Why We Preach Door to door and by telephone

Ways They Use to Share the Good News
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CHRISTIANS are commanded to "make disciples of people of all the nations," but this does not mean that they are to use pressure or convert others by force. Jesus' commission was to "tell good news to the meek ones," to "bind up the brokenhearted," to "comfort all the mourning ones." (Matthew 28:19; Isaiah 61:1, 2; Luke 4:18, 19) Jehovah's Witnesses seek to do this by declaring the good news from the Bible. Like the prophet Ezekiel of old, Jehovah's Witnesses today try to find those who "are sighing and groaning over all the detestable things that are being done."—Ezekiel 9:4.
The best-known way they use to find those who are distressed by present conditions is by going from house to house. Thus they make a positive effort to reach the public, just as Jesus did when "he went journeying from city to city and from village to village, preaching and declaring the good news of the kingdom of God." His early disciples did likewise. (Luke 8:1; 9:1-6; 10:1-9) Today, where it is possible, Jehovah's Witnesses endeavor to call at each home several times a year, seeking to converse with the householder for a few minutes on some local or world topic of interest or concern. A scripture or two may be offered for consideration, and if the householder shows interest, the Witness may arrange to call back at a convenient time for further discussion. Bibles and literature explaining the Bible are made available, and if the householder desires, a home Bible study is conducted free of charge. Millions of these helpful Bible studies are conducted regularly with individuals and families throughout the world.
Another way in which "the good news of the kingdom" is told to others is through meetings held at local Kingdom Halls. The Witnesses conduct meetings there weekly. One meeting is a public lecture on a subject of current interest, followed by a study of some Biblical theme or prophecy, using the Watchtower magazine as source material. Another meeting is a school for training Witnesses to be better proclaimers of the good news, followed by a part devoted to discussing the witnessing work in the local territory. Also, once a week Witnesses assemble in private homes, in small groups, for Bible studies.
Kingdom Halls, practicalin design, are places forBible discussion
All these meetings are open to the public. No collections are ever taken. Such meetings are beneficial for all. The Bible says: "We ought to see how each of us may best arouse others to love and active goodness, not staying away from our meetings, as some do, but rather encouraging one another, all the more because you see the Day drawing near." Private study and research are necessary, but meeting with others is stimulating: "As iron sharpens iron, so one man sharpens the wits of another."—Hebrews 10:24, 25; Proverbs 27:17, The New English Bible.
The Witnesses also make good use of openings for talking about the good news as they come in contact with other people in their daily lives. It may be a few words exchanged with a neighbor or with a fellow traveler on a bus or a plane, a longer conversation with a friend or a relative, or a discussion with a fellow worker during lunch hour. Much of the witnessing that Jesus did when he was on earth was of this kind—as he walked along the seashore, sat on a hillside, dined at someone's home, attended a wedding, or traveled in a fishing boat on the Sea of Galilee. He taught in the synagogues and at the temple in Jerusalem. Wherever he was, he found opportunities to talk about God's Kingdom. Jehovah's Witnesses endeavor to follow in his footsteps in this regard also.—1 Peter 2:21.
PREACHING BY EXAMPLE

In their family life and in contacts with others, the Witnesses sincerely try to do the things that they advocate
None of these ways of telling you the good news would be meaningful to you if the one telling you did not apply the teachings to himself. To say one thing and do another is hypocrisy, and religious hypocrisy has turned millions away from the Bible. The Bible is not rightly blamed. The scribes and Pharisees had the Hebrew Scriptures, but Jesus denounced them as hypocrites. He spoke of their reading from the Law of Moses, then added to his disciples: "All the things they tell you, do and observe, but do not do according to their deeds, for they say but do not perform." (Matthew 23:3) A Christian's being an example of right living says more than hours of sermonizing. This was pointed out to Christian wives who had unbelieving husbands: "They may be won without a word through the conduct of their wives, because of having been eyewitnesses of your chaste conduct."—1 Peter 3:1, 2.
Therefore, Jehovah's Witnesses try to recommend the good news to others in this way also: by being exemplary in the Christian conduct that they recommend to others. They try to 'do unto others as they would have others do unto them.' (Matthew 7:12) They try to be this way with all men, not just with fellow Witnesses, friends, neighbors, or relatives. Being imperfect, they do not always succeed 100 percent. But it is the desire of their hearts to do good unto all people not only in telling them the good news of the Kingdom but also in extending a helping hand whenever possible.—James 2:14-17

Jehovah's Witnesses - What They want you to hear

Jehovah's Witnesses—Who Are They? What Do They Believe?
The Good News They Want You to Hear

WHEN Jesus was on earth, his disciples came to him and asked: "What will be the sign of your presence and of the conclusion of the system of things?" He replied that there would be wars involving many nations, famines, pestilences, earthquakes, an increasing of lawlessness, false religious teachers misleading many, a hatred and persecution of his true followers, and a cooling off of the love of righteousness in many people. When these things would start to happen, it would indicate that Christ was invisibly present and that the heavenly Kingdom was at hand. This would be news—good news! So Jesus added these words as a part of the sign: "This good news of the kingdom will be preached in all the inhabited earth for a witness to all the nations; and then the end will come."—Matthew 24:3-14.
In themselves, recent world happenings are bad, but what they signify is good, namely, Christ's presence. The conditions mentioned above started to be evident in that widely heralded year 1914! It marked the end of the Gentile Times and the beginning of the transition period from human rule to the Thousand Year (Millennial) Reign of Christ.

"Critical times hard to deal with,"

BUT "then theend will come"
That there was to be a transition period is indicated by the 110th Psalm, verses 1 and 2, and Revelation 12:7-12. There it is shown that Christ would sit at God's right hand in heaven until the time for his becoming King. Then war in heaven would result in Satan's being cast to earth, bringing woe to the earth, and Christ would rule in the midst of his enemies. The complete end of wickedness would come by means of a "great tribulation," culminating in the war at Har-Magedon and followed by Christ's Thousand Year Reign of peace.—Matthew 24:21, 33, 34; Revelation 16:14-16.
"But know this," the Bible says, "that in the last days critical times hard to deal with will be here. For men will be lovers of themselves, lovers of money, self-assuming, haughty, blasphemers, disobedient to parents, unthankful, disloyal, having no natural affection, not open to any agreement, slanderers, without self-control, fierce, without love of goodness, betrayers, headstrong, puffed up with pride, lovers of pleasures rather than lovers of God, having a form of godly devotion but proving false to its power; and from these turn away."—2 Timothy 3:1-5.
Some may argue that these things have happened before in human history, but the fact is that they have never occurred to the same extent. As the historians and commentators say, there has never been a time on earth like the one experienced from 1914 onward. (See page 7.) The woes have been far more extensive than ever before. Moreover, as to other features of Christ's sign of the last days, these facts should be considered: The earth-wide proclamation of Christ's presence and Kingdom has been of a magnitude unprecedented in history. Persecution for preaching has never equaled that visited upon Jehovah's Witnesses. Many hundreds of them were executed in Nazi concentration camps. To this day Jehovah's Witnesses are under ban in some places, and in others they are arrested, imprisoned, tortured, and killed. This is all part of the sign Jesus gave.
As foretold at Revelation 11:18, 'the nations have become wrathful' against Jehovah's faithful Witnesses, and this indicates that Jehovah's "own wrath" will be expressed against those nations. This same scripture says that God will "bring to ruin those ruining the earth." Never before has there been a time in human history when the earth's capacity for sustaining life has been threatened. However, now it is different! Many scientists have warned that if man continues to pollute the earth, it will become uninhabitable. But Jehovah "formed it even to be inhabited," and he will get rid of the polluters before they complete their ruin of the earth.—Isaiah 45:18.
EARTHLY BLESSINGS UNDER THE KINGDOM
The thought of people living on earth as subjects of God's Kingdom may seem strange to many Bible believers who think of all those saved as being in heaven. The Bible shows that only a limited number go to heaven and that those who will live forever on earth will be a great crowd of unlimited number. (Psalm 37:11, 29; Revelation 7:9; 14:1-5) That God's Kingdom under Christ will fill the earth and reign over it is shown by a prophecy in the Bible book of Daniel.
Netherlands
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Christ's Kingdom is there represented as a stone cut from Jehovah's mountainlike sovereignty. It strikes and destroys an image that represents powerful nations of the earth, and "the stone that struck the image . . . became a large mountain and filled the whole earth." The prophecy continues: "In the days of those kings the God of heaven will set up a kingdom that will never be brought to ruin. And the kingdom itself will not be passed on to any other people. It will crush and put an end to all these kingdoms, and it itself will stand to times indefinite."—Daniel 2:34, 35, 44.
It is this Kingdom and the Scripturally supported hope of everlasting life on a cleansed and beautified earth that Jehovah's Witnesses wish to tell you about. Millions now living and many, many millions now in their graves will have opportunity to dwell therein forever. Then, under the Thousand Year Reign of Christ Jesus, Jehovah's original purpose for creating the earth and putting the first human pair on it will be realized. This earthly Paradise will never become boring. Just as Adam was assigned work in the garden of Eden, so humankind will have challenging projects in caring for the earth and the plant and animal life on it. They "shall long enjoy the work of their hands."—Isaiah 65:22, Revised Standard Version; Genesis 2:15.
Many scriptures could be presented to show the conditions that will exist when the prayer that Jesus taught us is answered: "Let your kingdom come. Let your will take place, as in heaven, also upon earth." (Matthew 6:10) However, let this one suffice for now: "I heard a loud voice from the throne say: 'Look! The tent of God is with mankind, and he will reside with them, and they will be his peoples. And God himself will be with them. And he will wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away.' And the One seated on the throne said: 'Look! I am making all things new.' Also, he says: 'Write, because these words are faithful and true.'"—Revelation 21:3-5.

