Monday, March 23, 2009

Blood Transfusions

Blood Transfusions-How Safe?
Before submitting to any serious medical procedure, a thinking person will learn the possible benefits and the risks. What about blood transfusions? They are now a prime tool in medicine. Many physicians who are genuinely interested in their patients may have little hesitation about giving blood. It has been called the gift of life.
Millions have donated blood or have accepted it. For 1986-87 Canada had 1.3 million donors in a population of 25 million. "[In] the most recent year for which figures are available, between 12 million and 14 million units of blood were used in transfusions in the United States alone."-The New York Times, February 18, 1990.
"Blood has always enjoyed a ‘magical’ quality," notes Dr. Louise J. Keating. "For its first 46 years, the blood supply was perceived as being safer than it actually was by both physicians and the public." (Cleveland Clinic Journal of Medicine, May 1989) What was the situation then, and what is it now?
Even 30 years ago, pathologists and blood-bank personnel were advised: "Blood is dynamite! It can do a great deal of good or a great deal of harm. The mortality from blood transfusion equals that from ether anesthesia or appendectomy. There is said to be approximately one death in 1,000 to 3,000 or possibly 5,000 transfusions. In the London area there has been reported one death for every 13,000 bottles of blood transfused."-New York State Journal of Medicine, January 15, 1960.
Have the dangers since been eliminated so that transfusions are now safe? Frankly, each year hundreds of thousands have adverse reactions to blood, and many die. In view of the preceding comments, what may come to your mind are blood-borne diseases. Before examining this aspect, consider some risks that are less well-known.
BLOOD AND YOUR IMMUNITY
Early in the 20th century, scientists deepened man’s understanding of the marvelous complexity of blood. They learned that there are different blood types. Matching a donor’s blood and a patient’s blood is critical in transfusions. If someone with type A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions.
The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match. Why? Well, in his article "Blood Transfusion: Uses, Abuses, and Hazards," Dr. Douglas H. Posey, Jr., writes: "Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure . . . [Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex."-Journal of the National Medical Association, July 1989.
Scientists are now studying the effect of transfused blood on the body’s defense, or immune, system. What might that mean for you or for a relative who needs surgery?
When doctors transplant a heart, a liver, or another organ, the recipient’s immune system may sense the foreign tissue and reject it. Yet, a transfusion is a tissue transplant. Even blood that has been "properly" cross matched can suppress the immune system. At a conference of pathologists, the point was made that hundreds of medical papers "have linked blood transfusions to immunologic responses."-"Case Builds Against Transfusions," Medical World News, December 11, 1989.
A prime task of your immune system is detecting and destroying malignant (cancer) cells. Could suppressed immunity lead to cancer and death? Note two reports.
The journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands: "In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients." Physicians at the University of Southern California followed up on a hundred patients who underwent cancer surgery. "The recurrence rate for all cancers of the larynx was 14% for those who did not receive blood and 65% for those who did. For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions."-Annals of Otology, Rhinology & Laryngology, March 1989.
What do such studies suggest regarding transfusions? In his article "Blood Transfusions and Surgery for Cancer," Dr. John S. Spratt concluded: "The cancer surgeon may need to become a bloodless surgeon."-The American Journal of Surgery, September 1986.
Another primary task of your immune system is to defend against infection. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr. P. I. Tartter did a study of colorectal surgery. Of patients given transfusions, 25 percent developed infections, compared with 4 percent of those who received no transfusions. He reports: "Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively . . . The risk of postoperative infection increased progressively with the number of units of blood given." (The British Journal of Surgery, August 1988) Those attending a 1989 meeting of the American Association of Blood Banks learned this: Whereas 23 percent of those who received donor blood during hip-replacement surgery developed infections, those given no blood had no infections at all.
Dr. John A. Collins wrote concerning this effect of blood transfusions: "It would be ironic indeed if a ‘treatment’ which has very little evidence of accomplishing anything worthwhile should subsequently be found to intensify one of the main problems faced by such patients."-World Journal of Surgery, February 1987.
DISEASE FREE OR FRAUGHT WITH DANGER?
Blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many.
After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses "other transfusion-associated infectious diseases," such as syphilis, cytomegalovirus infection, and malaria. It then says: "Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis [African sleeping sickness and Chagas’ disease], leishmaniasis, brucellosis [undulant fever], typhus, filariasis, measles, salmonellosis, and Colorado tick fever."
Actually, the list of such diseases is growing. You may have read headlines such as "Lyme Disease From a Transfusion? It’s Unlikely, but Experts Are Wary." How safe is blood from someone testing positive for Lyme disease? A panel of health officials were asked if they would accept such blood. "All of them answered no, although no one recommended discarding blood from such donors." How should the public feel about banked blood that experts themselves would not accept?-The New York Times, July 18, 1989.
A second reason for concern is that blood collected in one land where a certain disease abounds may be used far away, where neither the public nor the physicians are alert to the danger. With today’s increase in travel, including refugees and immigrants, the risk is growing that a strange disease may be in a blood product.
Moreover, a specialist in infectious diseases warned: "The blood supply may have to be screened to prevent transmission of several disorders that were not previously considered infectious, including leukemia, lymphoma, and dementia [or Alzheimer’s disease]."-Transfusion Medicine Reviews, January 1989.
Chilling as these risks are, others have created much wider fear.
THE AIDS PANDEMIC
"AIDS has changed forever the way doctors and patients think about blood. And that’s not a bad idea, said the doctors gathered at the National Institutes of Health for a conference on blood transfusion."-Washington Post, July 5, 1988.
