A Clear Conscience

During my medical residency, I was called to an urgent trauma case. It was in the middle of a General Surgery call shift, one I would never forget. That evening I came face to face with a critical medical case that had equally life-threatening ethical considerations. As I witnessed firsthand, not all patients agree to all medical interventions. 

Even when it could save a life.

“YOU COULD DIE…”

Linda was a middle aged woman who was transferred from a small town to our regional hospital. Earlier that day, she had been tending her horses when she made the mistake of walking behind one of them. It kicked her square in the stomach. At her local hospital, Linda was found to be bleeding internally. She was immediately transferred to a center with surgical capabilities, which was how she came to us. 

A CT scan showed her abdomen was full of blood, continuously leaking from a ruptured spleen. She needed an emergency splenectomy, the sooner the better. Linda’s hemoglobin level was 65, about half of what it should be - dangerously low. However, she was a Jehovah’s Witness and refused all blood products. This made her critical condition even more deadly.

When the surgeon and I arrived to assess her, Linda’s pastor was already there to make sure she stuck to her convictions. He stressed that she wouldn’t accept a transfusion under any circumstances, going so far as to answer questions directed at the patient herself. I could see the surgeon getting more irritated as he explained her chances of survival were much worse if she didn’t get a blood transfusion. His frustration stemmed not just from the apparent foolishness of refusing a life-saving transfusion but also from the overbearing pressure of her pastor. 

“Listen,” Dr Moffatt said, “your situation is very bad. You need surgery right away. Giving you blood could very well save your life…”

“We understand the risks,” the pastor cut in. “We respectfully refuse any blood products.”

The surgeon needed to obtain informed consent from our patient, without coercion from any outside influence. In hindsight, we probably should’ve asked the pastor to leave the room, because a patient can’t legally provide consent to surgery under duress. 

Eventually, Linda spoke for herself. “It’s okay. I know I could die. I still don’t want blood.”

Fair enough. Her pastor crossed the room and held her hand. “Good for you, Linda.”

Dr Moffatt grumbled all the way down the hall. Linda’s decision to forgo a transfusion would make our job of saving her life a lot more difficult.

In the OR, the anesthetist put her to sleep immediately. The surgeon cut her open from sternum to pelvis as dark blood oozed out. Surgical sponges were quickly packed into all corners of her abdomen to stop any active bleeding. The blood vessels to the spleen were clamped, tied off, and cut. The bleeding organ was pulled out and passed into the scrub nurse’s waiting hands. All other areas of her abdomen were examined - no further bleeds. 

“How’s she doing, Dave?” Dr Moffatt asked his anesthesia colleague.

“Surprisingly good. Blood pressure holding. Getting fluids in. Needs some vasopressors but nothing crazy. You sure we can’t give blood?”

“That’s a hard no, unfortunately.”

“Dang.”

The long incision was meticulously closed and bandaged, then Linda was transported - still in a medical coma - to the ICU for close monitoring. Her hemoglobin dropped from 65 to 50 during the case. We had done all we could. Only time would tell if it would be enough. 

Managing critically-ill cases is tough, especially when patients refuse treatments that could save their lives. However, regardless of whether we agreed with her reasons to decline a blood transfusion, some matters of conscience are worth dying for.

WHAT ABOUT CHILDREN?

Linda’s case reminded me of an ethicist - Dr Sinclair - who lectured my class in medical school. He had been a trauma surgeon for most of his career and had cared for a number of families who refused blood transfusions on religious grounds. One case in particular stood out. 

A child was scheduled for major surgery. The whole family were Jehovah’s Witnesses, and the parents’ morals didn’t permit their child to receive blood products. However, Dr Sinclair’s morals didn’t permit him to let a child die for lack of blood. The patient herself was too young to make the decision for herself. I’ll never forget his brilliant solution. The surgeon stated that he would only agree to do the surgery with the understanding that he would give blood if absolutely necessary (against the parents’ wishes), but if the parents didn’t specifically ask about a transfusion, he wouldn’t mention it. Conversely, if they did ask, he’d tell them the truth. Dr Sinclair smiled as he looked out at all of us medical students in the lecture hall. “In thirty years of practice, no one ever asked about it.” 