Divine Name

The Divine Name Through the Ages
JEHOVAH God wants man to know and use his name. This is evident from the fact that He revealed His name to the very first two persons on earth. We know that Adam and Eve were familiar with God’s name because after Eve gave birth to Cain, according to the original Hebrew text, she said: "I have produced a man with the aid of Jehovah."-Genesis 4:1.
Later we read that faithful men like Enoch and Noah "walked with the true God." (Genesis 5:24; 6:9) They also, then, must have known God’s name. The name survived the great Flood with the righteous man Noah and his family. In spite of the great rebellion some time later at Babel, true servants of God kept on using his name. It appears hundreds of times in the laws that God gave to Israel. In the book of Deuteronomy alone, it appears 551 times.
In the days of the judges, the Israelites evidently did not shy away from using God’s name. They even used it in greeting one another. We read (in the original Hebrew) of Boaz greeting his harvesters: "Jehovah be with you." They returned his greeting by saying: "Jehovah bless you."-Ruth 2:4.
Throughout the history of the Israelites right up until the time that they returned to Judah after their captivity in Babylon, Jehovah’s name continued in common usage. King David, a man agreeable to God’s own heart, used the divine name extensively-it appears hundreds of times in the psalms that he wrote. (Acts 13:22) God’s name was also incorporated in many Israelite personal names. Thus we read of Adonijah ("My Lord Is Jah"-"Jah" is a shortened form of Jehovah), Isaiah ("Salvation of Jehovah"), Jonathan ("Jehovah Has Given"), Micah ("Who is like Jah?") and Joshua ("Jehovah Is Salvation").
Outside the Bible
There is also evidence from sources outside the Bible of the extensive use of the divine name in ancient times. In 1961 an ancient burial cave was uncovered a short distance to the southwest of Jerusalem, according to a report in the Israel Exploration Journal (Volume 13, No. 2). On its walls were Hebrew inscriptions that appear to date from the second half of the eighth century B.C.E. The inscriptions contain statements such as "Jehovah is the God of the whole earth."
In 1966 a report was published in the Israel Exploration Journal (Volume 16, No. 1) about pottery fragments with Hebrew writing on them that were found in Arad, in southern Israel. These were written in the second half of the seventh century B.C.E. One of them was a private letter to a man named Eliashib. The letter begins: "To my lord Eliashib: May Jehovah ask for your peace." And it ends: "He dwells in the house of Jehovah."
In 1975 and 1976, archaeologists working in the Negeb uncovered a collection of Hebrew and Phoenician inscriptions on plaster walls, large storage jars and stone vessels. The inscriptions included the Hebrew word for God, as well as God’s name, YHWH, in Hebrew letters. In Jerusalem itself, there was recently discovered a small, rolled-up strip of silver, apparently dating from before the Babylonian exile. Researchers say that when it was unrolled, the name of Jehovah in Hebrew was found to be written on it.-Biblical Archaeology Review, March/April 1983, page 18.
Another example of the use of God’s name is found in the so-called Lachish Letters. These letters, written on potsherds, were found between the years 1935 and 1938 in the ruins of Lachish, a fortified city that figured prominently in Israel’s history. They appear to have been written by an officer at a Judean outpost to his superior, named Yaosh, at Lachish, apparently during the war between Israel and Babylon toward the end of the seventh century B.C.E.
Of the eight legible shards, seven begin their message with a salutation such as: "May Jehovah cause my lord to see this season in good health!" Altogether, God’s name appears 11 times in the seven messages, clearly indicating that the name of Jehovah enjoyed everyday usage toward the end of the seventh century B.C.E.
Even pagan rulers knew and used the divine name when referring to the God of the Israelites. Thus, on the Moabite Stone, King Mesha of Moab boasts of his military exploits against Israel and, among other things, states: "Chemosh said to me, ‘Go, take Nebo from Israel!’ So I went by night and fought against it from the break of dawn until noon, taking it and slaying all . . . And I took from there the [vessels] of Jehovah, dragging them before Chemosh."
In reference to these non-Biblical uses of the name of God, the Theologisches Wörterbuch zum Alten Testament (Theological Dictionary of the Old Testament), in Volume 3, column 538, says: "Thus some 19 documentary evidences of the Tetragrammaton in the form jhwh testify in this regard to the reliability of the M[asoretic] T[ext]; more can be expected, above all from the Arad-Archives."-Translated from German.
God’s Name Not Forgotten
This familiarity with and use of God’s name continued right up to the days of Malachi, who lived about 400 years before Jesus’ time. In the Bible book bearing his name, Malachi gives great prominence to the divine name, using it altogether 48 times.
As time went on, many Jews came to live far from the land of Israel, and some could no longer read the Bible in the Hebrew language. Hence, in the third century B.C.E., a start was made in translating the part of the Bible that existed then (the "Old Testament") into Greek, the new international language. But the name of God was not neglected. The translators retained it, writing it in its Hebrew form. Ancient copies of the Greek Septuagint that have been preserved to our day testify to that.
What, though, was the situation when Jesus walked the earth? How can we know whether he and his apostles used God’s name?
[Picture on page 12]
In this letter, written on a fragment of pottery in the second half of the seventh century B.C.E., God’s name appears twice.
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(Picture by courtesy of the Israel Department of Antiquities and Museums)
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God’s name is also found in the Lachish Letters and on the Moabite Stone

Hallowed be what NAME part 2

God’s Name-Its Meaning and Pronunciation
ONE of the Bible writers asked: "Who has gathered the wind in the hollow of both hands? Who has wrapped up the waters in a mantle? Who has made all the ends of the earth to rise? What is his name and what the name of his son, in case you know?" (Proverbs 30:4) How can we find out what God’s name is? That is an important question. The creation is a powerful proof that God must exist, but it does not tell us his name. (Romans 1:20) In fact, we could never know God’s name unless the Creator himself told us. And he has done that in his own Book, the Holy Bible.
On one celebrated occasion, God pronounced his own name, repeating it in the hearing of Moses. Moses wrote an account of that event that has been preserved in the Bible down to our day. (Exodus 34:5) God even wrote his name with his own "finger." When he had given Moses what we today call the Ten Commandments, God miraculously wrote them down. The record says: "Now as soon as [God] had finished speaking with him on Mount Sinai he proceeded to give Moses two tablets of the Testimony, tablets of stone written on by God’s finger." (Exodus 31:18) God’s name appears eight times in the original Ten Commandments. (Exodus 20:1-17) Thus God himself has revealed his name to man both verbally and in writing. So, what is that name?
In the Hebrew language it is written יהוה. These four letters, called the Tetragrammaton, are read from right to left in Hebrew and can be represented in many modern languages as YHWH or JHVH. God’s name, represented by these four consonants, appears almost 7,000 times in the original "Old Testament," or Hebrew Scriptures.
The name is a form of a Hebrew verb ha·wah´ (הוה), meaning "to become," and actually signifies "He Causes to Become." Thus, God’s name identifies him as the One who progressively fulfills his promises and unfailingly realizes his purposes. Only the true God could bear such a meaningful name.
Do you remember the different ways that God’s name appeared in Psalm 83:18, as set out in the previous section (page 5)? Two of those translations had mere titles ("the LORD," the "Eternal") as substitutes for God’s name. But in two of them, Yahweh and Jehovah, you can see the four letters of God’s name. However, the pronunciation is different. Why?
How Is God’s Name Pronounced?
The truth is, nobody knows for sure how the name of God was originally pronounced. Why not? Well, the first language used in writing the Bible was Hebrew, and when the Hebrew language was written down, the writers wrote only consonants-not vowels. Hence, when the inspired writers wrote God’s name, they naturally did the same thing and wrote only the consonants.
While ancient Hebrew was an everyday spoken language, this presented no problem. The pronunciation of the Name was familiar to the Israelites and when they saw it in writing they supplied the vowels without thinking (just as, for an English reader, the abbreviation "Ltd." represents "Limited" and "bldg." represents "building").
Two things happened to change this situation. First, a superstitious idea arose among the Jews that it was wrong to say the divine name out loud; so when they came to it in their Bible reading they uttered the Hebrew word ’Adho·nai´ ("Sovereign Lord"). Further, as time went by, the ancient Hebrew language itself ceased to be spoken in everyday conversation, and in this way the original Hebrew pronunciation of God’s name was eventually forgotten.
In order to ensure that the pronunciation of the Hebrew language as a whole would not be lost, Jewish scholars of the second half of the first millennium C.E. invented a system of points to represent the missing vowels, and they placed these around the consonants in the Hebrew Bible. Thus, both vowels and consonants were written down, and the pronunciation as it was at that time was preserved.
When it came to God’s name, instead of putting the proper vowel signs around it, in most cases they put other vowel signs to remind the reader that he should say ’Adho·nai´. From this came the spelling Iehouah, and, eventually, Jehovah became the accepted pronunciation of the divine name in English. This retains the essential elements of God’s name from the Hebrew original.
Which Pronunciation Will You Use?
Where, though, did pronunciations like Yahweh come from? These are forms that have been suggested by modern scholars trying to deduce the original pronunciation of God’s name. Some-though not all-feel that the Israelites before the time of Jesus probably pronounced God’s name Yahweh. But no one can be sure. Perhaps they pronounced it that way, perhaps not.
Nevertheless, many prefer the pronunciation Jehovah. Why? Because it has a currency and familiarity that Yahweh does not have. Would it not, though, be better to use the form that might be closer to the original pronunciation? Not really, for that is not the custom with Bible names.
To take the most prominent example, consider the name of Jesus. Do you know how Jesus’ family and friends addressed him in day-to-day conversation while he was growing up in Nazareth? The truth is, no human knows for certain, although it may have been something like Yeshua (or perhaps Yehoshua). It certainly was not Jesus.
However, when the accounts of his life were written in the Greek language, the inspired writers did not try to preserve that original Hebrew pronunciation. Rather, they rendered the name in Greek, I·e·sous´. Today, it is rendered differently according to the language of the reader of the Bible. Spanish Bible readers encounter Jesús (pronounced Hes·soos´). Italians spell it Gesù (pronounced Djay·zoo´). And Germans spell it Jesus (pronounced Yay´soos).
Must we stop using the name of Jesus because most of us, or even all of us, do not really know its original pronunciation? So far, no translator has suggested this. We like to use the name, for it identifies the beloved Son of God, Jesus Christ, who gave his lifeblood for us. Would it be showing honor to Jesus to remove all mention of his name in the Bible and replace it with a mere title like "Teacher," or "Mediator"? Of course not! We can relate to Jesus when we use his name the way it is commonly pronounced in our language.
Similar comments could be made regarding all the names we read in the Bible. We pronounce them in our own language and do not try to imitate the original pronunciation. Thus we say "Jeremiah," not Yir·meya´hu. Similarly we say Isaiah, although in his own day this prophet likely was known as Yesha?·ya´hu. Even scholars who are aware of the original pronunciation of these names use the modern pronunciation, not the ancient, when speaking about them.
And the same is true with the name Jehovah. Even though the modern pronunciation Jehovah might not be exactly the way it was pronounced originally, this in no way detracts from the importance of the name. It identifies the Creator, the living God, the Most High to whom Jesus said: "Our Father in the heavens, let your name be sanctified."-Matthew 6:9.
‘It Cannot Be Supplanted’
While many translators favor the pronunciation Yahweh, the New World Translation and also a number of other translations continue the use of the form Jehovah because of people’s familiarity with it for centuries. Moreover, it preserves, equally with other forms, the four letters of the Tetragrammaton, YHWH or JHVH.
Earlier, the German professor Gustav Friedrich Oehler made a similar decision for much the same reason. He discussed various pronunciations and concluded: "From this point onward I use the word Jehovah, because, as a matter of fact, this name has now become more naturalized in our vocabulary, and cannot be supplanted."-Theologie des Alten Testaments (Theology of the Old Testament), second edition, published in 1882, page 143.
Similarly, in his Grammaire de l’hébreu biblique (Grammar of Biblical Hebrew), 1923 edition, in a footnote on page 49, Jesuit scholar Paul Joüon states: "In our translations, instead of the (hypothetical) form Yahweh, we have used the form Jéhovah . . . which is the conventional literary form used in French." In many other languages Bible translators use a similar form, as indicated in the box on page 8.
Is it, then, wrong to use a form like Yahweh? Not at all. It is just that the form Jehovah is likely to meet with a quicker response from the reader because it is the form that has been "naturalized" into most languages. The important thing is that we use the name and declare it to others. "Give thanks to Jehovah, you people! Call upon his name. Make known among the peoples his dealings. Make mention that his name is put on high."-Isaiah 12:4.
Let us see how God’s servants have acted in harmony with that command through the centuries.
[Footnotes]
See Appendix 1A in the New World Translation of the Holy Scriptures, 1984 edition.
See Appendix 1A in the New World Translation of the Holy Scriptures, 1984 edition.
[Box on page 7]
Different scholars have different ideas about how the name YHWH was originally pronounced.
In The Mysterious Name of Y.H.W.H., page 74, Dr. M. Reisel said that the "vocalisation of the Tetragrammaton must originally have been YeHuàH or YaHuàH."
Canon D. D. Williams of Cambridge held that the "evidence indicates, nay almost proves, that Jahwéh was not the true pronunciation of the Tetragrammaton . . . The Name itself was probably JAHÔH."-Zeitschrift für die alttestamentliche Wissenschaft (Periodical for Old Testament Knowledge), 1936, Volume 54, page 269.
In the glossary of the French Revised Segond Version, page 9, the following comment is made: "The pronunciation Yahvé used in some recent translations is based on a few ancient witnesses, but they are not conclusive. If one takes into account personal names that include the divine name, such as the Hebrew name of the prophet Elijah (Eliyahou) the pronunciation might just as well be Yaho or Yahou."
In 1749 the German Bible scholar Teller told of some different pronunciations of God’s name he had read: "Diodorus from Sicily, Macrobius, Clemens Alexandrinus, Saint Jerome and Origenes wrote Jao; the Samaritans, Epiphanius, Theodoretus, Jahe, or Jave; Ludwig Cappel reads Javoh; Drusius, Jahve; Hottinger, Jehva; Mercerus, Jehovah; Castellio, Jovah; and le Clerc, Jawoh, or Javoh."
Thus it is evident that the original pronunciation of God’s name is no longer known. Nor is it really important. If it were, then God himself would have made sure that it was preserved for us to use. The important thing is to use God’s name according to its conventional pronunciation in our own language.
[Box on page 8]
Forms of the divine name in different languages, indicating international acceptance of the form Jehovah
Awabakal - Yehóa
Bugotu - Jihova
Cantonese - Yehwowah
Danish - Jehova
Dutch - Jehovah
Efik - Jehovah
English - Jehovah
Fijian - Jiova
Finnish - Jehova
French - Jéhovah
Futuna - Ihova
German - Jehova
Hungarian - Jehova
Igbo - Jehova
Italian - Geova
Japanese - Ehoba
Maori - Ihowa
Motu - Iehova
Mwala-Malu - Jihova
Narrinyeri - Jehovah
Nembe - Jihova
Petats - Jihouva
Polish - Jehowa
Portuguese - Jeová
Romanian - Iehova
Samoan - Ieova
Sotho - Jehova
Spanish - Jehová
Swahili - Yehova
Swedish - Jehova
Tahitian - Iehova
Tagalog - Jehova
Tongan - Jihova
Venda - Yehova
Xhosa - uYehova
Yoruba - Jehofah
Zulu - uJehova
[Box on page 11]
"Jehovah" has become widely known as the name of God even in non-Biblical contexts.
Franz Schubert composed the music for the lyric entitled "The Almightiness," written by Johann Ladislav Pyrker, in which the name Jehovah appears twice. It is also used at the end of the last scene of Verdi’s opera "Nabucco."
Additionally, French composer Arthur Honegger’s oratorio "King David" gives prominence to the name Jehovah, and renowned French author Victor Hugo used it in over 30 of his works. Both he and Lamartine wrote poems entitled "Jehovah."
In the book Deutsche Taler (The German Taler), published in 1967 by Germany’s Federal Bank, there is a picture of what is one of the oldest coins bearing the name "Jehovah," a 1634 Reichstaler from the Duchy of Silesia. Regarding the picture on the coin’s reverse side, it says: "Under the radiant name JEHOVAH, rising up out of the midst of clouds, is a crowned shield with the Silesian coat of arms."
In a museum in Rudolstadt, East Germany, you can see on the collar of the suit of armor once worn by Gustavus II Adolph, a 17th-century king of Sweden, the name JEHOVAH in capital letters.
Thus, for centuries the form Jehovah has been the internationally recognized way to pronounce God’s name, and people who hear it instantly recognize who is being spoken about. As Professor Oehler said, "This name has now become more naturalized in our vocabulary, and cannot be supplanted."-Theologie des Alten Testaments (Theology of the Old Testament).
[Picture on page 6]
Detail of an angel with God’s name, found on the tomb of Pope Clement XIII in St. Peter’s Basilica, the Vatican
[Picture on page 7]
Many coins were minted bearing God’s name. This one, dated 1661, is from Nuremberg, Germany. The Latin text reads: "Under the shadow of your wings"
[Pictures on page 9]
In times past, God’s name in the form of the Tetragrammaton was made part of the decoration of many religious buildings
Fourvière Catholic Basilica, Lyons, France
Bourges Cathedral, France
Church in La Celle Dunoise, France
Church in Digne, southern France
Church in São Paulo, Brazil
Strasbourg Cathedral, France
Saint Mark’s Cathedral, Venice, Italy
[Pictures on page 10]
Jehovah’s name as it appears in a monastery in Bordesholm, Germany;
on a German coin dated 1635;
over a church door in Fehmarn, Germany;
and on an 1845 gravestone in Harmannschlag, Lower Austria

