court of Appeals for the District of Columbia Circuit, asking for an immediate review of Tamm's decision.
Judge Wright telephoned the hospital, and Dr. Westura confirmed that Mrs. Jones would die without a blood transfusion. Wright then went to the hospital with the attorneys, where he met Mr. Jones. Jones remained firm in his refusalto grant consent. Father Bunn, Georgetown's president, even came to plead with Jones to no avail. Westura and other doctors assigned to the case tried without success to explain that a transfusion is very different from drinking blood. At 5:20 p.m., Wright signed the legal orders prepared by Georgetown, andMrs. Jones received blood transfusions that saved her life.
On 14 October 1963, Jones's attorneys, Ralph H. Decker and Bernard Margolius,filed a petition for rehearing before the full court of appeals to quash Wright's order. On 3 February 1964, the court of appeals denied Jones's petitionbecause Mrs. Jones had long since recovered and left the hospital. There wasa spirited dissent, however, by Circuit Judge Warren Burger, who subsequently became chief justice of the U.S. Supreme Court. Burger felt that the fact that Jones had signed a release upon bringing his wife to the hospital took the case out of the court's jurisdiction. In effect, the college had the release for legal protection without court help.
Also on 3 February 1964 Wright issued his written opinion concerning his actions, which recited various legal precedents permitting courts to act in preservation of human life, and ended by stating:
The final, and compelling, reason for granting the emergency writ was that a life hung in the balance. There was no time for research and reflection. Death could have mootedthe cause in a matter of minutes, if action were not taken to preserve the status quo. To refuse to act, only to find later that the law required action,was a risk I was unwilling to accept. I determined to act on the side of life.
Jones appealed to the U.S. Supreme Court, but his petition was denied withoutcomment on 15 June 1964.
Impact
Even though the 1960s was an era of increasing civil liberties, the Supreme Court under Chief Justice Earl Warren refused to overturn the court of appeals' de facto approval of Judge Wright's actions to save Mrs. Jones's life. Although the Supreme Court and the judicial system were increasingly sensitive to the rights of religious minorities, they drew the line when religioussensibilities meant that modern medical technology would be denied to a person in need. Later in 1986, the New York Supreme Court awarded damages to a Jehovah's Witness patient given blood products against wishes. The Court in Randolph v. City of New York ruled a Jehovah's Witness could legally refuse treatment even if detrimental to his health.
Conflict between physicians and patients' religious beliefs led to several forms of response by health care teams. Two alternatives included coercion often in treating young patients and deception by not revealing the treatment administered when possible. The more increasingly common option was cooperationbetween the patient and staff in reaching a mutual understanding of the situation and the medical options available. Since the Georgetown decision,use of coercion and deception became accepted as ethically wrong in denyingthe autonomy of the patient, long respected in medical ethics. In fact, somefeared such medical tactics would actually deter Jehovah's Witnesses from coming to hospitals at all, thus endangering lives where blood transfusions would not be a factor. The right of a patient to refuse blood transfusions basedon religious reasons became well accepted ethically and legally, though stillintroducing additional stress on hospital staff in such situations. Some hospitals began asking Jehovah's Witnesses to sign waivers relieving hospitals of the threat of lawsuits. Most Jehovah's Witnesses began carrying medical directive cards expressing their refusal of blood transfusions under all circumstances.
Medical professionals had to accept and respect the patient's rights to refuse treatment and the patient's values and beliefs, even if death could result.A cooperative relationship between the medical profession and the sect evolved by the end of the 1990s. Jehovah's Witnesses divide blood products into two main categories. They will not accept transfusions of whole blood, red blood cells, plasma, white blood cells and platelets. Acceptable are immune globulins, vaccines, serum, hemophiliac preparations, and organ transplants. As aresult, treatment of Jehovah's Witnesses often presented difficult situationsfor health care specialists, but new approaches in treating diseases such asleukemia were explored and shared in the medical profession.
The case also raised issues concerning ethical and legal responsibilities ofhospitals and physicians who accept patients under their care. A physician'srelationship with a patient is a voluntary one with no requirement to accepta particular person. But once a relationship is established, the doctor is legally responsible to provide medical treatment and can be held liable for notproviding treatment. The case of Cruzan v. Director, Missouri Departmentof Health (1990) highlighted hospital employees' apprehensiveness to passively allow death without clear legal footing. In Cruzan the Court essentially ruled that the hospital was compelled to sustain life with whatevermeans available regardless of the desires of the immediate family when the wishes of the patient were not clear, either due to his current incapacitated state or lack of prior guidance.
Related Cases
- Randolph v. City of New York, 117 A.2d. 44 (1986).
- Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).
Refusal of Treatment
When it comes time to choose a cure for a medical problem, members of faith-healing religions will turn to prayer rather than conventional medicine. Thesereligions believe that faith in the healing power of God, not medical procedures, will heal them.
Over the years, court cases have been brought against those who believe in faith healing to force them to accept medical treatment and procedures, especially if the health of a third party, such as a fetus, is at stake. In the situation where a woman refuses medical treatment that could save the health of her child, the court must weigh the rights of the mother against the unborn child. Court-appointed advocates for the third party contend that the rights ofan unborn child must be ensured, even if this means forcing a pregnant womanto undergo unwanted medical treatment.
But those in favor of a patient's right to refuse treatment counter that theConstitution provides a right to privacy and the free exercise of religious beliefs. It would be a breach of the Constitution, proponents say, to make someone undergo conventional medical treatment when that is against the tenets of his religion.
Sources
Crawford, Jan. "Caesarean Case Appeal is Rejected." Chicago Tribune, 17 December 1993.
User Comments Add a comment…