I don’t know how many children he had to transfuse during his career, if any, but that wise surgeon-turned-ethicist never had to disclose whether a Jehovah’s Witness child received a transfusion. The principle of “don’t ask, don’t tell” worked brilliantly to ensure all parties left with a clear conscience and every pediatric patient received the care they needed.

WHAT THE BIBLE SAYS

Paul discussed a similar issue with respect to meat being sold in the market. 

Eat whatever is sold in the meat market without raising any question on the ground of conscience… If one of the unbelievers invites you to dinner and you are disposed to go, eat whatever is set before you without raising any question on the ground of conscience. But if someone says to you, “This has been offered in sacrifice,” then do not eat it, for the sake of the one who informed you, and for the sake of conscience — I do not mean your conscience, but his. (1 Cor 10:25-30)

Throughout life, we need to make every effort to live with a clear conscience, but that doesn’t mean we should go digging for things that may offend us. It’s hard enough to keep a clear conscience in such an immoral world without finding more reasons to feel guilty or offended.

Additionally, we’re not only responsible for our own conscience but also for others’ convictions. We must be careful not to deliberately offend (“I do not mean your conscience, but his”). We also have no right to impose our beliefs on others.

The faith that you have, keep between yourself and God. (Rom 14:22)

Some choose certain diets, others honor a certain day of the week. To each their own. 

The Bible tells us repeatedly we are not to judge. 

Who are you to pass judgment on the servant of another? It is before his own master that he stands or falls. (Rom 14:4)

Condemnation of our spiritual brothers and sisters over matters of conscience doesn’t help anyone. When I was writing a book on birth control, my editor ghosted me because I wouldn’t condemn particular methods she disagreed with. Another time, I nearly lost a close friend who discovered I’d gone out for a beer after finishing Bible school. He came from a long line of alcoholics and had strong convictions that all alcohol was sinful. On the other hand, perhaps I could have been more careful to guard my friend's heart. 

It is good not to eat meat or drink wine or do anything that causes your brother to stumble. (Rom 14:21)

Unlike the pastor who was so pushy with us about a potential transfusion, it’s also important to respect others’ decision to abandon prior convictions. If Linda wanted to accept blood when her life was in danger, that was her call to make, not his. 

Choices based on conscience should always be respected, whether we agree with them or not.

SUMMARY

I visited Linda in the ICU the day after her splenectomy. She was pale as a ghost, with hardly the strength to speak. Her hemoglobin hovered around 35, barely high enough to keep her alive. The ICU doctors had stopped drawing blood tests, since she couldn’t even spare a few drops. Intravenous fluids, vitamins, iron supplements, even bone-marrow stimulating medications were given to get her body to make more blood. A week later, I moved onto another rotation and didn’t see her again. I never found out if she survived or not. 

For better or worse, Linda stuck to her guns. I respected her steadfastness, even though others in the hospital thought it was foolish. She had the right to make such a decision for herself.

It’s hard to justify a faith-based decision to those with different convictions. We live in a world that rarely sees things the way God does. Wouldn’t non-Christians view confessing Jesus in the face of death as similarly foolish? And even within the church, there are many issues believers disagree on — alcohol, swear words, certain types of entertainment, inappropriate clothing, birth control, gambling, marijuana. We each have different convictions, and each of us will answer to God individually. 

Let’s not get fussed about convictions we don’t agree with. A little creativity (and a healthy dose of ignorance) can go a long way to satisfy our individual consciences and help us all get along. 

© D. B. Ryen Incorporated, March 2025.

All Scripture quotations are from The English Standard Bible (ESV). Crossway, 2001.