Hallowed be what NAME

"Hallowed Be Your Name"-What Name?
ARE you a religious person? Then doubtless, like many others, you believe in a Supreme Being. And likely you have great respect for the well-known prayer to that Being, taught by Jesus to his followers and known as the Lord’s Prayer, or the Our Father. The prayer begins like this: "Our Father in heaven, hallowed be your name."-Matthew 6:9, New International Version.
Have you ever wondered why Jesus put the ‘hallowing,’ or sanctifying, of God’s name first in this prayer? Afterward, he mentioned other things such as the coming of God’s Kingdom, God’s will being done on earth and our sins being forgiven. The fulfillment of these other requests will ultimately mean lasting peace on earth and everlasting life for mankind. Can you think of anything more important than that? Nevertheless, Jesus told us to pray first of all for the sanctification of God’s name.
It was not merely by chance that Jesus taught his followers to put God’s name first in their prayers. That name was clearly of crucial importance to him, since he mentioned it repeatedly in his own prayers. On one occasion when he was praying publicly to God, he was heard to say: "Father, glorify your name!" And God himself answered: "I have glorified it, and I will glorify it again."-John 12:28, The Jerusalem Bible.
The evening before Jesus died, he was praying to God in the hearing of his disciples, and once again they heard him highlight the importance of God’s name. He said: "I have made your name known to the men you took from the world to give me." Later, he repeated: "I have made your name known to them and will continue to make it known."-John 17:6, 26, JB.
Why was God’s name so important to Jesus? Why did he show that it is important for us, too, by telling us to pray for its sanctification? To understand this, we need to realize how names were viewed in Bible times.
Names in Bible Times
Jehovah God evidently put in man a desire to name things. The first human had a name, Adam. In the story of creation, one of the first things Adam is reported as doing is naming the animals. When God gave Adam a wife, immediately Adam called her "Woman" (’Ish·shah´, in Hebrew). Later, he gave her the name Eve, meaning "Living One," because "she had to become the mother of everyone living." (Genesis 2:19, 23; 3:20) Even today we follow the custom of giving names to people. Indeed, it is hard to imagine how we could manage without names.
In Israelite times, however, names were not mere labels. They meant something. For example, the name of Isaac, "Laughter," recalled the laughter of his aged parents when they first heard that they were to have a child. (Genesis 17:17, 19; 18:12) Esau’s name meant "Hairy," describing a physical characteristic. His other name, Edom, "Red," or "Ruddy," was a reminder that he sold his birthright for a dish of red stew. (Genesis 25:25, 30-34; 27:11; 36:1) Jacob, although he was only slightly younger than his twin brother, Esau, bought the birthright from Esau and received the firstborn’s blessing from his father. From birth, the meaning of Jacob’s name was "Taking Hold of the Heel" or "Supplanter." (Genesis 27:36) Similarly the name of Solomon, during whose reign Israel enjoyed peace and prosperity, meant "Peaceable."-1 Chronicles 22:9.
Thus, The Illustrated Bible Dictionary (Volume 1, page 572) states the following: "A study of the word ‘name’ in the O[ld] T[estament] reveals how much it means in Hebrew. The name is no mere label, but is significant of the real personality of him to whom it belongs."
The fact that God views names as important is seen in that, through an angel, he instructed the future parents of John the Baptist and Jesus as to what their sons’ names should be. (Luke 1:13, 31) And at times he changed names, or he gave people additional names, to show the place they were to have in his purpose. For example, when God foretold that his servant Abram ("Father of Exaltation") would become father to many nations He changed his name to Abraham ("Father of a Multitude"). And he changed the name of Abraham’s wife, Sarai ("Contentious"), to Sarah ("Princess"), since she would be the mother of Abraham’s seed.-Genesis 17:5, 15, 16; compare Genesis 32:28; 2 Samuel 12:24, 25.
Jesus, too, recognized the importance of names and he referred to Peter’s name in giving him a privilege of service. (Matthew 16:16-19) Even spirit creatures have names. Two mentioned in the Bible are Gabriel and Michael. (Luke 1:26; Jude 9) And when man gives names to inanimate things such as stars, planets, towns, mountains and rivers, he is merely imitating his Creator. For example, the Bible tells us that God calls all the stars by name.-Isaiah 40:26.
Yes, names are important in God’s eyes, and he put in man the desire to identify people and things by means of names. Thus angels, people, animals, as well as stars and other inanimate things, have names. Would it be consistent for the Creator of all these things to leave himself nameless? Of course not, especially in view of the psalmist’s words: "Let all flesh bless [God’s] holy name to time indefinite, even forever."-Psalm 145:21.
The New International Dictionary of New Testament Theology (Volume 2, page 649) says: "One of the most fundamental and essential features of the biblical revelation is the fact that God is not without a name: he has a personal name, by which he can, and is to be, invoked." Jesus certainly had that name in mind when he taught his followers to pray: "Our Father in the heavens, let your name be sanctified."-Matthew 6:9.
In view of all of this, it is evidently important for us to know what God’s name is. Do you know God’s personal name?
What Is God’s Name?
Surprisingly, the majority of the hundreds of millions of members of the churches of Christendom would probably find it difficult to answer that question. Some would say that God’s name is Jesus Christ. Yet Jesus was praying to someone else when he said: "I have made your name manifest to the men you gave me out of the world." (John 17:6) He was praying to God in heaven, as a son speaking to his father. (John 17:1) It was his heavenly Father’s name that had to be "hallowed," or "sanctified."
Yet many modern Bibles do not contain the name, and it is rarely used in the churches. Hence, far from being "hallowed," it has been lost to millions of Bible readers. As an example of the way Bible translators have treated God’s name, consider just one verse where it appears: Psalm 83:18. Here is how this scripture is rendered in four different Bibles:
"Let them know that thou alone, whose name is the LORD, art the Most High over all the earth." (Revised Standard Version of 1952)
"To teach them that thou, O Eternal, thou art God Most High o’er all the world." (A New Translation of the Bible, by James Moffatt, of 1922)
"Let them know this: you alone bear the name Yahweh, Most High over the whole world." (Catholic Jerusalem Bible of 1966)
"That men may know that thou, whose name alone is JEHOVAH, art the most high over all the earth." (Authorized, or King James, Version of 1611)
Why does God’s name look so different in these versions? Is his name LORD, the Eternal, Yahweh or Jehovah? Or are these all acceptable?
To answer this, we have to remember that the Bible was not originally written in English. The Bible writers were Hebrews, and they mostly wrote in the Hebrew and Greek languages of their day. Most of us do not speak those ancient languages. But the Bible has been translated into numerous modern tongues, and we can use these translations when we want to read God’s Word.
Christians have a deep respect for the Bible and rightly believe that "all Scripture is inspired of God." (2 Timothy 3:16) Hence, translating the Bible is a weighty responsibility. If someone deliberately changes or omits part of the contents of the Bible, he is tampering with the inspired Word. To such a one the Scriptural warning would apply: "If anyone makes an addition to these things, God will add to him the plagues that are written in this scroll; and if anyone takes anything away from the words of the scroll of this prophecy, God will take his portion away from the trees of life."-Revelation 22:18, 19; see also Deuteronomy 4:2.
Most Bible translators doubtless respect the Bible and sincerely want to make it understandable in this modern age. But translators are not inspired. Most of them have strong opinions, too, on religious matters and may be influenced by personal ideas and preferences. They can also make human errors or mistakes in judgment.
Hence, we have the right to ask some important questions: What is God’s real name? And why do different Bible translations have different names for God? Having established the answer to these questions, we can return to our original problem: Why is the sanctification of God’s name so important?
[Blurb on page 4]
Angels, people, animals, as well as stars and other inanimate things, have names. Would it be consistent for the Creator of all these things to be nameless?
[Blurb on page 5]
God’s name was clearly of crucial importance to Jesus, since he mentioned it repeatedly in his prayers

Blood and Doctors

Blood: Whose Choice and Whose Conscience?
by J. Lowell Dixon, M.D.
Reprinted by permission of the New York State Journal of Medicine, 1988; 88:463-464, copyright by the Medical Society of the State of New York.
PHYSICIANS are committed to applying their knowledge, skills, and experience in fighting disease and death. Yet, what if a patient refuses a recommended treatment? This will likely occur if the patient is a Jehovah’s Witness and the treatment is whole blood, packed red blood cells, plasma, or platelets.
When it comes to the use of blood, a physician may feel that a patient’s choice of nonblood treatment will tie the hands of dedicated medical personnel. Still, one must not forget that patients other than Jehovah’s Witnesses often choose not to follow their doctor’s recommendations. According to Appelbaum and Roth,1 19% of patients at teaching hospitals refused at least one treatment or procedure, even though 15% of such refusals "were potentially life endangering."
The general view that "the doctor knows best" causes most patients to defer to their doctor’s skill and knowledge. But how subtly dangerous it would be for a physician to proceed as if this phrase were a scientific fact and to treat patients accordingly. True, our medical training, licensing, and experience give us noteworthy privileges in the medical arena. Our patients, though, have rights. And, as we are likely aware, the law (even the Constitution) gives greater weight to rights.
On the walls of most hospitals, one sees displayed the "Patient’s Bill of Rights." One of these rights is informed consent, which might more accurately be called informed choice. After the patient is informed of the potential results of various treatments (or of nontreatment), it is his choice what he will submit to. At Albert Einstein Hospital in the Bronx, New York, a draft policy on blood transfusion and Jehovah’s Witnesses stated: "Any adult patient who is not incapacitated has the right to refuse treatment no matter how detrimental such a refusal may be to his health."2
While physicians may voice concerns about ethics or liability, courts have stressed the supremacy of patient choice.3 The New York Court of Appeals stated that "the patient’s right to determine the course of his own treatment [is] paramount . . . [A] doctor cannot be held to have violated his legal or professional responsibilities when he honors the right of a competent adult patient to decline medical treatment."4 That court has also observed that "the ethical integrity of the medical profession, while important, cannot outweigh the fundamental individual rights here asserted. It is the needs and desires of the individual, not the requirements of the institution, that are paramount."5
When a Witness refuses blood, physicians may feel pangs of conscience at the prospect of doing what seems to be less than the maximum. What the Witness is asking conscientious doctors to do, though, is to provide the best alternative care possible under the circumstances. We often must alter our therapy to accommodate circumstances, such as hypertension, severe allergy to antibiotics, or the unavailability of certain costly equipment. With the Witness patient, physicians are being asked to manage the medical or surgical problem in harmony with the patient’s choice and conscience, his moral/religious decision to abstain from blood.
Numerous reports of major surgery on Witness patients show that many physicians can, in good conscience and with success, accommodate the request not to employ blood. For example, in 1981, Cooley reviewed 1,026 cardiovascular operations, 22% on minors. He determined "that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others."6 Kambouris7 reported on major operations on Witnesses, some of whom had been "denied urgently needed surgical treatment because of their refusal to accept blood." He said: "All patients received pretreatment assurances that their religious beliefs would be respected, regardless of the circumstances in the operating room. There were no untoward effects of this policy."
When a patient is a Jehovah’s Witness, beyond the matter of choice, conscience comes into the picture. One cannot think only of the physician’s conscience. What of the patient’s? Jehovah’s Witnesses view life as God’s gift represented by blood. They believe the Bible’s command that Christians must "abstain from blood" (Acts 15:28, 29).8 Hence, if a physician paternalistically violated such patients’ deep and long-held religious convictions, the result could be tragic. Pope John Paul II has observed that forcing someone to violate his conscience "is the most painful blow inflicted to human dignity. In a certain sense, it is worse than inflicting physical death, or killing."9
While Jehovah’s Witnesses refuse blood for religious reasons, more and more non-Witness patients are choosing to avoid blood because of risks such as AIDS, non-A non-B hepatitis, and immunologic reactions. We may present to them our views as to whether such risks seem minor compared to the benefits. But, as the American Medical Association points out, the patient is "the final arbiter as to whether he will take his chances with the treatment or operation recommended by the doctor or risk living without it. Such is the natural right of the individual, which the law recognizes."10
Related to this, Macklin11 brought up the risk/benefit issue regarding a Witness "who risked bleeding to death without a transfusion." A medical student said: "His thought processes were intact. What do you do when religious beliefs are against the only source of treatment?" Macklin reasoned: "We may believe very strongly this man is making a mistake. But Jehovah’s Witnesses believe that to be transfused . . . [may] result in eternal damnation. We are trained to do risk-benefit analyses in medicine but if you weigh eternal damnation against remaining life on earth, the analysis assumes a different angle."11
Vercillo and Duprey12 in this issue of the Journal refer to In re Osborne to highlight the interest in ensuring the security of dependents, but how was that case resolved? It concerned a severely injured father of two minor children. The court determined that if he died, relatives would materially and spiritually care for his children. So, as in other recent cases,13 the court found no compelling state interest to justify overriding the patient’s choice of treatment; judicial intervention to authorize treatment deeply objectionable to him was unwarranted.14 With alternative treatment the patient recovered and continued to care for his family.
Is it not true that the vast majority of cases physicians have confronted, or likely will, can be managed without blood? What we studied and know best has to do with medical problems, yet patients are human beings whose individual values and goals cannot be ignored. They know best about their own priorities, their own morals and conscience, which give life meaning for them.
Respecting the religious consciences of Witness patients may challenge our skills. But as we meet this challenge, we underscore valuable liberties that all of us cherish. As John Stuart Mill aptly wrote: "No society in which these liberties are not, on the whole, respected, is free, whatever may be its form of government . . . Each is the proper guardian of his own health, whether bodily, or mental and spiritual. Mankind are greater gainers by suffering each other to live as seems good to themselves, than by compelling each to live as seems good to the rest."15
[REFERENCES]
1. Appelbaum PS, Roth LH: Patients who refuse treatment in medical hospitals. JAMA 1983; 250:1296-1301.
2. Macklin R: The inner workings of an ethics committee: Latest battle over Jehovah’s Witnesses. Hastings Cent Rep 1988; 18(1):15-20.
3. Bouvia v Superior Court, 179 Cal App 3d 1127, 225 Cal Rptr 297 (1986); In re Brown, 478 So 2d 1033 (Miss 1985).
4. In re Storar, 438 NYS 2d 266, 273, 420 NE 2d 64, 71 (NY 1981).
5. Rivers v Katz, 504 NYS 2d 74, 80 n 6, 495 NE 2d 337, 343 n 6 (NY 1986).
6. Dixon JL, Smalley MG: Jehovah’s Witnesses. The surgical/ethical challenge. JAMA 1981; 246:2471-2472.
7. Kambouris AA: Major abdominal operations on Jehovah’s Witnesses. Am Surg 1987; 53:350-356.
8. Jehovah’s Witnesses and the Question of Blood. Brooklyn, NY, Watchtower Bible and Tract Society, 1977, pp 1-64.
9. Pope denounces Polish crackdown. NY Times, January 11, 1982, p A9.
10. Office of the General Counsel: Medicolegal Forms with Legal Analysis. Chicago, American Medical Association, 1973, p 24.
11. Kleiman D: Hospital philosopher confronts decisions of life. NY Times, January 23, 1984, pp B1, B3.
12. Vercillo AP, Duprey SV: Jehovah’s Witnesses and the transfusion of blood products. NY State J Med 1988; 88:493-494.
13. Wons v Public Health Trust, 500 So 2d 679 (Fla Dist Ct App) (1987); Randolph v City of New York, 117 AD 2d 44, 501 NYS 2d 837 (1986); Taft v Taft, 383 Mass 331, 446 NE 2d 395 (1983).
14. In re Osborne, 294 A 2d 372 (DC Ct App 1972).
15. Mill JS: On liberty, in Adler MJ (ed): Great Books of the Western World. Chicago, Encyclopaedia Britannica, Inc, 1952, vol 43, p 273.

Your Rights regarding Blood

You Have the Right to Choose
A current medical approach (called risk/benefit analysis) is making it easier for doctors and patients to cooperate in avoiding blood therapy. Doctors weigh factors such as the risks of a certain drug or surgery and the probable benefits. Patients too can share in such an analysis.
Let us use one example that people in many places can relate to-chronic tonsillitis. If you had this problem, likely you would go to a doctor. In fact, you might consult two, since health experts often recommend getting a second opinion. One might recommend surgery. He outlines what that means: length of hospital stay, amount of pain, and cost. As to risks, he says that severe bleeding is not common and death from such an operation is very rare. But the doctor giving a second opinion urges you to try antibiotic therapy. He explains the type of drug, likelihood of success, and expense. As to risk, he says that very few patients have life-threatening reactions to the drug.
Each competent physician likely considered risks and benefits, but now you have to weigh the risks and possible benefits, as well as other factors that you best know. (You are in the best position to consider such aspects as your emotional or spiritual strength, family finances, effect on the family, and your own ethics.) Then you make a choice. Possibly you give informed consent for one therapy but decline the other.
This would also be so if it was your child that had the chronic tonsillitis. The risks, benefits, and therapies would be outlined for you, the loving parents who are most directly affected and who will be responsible to cope with the results. After considering all aspects, you can make an informed choice on this matter involving your child’s health and even his or her life. Perhaps you consent to the surgery, with its risks. Other parents might choose the antibiotics, with their risks. As physicians differ in their advice, so patients or parents differ as to what they feel is best. Such is an understood feature of making informed (risk/benefit) choices.
What about use of blood? No one who objectively examines the facts can deny that blood transfusions involve great risk. Dr. Charles Huggins, who is the director of transfusion service at the large Massachusetts General Hospital, made this very clear: "Blood has never been safer. But it must be considered unavoidably non-safe. It is the most dangerous substance we use in medicine."-The Boston Globe Magazine, February 4, 1990.
With good reason, medical personnel have been advised: "It is necessary to reevaluate as well the risk part of the benefit/risk relationship for blood transfusion and to seek alternatives." (Italics ours.)-Perioperative Red Cell Transfusion, National Institutes of Health conference, June 27-29, 1988.
Physicians may disagree as to the benefits or risks in using blood. One may give many transfusions and be convinced that they are worth the risk. Another may feel the risks are unjustified, for he has had good results with nonblood management. Ultimately, however, you, the patient or the parent, must decide. Why you? Because your (or your child’s) body, life, ethics, and profoundly important relationship with God are involved.
YOUR RIGHT IS RECOGNIZED
In many places today, the patient has an inviolable right to decide what treatment he will accept. "The law of informed consent has been based on two premises: first, that a patient has the right to receive sufficient information to make an informed choice about the treatment recommended; and second, that the patient may choose to accept or to decline the physician’s recommendation. . . . Unless patients are viewed as having the right to say no, as well as yes, and even yes with conditions, much of the rationale for informed consent evaporates."-Informed Consent-Legal Theory and Clinical Practice, 1987.
Some patients have encountered resistance when they have tried to exercise their right. It might have been from a friend having strong feelings about a tonsillectomy or about antibiotics. Or a physician might have been convinced of the rightness of his advice. A hospital official might even have disagreed, based on legal or financial interests.
"Many orthopaedists elect not to operate on [Witness] patients," says Dr. Carl L. Nelson. "It is our belief that the patient has the right to refuse any type of medical therapy. If it is technically possible to provide surgery safely while excluding a particular treatment, such as transfusion, then it should exist as an option."-The Journal of Bone and Joint Surgery, March 1986.
A considerate patient will not pressure a physician to use a therapy at which the doctor is unskilled. As Dr. Nelson noted, though, many dedicated physicians can accommodate the patient’s beliefs. A German official advised: "The doctor cannot refuse to render aid . . . reasoning that with a Jehovah’s Witness not all medical alternatives are at his disposal. He still has a duty to render assistance even when the avenues open to him are reduced." (Der Frauenarzt, May-June 1983) Similarly, hospitals exist not merely to make money but to serve all people without discrimination. Catholic theologian Richard J. Devine states: "Although the hospital must make every other medical effort to preserve the patient’s life and health, it must ensure that medical care does not violate [his] conscience. Moreover, it must avoid all forms of coercion, from cajoling the patient to obtaining a court order to force a blood transfusion."-Health Progress, June 1989.
RATHER THAN THE COURTS
Many people agree that a court is no place for personal medical issues. How would you feel if you chose antibiotic therapy but someone went to court to force a tonsillectomy on you? A doctor may want to provide what he thinks is the best care, but he has no duty to seek legal justification to trample on your basic rights. And since the Bible puts abstaining from blood on the same moral level as avoiding fornication, to force blood on a Christian would be the equivalent of forcible sex-rape.-Acts 15:28, 29.
Yet, Informed Consent for Blood Transfusion (1989) reports that some courts are so distressed when a patient is willing to accept a certain risk because of his religious rights "that they make up some legal exceptions-legal fictions, if you will-to allow a transfusion to occur." They might try to excuse it by saying that a pregnancy is involved or that there are children to be supported. "Those are legal fictions," the book says. "Competent adults are entitled to refuse treatment."
Some who insist on transfusing blood ignore the fact that Witnesses do not decline all therapies. They reject just one therapy, which even experts say is fraught with danger. Usually a medical problem can be managed in a variety of ways. One has this risk, another that risk. Can a court or a doctor paternalistically know which risk is "in your best interests"? You are the one to judge that. Jehovah’s Witnesses are firm that they do not want someone else to decide for them; it is their personal responsibility before God.
If a court forced an abhorrent treatment on you, how might this affect your conscience and the vital element of your will to live? Dr. Konrad Drebinger wrote: "It would certainly be a misguided form of medical ambition that would lead one to force a patient to accept a given therapy, overruling his conscience, so as to treat him physically but dealing his psyche a mortal blow."-Der Praktische Arzt, July 1978.
LOVING CARE FOR CHILDREN
Court cases regarding blood mainly involve children. On occasion, when loving parents have respectfully asked that nonblood management be used, some medical personnel have sought court backing to give blood. Of course, Christians agree with laws or court action to prevent child abuse or neglect. Perhaps you have read of cases in which some parent brutalized a child or denied it all medical care. How tragic! Clearly, the State can and should step in to protect a neglected child. Still, it is easy to see how very different it is when a caring parent requests high-quality nonblood medical therapy.
These court cases usually focus on a child in a hospital. How did the youngster get there, and why? Almost always the concerned parents brought their child to get quality care. Even as Jesus was interested in children, Christian parents care for their children. The Bible speaks of ‘a nursing mother cherishing her own children.’ Jehovah’s Witnesses have such deep love for their children.-1 Thessalonians 2:7; Matthew 7:11; 19:13-15.
Naturally, all parents make decisions affecting their children’s safety and life: Will the family use gas or oil to heat the home? Will they take a child on a long-distance drive? May he go swimming? Such matters involve risks, even life-and-death ones. But society recognizes parental discretion, so parents are granted the major voice in nearly all decisions affecting their children.
In 1979 the U.S. Supreme Court stated clearly: "The law’s concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life’s difficult decisions. . . . Simply because the decision of a parent [on a medical matter] involves risks does not automatically transfer the power to make that decision from the parents to some agency or officer of the state."-Parham v. J.R.
That same year the New York Court of Appeals ruled: "The most significant factor in determining whether a child is being deprived of adequate medical care . . . is whether the parents have provided an acceptable course of medical treatment for their child in light of all the surrounding circumstances. This inquiry cannot be posed in terms of whether the parent has made a ‘right’ or a ‘wrong’ decision, for the present state of the practice of medicine, despite its vast advances, very seldom permits such definitive conclusions. Nor can a court assume the role of a surrogate parent."-In re Hofbauer.
Recall the example of parents choosing between surgery and antibiotics. Each therapy would have its own risks. Loving parents are responsible to weigh risks, benefits, and other factors and then to make a choice. In this connection, Dr. Jon Samuels (Anesthesiology News, October 1989) suggested a review of Guides to the Judge in Medical Orders Affecting Children, which took this position:
"Medical knowledge is not sufficiently advanced to enable a physician to predict with reasonable certainty that his patient will live or die . . . If there is a choice of procedures-if, for example, the doctor recommends a procedure which has an 80 per cent chance of success but which the parents disapprove, and the parents have no objection to a procedure which has only a 40 per cent chance of success-the doctor must take the medically riskier but parentally unobjectionable course."
In view of the many lethal hazards in medical use of blood that have surfaced and because there are effective alternative ways of management, might not avoiding blood even carry the lower risk?
Naturally, Christians weigh many factors if their child needs surgery. Every operation, with or without the use of blood, has risks. What surgeon gives guarantees? The parents may know that skilled physicians have had fine success with bloodless surgery on Witness children. So even if a physician or a hospital official has another preference, rather than cause a stressful and time-consuming legal battle, is it not reasonable for them to work with the loving parents? Or parents may transfer their child to another hospital where the staff is experienced in handling such cases and willing to do so. In fact, nonblood management will more likely be quality care, for it can help the family "to achieve legitimate medical and nonmedical goals," as we noted earlier.
[Footnotes]
See the medical article "Blood: Whose Choice and Whose Conscience?" reprinted in the Appendix, on pages 30-1.
[Box on page 18]
RELIEVING LEGAL CONCERNS
You may wonder, ‘Why are some doctors and hospitals quick to get a court order to give blood?’ In some places a common reason is fear of liability.
There is no basis for such concern when Jehovah’s Witnesses choose nonblood management. A doctor at Albert Einstein College of Medicine (U.S.A.) writes: "Most [Witnesses] readily sign the American Medical Association form relieving physicians and hospitals of liability, and many carry a Medical Alert [card]. A properly signed and dated ‘Refusal to Accept Blood Products’ form is a contractual agreement and is legally binding."-Anesthesiology News, October 1989.
Yes, Jehovah’s Witnesses cooperatively offer legal assurance that a physician or hospital will not incur liability in providing requested nonblood therapy. As recommended by medical experts, each Witness carries a Medical Document card. This is renewed annually and is signed by the person and by witnesses, often his next of kin.
In March 1990, the Supreme Court of Ontario, Canada, upheld a decision that commented approvingly on such a document: "The card is a written declaration of a valid position which the card carrier may legitimately take in imposing a written restriction on [the] contract with the doctor." In Medicinsk Etik (1985), Professor Daniel Andersen wrote: "If there is an unambiguous written statement from the patient saying that he is one of Jehovah’s Witnesses and does not want blood under any circumstances, respect for the patient’s autonomy requires that this wish be respected, just as if it had been expressed orally."
Witnesses will also sign hospital consent forms. One used at a hospital in Freiburg, Germany, has space where the physician can describe the information he gave the patient about the treatment. Then, above the signatures of the physician and the patient, this form adds: "As a member of the religious body of Jehovah’s Witnesses, I categorically refuse the use of foreign blood or blood components during my surgery. I am aware that the planned and needed procedure thus has a higher risk due to bleeding complications. After receiving thorough explanation particularly about that, I request that the needed surgery be performed without using foreign blood or blood components."-Herz Kreislauf, August 1987.
Actually, nonblood management may have a lower risk. But the point here is that Witness patients happily relieve any needless concerns so that medical personnel can move forward in doing what they are committed to do, helping people get well. This cooperation benefits all, as Dr. Angelos A. Kambouris showed in "Major Abdominal Operations on Jehovah’s Witnesses":
"Preoperative agreement should be viewed as binding by the surgeon and should be adhered to regardless of events developing during and after operation. [This] orients the patients positively toward their surgical treatment, and diverts the surgeon’s attention from the legal and philosophical considerations to the surgical and technical ones, thus, allowing him to perform optimally and serve his patient’s best interests."-The American Surgeon, June 1987.
[Box on page 19]
"Overuse of medical technology is a major factor in the increase of current health care expenditures. . . . Blood transfusion is of particular importance because of its cost and high risk potential. Accordingly, blood transfusion was classified by the American Joint Commission on Accreditation of Hospitals as ‘high volume, high risk and error prone.’"-"Transfusion," July-August 1989.
[Box on page 20]
United States: "Underlying the necessity for patient consent is the ethical concept of individual autonomy, that decisions about one’s own fate should be made by the person involved. The legal ground for requiring consent is that a medical act performed without the patient’s consent constitutes battery."-"Informed Consent for Blood Transfusion," 1989.
Germany: "The patient’s right of self-determination overrides the principle of rendering assistance and preservation of life. As a result: no blood transfusion against the will of the patient."-"Herz Kreislauf," August 1987.
Japan: "There is no ‘absolute’ in the medical world. Doctors believe that the course of modern medicine is the best and follow its course, but they should not force every detail of it as an ‘absolute’ on patients. Patients too must have freedom of choice."-"Minami Nihon Shimbun," June 28, 1985.
[Box on page 21]
"I have found the families [of Jehovah’s Witnesses] to be close knit and loving," reports Dr. Lawrence S. Frankel. "The children are educated, caring, and respectful. . . . There even appears to possibly be stronger compliance to medical dictates, which might represent an effort to demonstrate acceptance of medical intervention to the extent that their beliefs permit."-Department of Pediatrics, M. D. Anderson Hospital and Tumor Institute, Houston, U.S.A., 1985.
[Box on page 22]
"I fear it is not uncommon," comments Dr. James L. Fletcher, Jr., "for professional arrogance to supplant sound medical judgment. Treatments that are regarded as ‘the best today’ are modified or discarded tomorrow. Which is more dangerous, a ‘religious parent’ or an arrogant physician who is convinced that his or her treatment is absolutely vital?"-"Pediatrics," October 1988.

Blood and Surgical challenges

Jehovah’s Witnesses-The Surgical/Ethical Challenge
Reprinted with permission of the American Medical Association from The Journal of the American Medical Association (JAMA), November 27, 1981, Volume 246, No. 21, pages 2471, 2472. Copyright 1981, American Medical Association.
Physicians face a special challenge in treating Jehovah’s Witnesses. Members of this faith have deep religious convictions against accepting homologous or autologous whole blood, packed RBCs [red blood cells], WBCs [white blood cells], or platelets. Many will allow the use of (non-blood-prime) heart-lung, dialysis, or similar equipment if the extracorporeal circulation is uninterrupted. Medical personnel need not be concerned about liability, for Witnesses will take adequate legal steps to relieve liability as to their informed refusal of blood. They accept nonblood replacement fluids. Using these and other meticulous techniques, physicians are performing major surgery of all types on adult and minor Witness patients. A standard of practice for such patients has thus developed that accords with the tenet of treating the "whole person." (JAMA 1981;246:2471-2472)
PHYSICIANS face a growing challenge that is a major health issue. There are over half a million Jehovah’s Witnesses in the United States who do not accept blood transfusions. The number of Witnesses and those associated with them is increasing. Although formerly, many physicians and hospital officials viewed refusal of a transfusion as a legal problem and sought court authorization to proceed as they believed was medically advisable, recent medical literature reveals that a notable change in attitude is occurring. This may be a result of more surgical experience with patients having very low hemoglobin levels and may also reflect increased awareness of the legal principle of informed consent.
Now, large numbers of elective surgical and trauma cases involving both adult and minor Witnesses are being managed without blood transfusions. Recently, representatives of Jehovah’s Witnesses met with surgical and administrative personnel at some of the largest medical centers in the country. These meetings improved understanding and helped resolve questions about blood salvage, transplants, and the avoidance of medical/legal confrontations.
WITNESS POSITION ON THERAPY
Jehovah’s Witnesses accept medical and surgical treatment. In fact, scores of them are physicians, even surgeons. But Witnesses are deeply religious people who believe that blood transfusion is forbidden for them by Biblical passages such as: "Only flesh with its soul-its blood-you must not eat" (Genesis 9:3-4); "[You must] pour its blood out and cover it with dust" (Leviticus 17:13-14); and "Abstain from . . . fornication and from what is strangled and from blood" (Acts 15:19-21).1
While these verses are not stated in medical terms, Witnesses view them as ruling out transfusion of whole blood, packed RBCs, and plasma, as well as WBC and platelet administration. However, Witnesses’ religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these.2
Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood. Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them. However, many Witnesses permit the use of dialysis and heart-lung equipment (non-blood-prime) as well as intraoperative salvage where the extracorporeal circulation is uninterrupted; the physician should consult with the individual patient as to what his conscience dictates.2
The Witnesses do not feel that the Bible comments directly on organ transplants; hence, decisions regarding cornea, kidney, or other tissue transplants must be made by the individual Witness.
MAJOR SURGERY POSSIBLE
Although surgeons have often declined to treat Witnesses because their stand on the use of blood products seemed to "tie the doctor’s hands," many physicians have now chosen to view the situation as only one more complication challenging their skill. Since Witnesses do not object to colloid or crystalloid replacement fluids, nor to electrocautery, hypotensive anesthesia,3 or hypothermia, these have been employed successfully. Current and future applications of hetastarch,4 large-dose intravenous iron dextran injections,5,6 and the "sonic scalpel"7 are promising and not religiously objectionable. Also, if a recently developed fluorinated blood substitute (Fluosol-DA) proves to be safe and effective,8 its use will not conflict with Witness beliefs.
In 1977, Ott and Cooley9 reported on 542 cardiovascular operations performed on Witnesses without transfusing blood and concluded that this procedure can be done "with an acceptably low risk." In response to our request, Cooley recently did a statistical review of 1,026 operations, 22% on minors, and determined "that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others." Similarly, Michael E. DeBakey, MD, communicated "that in the great majority of situations [involving Witnesses] the risk of operation without the use of blood transfusions is no greater than in those patients on whom we use blood transfusions" (personal communication, March 1981). The literature also records successful major urologic10 and orthopedic surgery.11 G. Dean MacEwen, MD, and J. Richard Bowen, MD, write that posterior spinal fusion "has been successfully accomplished for 20 [Witness] minors" (unpublished data, August 1981). They add: "The surgeon needs to establish the philosophy of respect for a patient’s right to refuse a blood transfusion but still perform surgical procedures in a manner that allows safety to the patient."
Herbsman12 reports success in cases, including some involving youths, "with massive traumatic blood loss." He admits that "Witnesses are somewhat at a disadvantage when it comes to blood requirements. Nevertheless it’s also quite clear that we do have alternatives to blood replacement." Observing that many surgeons have felt restrained from accepting Witnesses as patients out of "fear of legal consequences," he shows that this is not a valid concern.
LEGAL CONCERNS AND MINORS
Witnesses readily sign the American Medical Association form relieving physicians and hospitals of liability,13 and most Witnesses carry a dated, witnessed Medical Alert card prepared in consultation with medical and legal authorities. These documents are binding on the patient (or his estate) and offer protection to physicians, for Justice Warren Burger held that a malpractice proceeding "would appear unsupported" where such a waiver had been signed. Also, commenting on this in an analysis of "compulsory medical treatment and religious freedom," Paris14 wrote: "One commentator who surveyed the literature reported, ‘I have not been able to find any authority for the statement that the physician would incur . . . criminal . . . liability by his failure to force a transfusion on an unwilling patient.’ The risk seems more the product of a fertile legal mind than a realistic possibility."
Care of minors presents the greatest concern, often resulting in legal action against parents under child-neglect statutes. But such actions are questioned by many physicians and attorneys familiar with Witness cases, who believe that Witness parents seek good medical care for their children. Not desirous of shirking their parental responsibility or of shifting it to a judge or other third party, Witnesses urge that consideration be given to the family’s religious tenets. Dr. A. D. Kelly, former Secretary of the Canadian Medical Association, wrote15 that "parents of minors and the next of kin of unconscious patients possess the right to interpret the will of the patient. . . . I do not admire the proceedings of a moot court assembled at 2:00 AM to remove a child from his parent’s custody."
It is axiomatic that parents have a voice in the care of their children, such as when the risk-benefit potentials of surgery, radiation, or chemotherapy are faced. For moral reasons that go beyond the issue of the risk of transfusion,16 Witness parents ask that therapies be used that are not religiously prohibited. This accords with the medical tenet of treating "the whole person," not overlooking the possible lasting psychosocial damage of an invasive procedure that violates a family’s fundamental beliefs. Often, large centers around the country having experience with the Witnesses now accept patient transfers from institutions unwilling to treat Witnesses, even pediatric cases.
THE PHYSICIAN’S CHALLENGE
Understandably, caring for Jehovah’s Witnesses might seem to pose a dilemma for the physician dedicated to preserving life and health by employing all the techniques at his disposal. Editorially prefacing a series of articles about major surgery on Witnesses, Harvey17 admitted, "I do find annoying those beliefs that may interfere with my work." But, he added: "Perhaps we too easily forget that surgery is a craft dependent upon the personal technique of individuals. Technique can be improved."
Professor Bolooki18 took note of a disturbing report that one of the busiest trauma hospitals in Dade County, Florida, had a "blanket policy of refusing to treat" Witnesses. He pointed out that "most surgical procedures in this group of patients are associated with less risk than usual." He added: "Although the surgeons may feel that they are deprived of an instrument of modern medicine . . . I am convinced that by operating on these patients they will learn a great deal."
Rather than consider the Witness patient a problem, more and more physicians accept the situation as a medical challenge. In meeting the challenge they have developed a standard of practice for this group of patients that is accepted at numerous medical centers around the country. These physicians are at the same time providing care that is best for the patient’s total good. As Gardner et al19 observe: "Who would benefit if the patient’s corporal malady is cured but the spiritual life with God, as he sees it, is compromised, which leads to a life that is meaningless and perhaps worse than death itself."
Witnesses recognize that, medically, their firmly held conviction appears to add a degree of risk and may complicate their care. Accordingly, they generally manifest unusual appreciation for the care they receive. In addition to having the vital elements of deep faith and an intense will to live, they gladly cooperate with physicians and medical staff. Thus, both patient and physician are united in facing this unique challenge.
REFERENCES
1. Jehovah’s Witnesses and the Question of Blood. Brooklyn, NY, Watchtower Bible and Tract Society, 1977, pp. 1-64.
2. The Watchtower 1978;99 (June 15):29-31.
3. Hypotensive anesthesia facilitates hip surgery, MEDICAL NEWS. JAMA 1978;239:181.
4. Hetastarch (Hespan)-a new plasma expander. Med Lett Drugs Ther 1981;23:16.
5. Hamstra RD, Block MH, Schocket AL:Intravenous iron dextran in clinical medicine. JAMA 1980;243:1726-1731.
6. Lapin R: Major surgery in Jehovah’s Witnesses. Contemp Orthop 1980;2:647-654.
7. Fuerst ML: ‘Sonic scalpel’ spares vessels. Med Trib 1981;22:1,30.
8. Gonzáles ER: The saga of ‘artificial blood’: Fluosol a special boon to Jehovah’s Witnesses. JAMA 1980;243:719-724.
9. Ott DA, Cooley DA: Cardiovascular surgery in Jehovah’s Witnesses. JAMA 1977;238:1256-1258.
10. Roen PR, Velcek F: Extensive urologic surgery without blood transfusion. NY State J Med 1972;72:2524-2527.
11. Nelson CL, Martin K, Lawson N, et al: Total hip replacement without transfusion. Contemp Orthop 1980;2:655-658.
12. Herbsman H: Treating the Jehovah’s Witness. Emerg Med 1980;12:73-76.
13. Medicolegal Forms With Legal Analysis. Chicago, American Medical Association, 1976, p. 83.
14. Paris JJ: Compulsory medical treatment and religious freedom: Whose law shall prevail? Univ San Francisco Law Rev 1975;10:1-35.
15. Kelly AD: Aequanimitas Can Med Assoc J 1967;96:432.
16. Kolins J: Fatalities from blood transfusion. JAMA 1981;245:1120.
17. Harvey JP: A question of craftsmanship. Contemp Orthop 1980;2:629.
18. Bolooki H: Treatment of Jehovah’s Witnesses: Example of good care. Miami Med 1981;51:25-26.
19. Gardner B, Bivona J, Alfonso A, et al: Major surgery in Jehovah’s Witnesses. NY State J Med 1976;76:765-766.

Blood VS Life

The Blood That Really Saves Lives
Certain points are clear from the foregoing information. Though many people view them as lifesaving, blood transfusions are fraught with risks. Each year thousands die as a result of transfusions; multitudes more get very sick and face long-term consequences. So, even from a physical standpoint, there is wisdom right now in heeding the Biblical command to ‘abstain from blood.’-Acts 15:28, 29.
Patients are protected from many hazards if they request nonblood medical management. Skilled physicians who have accepted the challenge of applying this on Jehovah’s Witnesses have developed a standard of practice that is safe and effective, as is proved in numerous medical reports. Physicians who provide quality care without blood are not compromising valued medical principles. Rather, they show respect for a patient’s right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life.
We are not being naive in this matter, for we realize that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook. Hence, others, including some doctors, may find it hard to accept a patient’s decision to abstain from blood. One New York surgeon wrote: "I will never forget 15 years ago, as a young intern when I stood at the bedside of a Jehovah’s Witness who bled to death from a duodenal ulcer. The patient’s wishes were respected and no transfusions were given, but I can still remember the tremendous frustration as a physician I felt."
He no doubt believed that blood would have been lifesaving. The year after he wrote that, however, The British Journal of Surgery (October 1986) reported that prior to the advent of transfusions, gastrointestinal hemorrhage had "a mortality rate of only 2.5 per cent." Since transfusions became customary, ‘most large studies report a 10-percent mortality.’ Why a death rate four times as high? The researchers suggested: "Early blood transfusion appears to reverse the hypercoagulable response to haemorrhage thereby encouraging rebleeding." When the Witness with the bleeding ulcer refused blood, his choice may actually have maximized his prospects for survival.
This same surgeon added: "The passage of time and treating many patients has a tendency to change one’s perspective, and today I find the trust between a patient and his physician, and the duty to respect a patient’s wishes far more important than the new medical technology which surrounds us. . . . It is interesting that the frustration has now given way to a sense of awe and reverence for that particular patient’s steadfast faith." The physician concluded: ‘It reminds me that I should always respect a patient’s personal and religious wishes regardless of my feelings or the consequences.’
You may already realize something that many physicians come to appreciate with "the passage of time and treating many patients." Even with the best of medical care in the finest of hospitals, at some point people die. With or without blood transfusions, they die. All of us are aging, and life’s end is approaching. That is not fatalistic. It is realistic. Dying is a fact of life.
The evidence shows that people who disregard God’s law on blood often experience immediate or delayed harm; some even die from the blood. Those who survive have not gained endless life. So blood transfusions do not save lives permanently.
Most people who, for religious and/or medical reasons, refuse blood but accept alternative medical therapy do very well. They may thus extend their life for years. But not endlessly.
That all humans are imperfect and are gradually dying leads us to the central truth of what the Bible says about blood. If we understand and appreciate this truth, we will see how blood can actually save life-our life-lastingly.
THE ONLY BLOOD THAT IS LIFESAVING
As noted earlier, God told all mankind that they must not eat blood. Why? Because blood represents life. (Genesis 9:3-6) He explained this further in the Law code given to Israel. At the time the Law code was ratified, the blood of sacrificed animals was used on an altar. (Exodus 24:3-8) Laws in that code addressed the fact that all humans are imperfect; they are sinful, as the Bible puts it. God told the Israelites that by means of animal sacrifices offered to him, they could acknowledge the need to have their sins covered. (Leviticus 4:4-7, 13-18, 22-30) Granted, that was what God asked of them back then, not what he asks of true worshipers today. Yet it has vital import for us now.
God himself explained the principle underlying those sacrifices: "The soul [or, life] of the flesh is in the blood, and I myself have put it upon the altar for you to make atonement for your souls, because it is the blood that makes atonement by the soul in it. That is why I have said to the sons of Israel: ‘No soul of you must eat blood.’"-Leviticus 17:11, 12.
On the ancient festival called Atonement Day, Israel’s high priest took blood of sacrificed animals into the most sacred part of the temple, the center of God’s worship. Doing that was a symbolic way of asking God to cover the people’s sins. (Leviticus 16:3-6, 11-16) Those sacrifices did not actually do away with all sin, so they had to be repeated each year. Still, this use of blood set a meaningful pattern.
A major teaching in the Bible is that God would eventually provide one perfect sacrifice that could fully atone for the sins of all believers. This is called the ransom, and it focuses on the sacrifice of the foretold Messiah, or Christ.
The Bible compares the Messiah’s role to what was done on Atonement Day: "When Christ came as a high priest of the good things that have come to pass, through the greater and more perfect [temple] not made with hands, . . . he entered, no, not with the blood of goats and of young bulls, but with his own blood, once for all time into the holy place [heaven] and obtained an everlasting deliverance for us. Yes, nearly all things are cleansed with blood according to the Law, and unless blood is poured out no forgiveness takes place."-Hebrews 9:11, 12, 22.
It thus becomes plain why we need to have God’s view of blood. In accord with his right as Creator, he has determined its exclusive usefulness. Israelites of old may have reaped health benefits by not taking in animal or human blood, but that was not the most important point. (Isaiah 48:17) They had to avoid sustaining their lives with blood, not primarily because doing otherwise was unhealthy, but because it was unholy to God. They were to abstain from blood, not because it was polluted, but because it was precious in obtaining forgiveness.
The apostle Paul explained about the ransom: "By means of him [Christ] we have the release by ransom through the blood of that one, yes, the forgiveness of our trespasses, according to the riches of his undeserved kindness." (Ephesians 1:7) The original Greek word found there is properly translated "blood," but a number of Bible versions err in substituting the word "death." Hence, readers might miss the emphasis on our Creator’s view of blood and the sacrificial value that he has linked to it.
The Bible’s theme revolves around the fact that Christ died as a perfect ransom sacrifice but did not remain dead. Following the pattern that God set on Atonement Day, Jesus was raised to heaven to "appear before the person of God for us." He presented there the value of his sacrificial blood. (Hebrews 9:24) The Bible emphasizes that we must avoid any course that would amount to ‘trampling on the Son of God and esteeming his blood as of ordinary value.’ Only thus may we keep a good relationship and peace with God.-Hebrews 10:29; Colossians 1:20.
ENJOY LIFE SAVED BY BLOOD
When we understand what God says about blood, we come to have the greatest respect for its lifesaving value. The Scriptures describe Christ as the one who ‘loves us and who loosed us from our sins by means of his own blood.’ (Revelation 1:5; John 3:16) Yes, by means of Jesus’ blood, we can gain full and lasting forgiveness of our sins. The apostle Paul wrote: "Since we have been declared righteous now by his blood, shall we be saved through him from wrath." That is how lasting life can be saved by blood.-Romans 5:9; Hebrews 9:14.
Jehovah God long ago gave assurance that by means of Christ ‘all the families of the earth can bless themselves.’ (Genesis 22:18) That blessing includes restoring the earth to a paradise. Then believing mankind will no longer be afflicted with sickness, aging, or even death; they will enjoy blessings that far exceed the temporary aid medical personnel can now offer us. We have this marvelous promise: "He will wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away."-Revelation 21:4.
How wise, then, for us to take to heart all of God’s requirements! That includes obeying his commands about blood, not misusing it even in medical situations. We thus will not live just for the moment. Rather, we will manifest our high regard for life, including our future prospect of everlasting life in human perfection.
[Box on page 25]
God’s people refused to sustain their lives with blood, not because doing that was unhealthy, but because it was unholy, not because blood was polluted, but because it was precious.
[Picture on page 24]
"By means of him [Jesus] we have the release by ransom through the blood of that one, yes, the forgiveness of our trespasses."-Ephesians 1:7
[Picture on page 26]
Saving life with Jesus’ blood opens the way to endless, healthy life in an earthly paradise

Alternatives to transfusions

Quality Alternatives to Transfusion
You might feel, ‘Transfusions are hazardous, but are there any high-quality alternatives?’ A good question, and note the word "quality."
Everyone, including Jehovah’s Witnesses, wants effective medical care of high quality. Dr. Grant E. Steffen noted two key elements: "Quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals." (The Journal of the American Medical Association, July 1, 1988) "Nonmedical goals" would include not violating the ethics or Bible-based conscience of the patient.-Acts 15:28, 29.
Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the answer is yes.
Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that "one of the few benefits of the epidemic" was that it "resulted in various strategies on the part of patients and physicians to avoid blood transfusion." A blood-bank official explains: "What has changed is the intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration of alternatives."-Transfusion Medicine Reviews, October 1989.
Note, there are alternatives! This becomes understandable when we review why blood is transfused.
The hemoglobin in the red cells carries oxygen needed for good health and life. So if a person has lost a lot of blood, it might seem logical just to replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood. (Another measure of the concentration is hematocrit, which is commonly about 45 percent.) The accepted "rule" was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30 percent hematocrit). The Swiss journal Vox Sanguinis (March 1987) reported that "65% of [anesthesiologists] required patients to have a preoperative hemoglobin of 10 gm/dl for elective surgery."
But at a 1988 conference on blood transfusion, Professor Howard L. Zauder asked, "How Did We Get a ‘Magic Number’?" He stated clearly: "The etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in obscurity, and unsubstantiated by clinical or experimental evidence." Imagine the many thousands of patients whose transfusions were triggered by an ‘obscure, unsubstantiated’ requirement!
Some might wonder, ‘Why is a hemoglobin level of 14 normal if you can get by on much less?’ Well, you thus have considerable reserve oxygen-carrying capacity so that you are ready for exercise or heavy work. Studies of anemic patients even reveal that "it is difficult to detect a deficit in work capacity with hemoglobin concentrations as low as 7 g/dl. Others have found evidence of only moderately impaired function."-Contemporary Transfusion Practice, 1987.
While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says: "With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three months . . . The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration with no apparent clinical difficulties."-Pediatric Clinics of North America, February 1986.
Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery. If the loss is rapid and great, a person’s blood pressure drops, and he may go into shock. What is primarily needed is that the bleeding be stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.
Volume replacement can be accomplished without using whole blood or blood plasma. Various nonblood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as dextran, Haemaccel, and lactated Ringer’s solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989) Such fluids have definite advantages. "Crystalloid solutions [such as normal saline and lactated Ringer’s solution], Dextran and HES are relatively nontoxic and inexpensive, readily available, can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease."-Blood Transfusion Therapy-A Physician’s Handbook, 1989.
You may ask, though, ‘Why do nonblood replacement fluids work well, since I need red cells to get oxygen throughout my body?’ As mentioned, you have oxygen-carrying reserves. If you lose blood, marvelous compensatory mechanisms start up. Your heart pumps more blood with each beat. Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more oxygen is released to the tissues. These adaptations are so effective that if only half of your red cells remain, oxygen delivery may be about 75 percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. And most general anesthetics reduce the body’s need for oxygen.
HOW CAN DOCTORS HELP?
Skilled physicians can help one who has lost blood and so has fewer red cells. Once volume is restored, doctors can administer oxygen at high concentration. This makes more of it available for the body and has often had remarkable results. British doctors used this with a woman who had lost so much blood that "her haemoglobin fell to 1.8 g/dlitre. She was successfully treated . . . [with] high inspired oxygen concentrations and transfusions of large volumes of gelatin solution [Haemaccel]." (Anaesthesia, January 1987) The report also says that others with acute blood loss have been successfully treated in hyperbaric oxygen chambers.
Physicians can also help their patients to form more red cells. How? By giving them iron-containing preparations (into muscles or veins), which can aid the body in making red cells three to four times faster than normal. Recently another help has become available. Your kidneys produce a hormone called erythropoietin (EPO), which stimulates bone marrow to form red cells. Now synthetic (recombinant) EPO is available. Doctors may give this to some anemic patients, thus helping them to form replacement red cells very quickly.
Even during surgery, skilled and conscientious surgeons and anesthesiologists can help by employing advanced blood-conservation methods. Meticulous operative technique, such as electrocautery to minimize bleeding, cannot be overstressed. Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation.
Patients on a heart-lung machine primed with a nonblood fluid may benefit from the resulting hemodilution, fewer red cells being lost.
And there are other ways to help. Cooling a patient to lessen his oxygen needs during surgery. Hypotensive anesthesia. Therapy to improve coagulation. Desmopressin (DDAVP) to shorten bleeding time. Laser "scalpels." You will see the list grow as physicians and concerned patients seek to avoid blood transfusions. We hope that you never lose a great amount of blood. But if you did, it is very likely that skilled doctors could manage your care without using blood transfusions, which have so many risks.
SURGERY, YES-BUT WITHOUT TRANSFUSIONS
Many people today will not accept blood. For health reasons, they are requesting what Witnesses seek primarily on religious grounds: quality medical care employing alternative nonblood management. As we have noted, major surgery is still possible. If you have any lingering doubts, some other evidence from medical literature may dispel them.
The article "Quadruple Major Joint Replacement in Member of Jehovah’s Witnesses" (Orthopaedic Review, August 1986) told of an anemic patient with "advanced destruction in both knees and hips." Iron dextran was employed before and after the staged surgery, which was successful. The British Journal of Anaesthesia (1982) reported on a 52-year-old Witness with a hemoglobin level under 10. With the use of hypotensive anesthesia to minimize blood loss, she had a total hip and shoulder replacement. A surgical team at the University of Arkansas (U.S.A.) also used this method in a hundred hip replacements on Witnesses, and all the patients recovered. The professor heading the department comments: "What we have learned from those (Witness) patients, we now apply to all our patients that we do total hips on."
The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded: "The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah’s Witnesses." (Transplantation, June 1988) Likewise, refusal of blood has not stood in the way even of successful heart transplants.
‘What about bloodless surgery of other types?’ you may wonder. Medical Hotline (April/May 1983) told of surgery on "Jehovah’s Witnesses who underwent major gynecological and obstetric operations [at Wayne State University, U.S.A.] without blood transfusions." The newsletter reported: "There were no more deaths and complications than in women who had undergone similar operations with blood transfusions." The newsletter then commented: "The results of this study may warrant a fresh look at the use of blood for all women undergoing obstetric and gynecological operations."
At the hospital of Göttingen University (Germany), 30 patients who declined blood underwent general surgery. "No complications arose that could not also have arisen with patients who accept blood transfusions. . . . That recourse to a transfusion is not possible should not be overrated, and thus should not lead to refraining from an operation that is necessary and surgically justifiable."-Risiko in der Chirurgie, 1987.
Even brain surgery without using blood has been done on numerous adults and children, for instance, at New York University Medical Center. In 1989 Dr. Joseph Ransohoff, head of neurosurgery, wrote: "It is very clear that in most instances avoidance of blood products can be achieved with minimal risk in patients who have religious tenets against the use of these products, particularly if surgery can be carried out expeditiously and with a relatively short operative period. Of considerable interest is the fact that I often forget that the patient is a Witness until at the time of discharge when they thank me for having respected their religious beliefs."
Finally, can intricate heart and vascular surgery without blood be performed on adults and children? Dr. Denton A. Cooley was a pioneer in doing just that. As you can see in the medical article reprinted in the Appendix, on pages 27-9, based on an earlier analysis, Dr. Cooley’s conclusion was "that the risk of surgery in patients of the Jehovah’s Witness group has not been substantially higher than for others." Now, after performing 1,106 of these operations, he writes: "In every instance my agreement or contract with the patient is maintained," that is, to use no blood.
Surgeons have observed that good attitude is another factor with Jehovah’s Witnesses. "The attitude of these patients has been exemplary," wrote Dr. Cooley in October 1989. "They do not have the fear of complications or even death that most patients have. They have a deep and abiding faith in their belief and in their God."
This does not mean that they assert a right to die. They actively pursue quality care because they want to get well. They are convinced that obeying God’s law on blood is wise, which view has a positive influence in nonblood surgery.
Professor Dr. V. Schlosser, of the surgical hospital at the University of Freiburg (Germany), noted: "Among this group of patients, the incidence of bleeding during the perioperative period was not higher; the complications were, if anything, fewer. The special view of illness, typical of Jehovah’s Witnesses, had a positive influence in the perioperative process."-Herz Kreislauf, August 1987.
[Footnotes]
Witnesses do not accept transfusions of whole blood, red cells, white cells, platelets, or blood plasma. As to minor fractions, such as immune globulin, see The Watchtower of June 1, 1990, pages 30-1.
The Watchtower of March 1, 1989, pages 30-1, considers Bible principles that bear on methods of blood salvage and on blood-circulating (extracorporeal) equipment.
[Box on page 13]
"We must conclude that currently there are many patients receiving blood components who have no chance for a benefit from transfusion (the blood is not needed) and yet still have a significant risk of undesired effect. No physician would knowingly expose a patient to a therapy that cannot help but might hurt, but that is exactly what occurs when blood is transfused unnecessarily."-"Transfusion-Transmitted Viral Diseases," 1987.
[Box on page 14]
"Some authors have stated that hemoglobin values as low as 2 to 2.5 gm./100ml. may be acceptable. . . . A healthy person may tolerate a 50 percent loss of red blood cell mass and be almost entirely asymptomatic if blood loss occurs over a period of time."-"Techniques of Blood Transfusion," 1982.
[Box on page 15]
"Older concepts about oxygen transport to tissues, wound healing, and ‘nutritional value’ of blood are being abandoned. Experience with patients who are Jehovah’s Witnesses demonstrates that severe anemia is well tolerated."-"The Annals of Thoracic Surgery," March 1989.
[Box on page 16]
Little children too? "Forty-eight pediatric open heart surgical procedures were performed with bloodless techniques regardless of surgical complexity." The children were as small as 10.3 pounds (4.7 kg). "Because of consistent success in Jehovah’s Witnesses and the fact that blood transfusion carries a risk of serious complications, we are currently performing most of our pediatric cardiac operations without transfusion."-"Circulation," September 1984.
[Picture on page 15]
The heart-lung machine has been a great help in heart surgery on patients who do not want blood