The AIDS (acquired immunodeficiency syndrome) pandemic has, with a vengeance, awakened people to the danger of acquiring infectious diseases from blood. Millions are now infected. It is spreading out of control. And its death rate is virtually 100 percent.
AIDS is caused by the human immunodeficiency virus (HIV), which can be spread by blood. The modern plague of AIDS came to light in 1981. The very next year, health experts learned that the virus could probably be passed on in blood products. It is now admitted that the blood industry was slow to respond, even after tests were available to identify blood containing HIV antibodies. Testing of donor blood finally began in 1985, but even then it was not applied to blood products that were already on the shelf.
Thereafter the public was assured, ‘The blood supply is now safe.’ Later, however, it was revealed that there is a dangerous "window period" for AIDS. After a person is infected, it could be months before he produces detectable antibodies. Unaware that he harbors the virus, he might donate blood that would test negative. This has happened. People have developed AIDS after being transfused with such blood!
The picture got even grimmer. The New England Journal of Medicine (June 1, 1989) reported on "Silent HIV Infections." It was established that people can carry the AIDS virus for years without its being detectable by current indirect tests. Some would like to minimize these as rare cases, but they prove "that the risk of AIDS transmission via blood and its components cannot be totally eliminated." (Patient Care, November 30, 1989) The disturbing conclusion: A negative test cannot be read as a clean bill of health. How many will yet get AIDS from blood?
THE NEXT SHOE? OR SHOES?
Many apartment dwellers have heard the thump of one shoe hitting the floor above them; they may then get tense awaiting the second. In the blood dilemma, no one knows how many deadly shoes may still hit.
The AIDS virus was designated HIV, but some experts now call it HIV-1. Why? Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by the AIDS tests now in use here," reports The New York Times. (June 27, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe."
Or what of distant relatives to the AIDS virus? A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease." This virus is already in the blood donor population and can be spread in blood. People have a right to wonder, ‘How effective is the blood-bank screening for such other viruses?’
Really, only time will tell how many blood-borne viruses are lurking in the blood supply. "The unknown may be more cause for concern than the known," writes Dr. Harold T. Meryman. "Transmissible viruses with incubation times measured in many years will be difficult to associate with transfusions and even more difficult to detect. The HTLV group is surely only the first of these to surface." (Transfusion Medicine Reviews, July 1989) "As if the AIDS epidemic were not misery enough, . . . a number of newly proposed or described risks of transfusion have drawn attention during the 1980’s. It does not require great imagination to predict that other serious viral diseases exist and are transmitted by homologous transfusions."-Limiting Homologous Exposure: Alternative Strategies, 1989.
So many "shoes" have already dropped that the Centers for Disease Control recommends "universal precautions." That is, ‘health-care workers should assume that all patients are infectious for HIV and other blood-borne pathogens.’ With good reason, health-care workers and members of the public are reassessing their view of blood.
[Footnotes]
We cannot assume that all blood is yet being tested. For example, it is reported that by the start of 1989, about 80 percent of Brazil’s blood banks were not under government control, nor were they testing for AIDS.
[Box on page 8]
"Approximately 1 in 100 transfusions are accompanied by fever, chills, or urticaria [hives]. . . . Approximately 1 in 6,000 red cell transfusions results in a hemolytic transfusion reaction. This is a severe immunologic reaction that may occur acutely or in a delayed fashion some days after the transfusion; it may result in acute [kidney] failure, shock, intravascular coagulation, and even death."-National Institutes of Health (NIH) conference, 1988.
[Box on page 9]
Danish scientist Niels Jerne shared the 1984 Nobel Prize for Medicine. When asked why he refused a blood transfusion, he said: "A person’s blood is like his fingerprints-there are no two types of blood that are exactly alike."
[Box on page 10]
BLOOD, RUINED LIVERS, AND . . .
"Ironically, blood-borne AIDS . . . has never been as great a threat as other diseases-hepatitis, for instance," explained the Washington Post.
Yes, vast numbers have got very sick and have died from such hepatitis, which has no specific treatment. According to U.S.News & World Report (May 1, 1989), about 5 percent of those given blood in the United States get hepatitis-175,000 people a year. About half become chronic carriers, and at least 1 in 5 develop cirrhosis or cancer of the liver. It is estimated that 4,000 die. Imagine the headlines you would read if a jumbo jet crashed, killing all aboard. But 4,000 deaths amount to a full jumbo jet crashing every month!
Physicians had long known that a milder hepatitis (type A) was spread through unclean food or water. Then they saw that a more serious form was spreading through blood, and they had no way to screen blood for it. Eventually, brilliant scientists learned how to detect "footprints" of this virus (type B). By the early 1970’s, blood was being screened in some lands. The blood supply appeared safe and the future for blood bright! Or was it?
Before long it was clear that thousands who were given screened blood still developed hepatitis. Many, after debilitating illness, learned that their livers were ruined. But if the blood had been tested, why was this happening? The blood contained another form, called non-A, non-B hepatitis (NANB). For a decade it plagued transfusions-between 8 and 17 percent of those transfused in Israel, Italy, Japan, Spain, Sweden, and the United States contracted it.
Then came headlines such as "Mysterious Hepatitis Non-A, Non-B Virus Isolated at Last"; "Breaking a Fever in the Blood." Again, the message was, ‘The elusive agent is found!’ In April 1989, the public was told that a test was available for NANB, now being called hepatitis C.
You might wonder if this relief is premature. In fact, Italian researchers have reported another hepatitis virus, a mutant, which might be responsible for a third of the cases. "Some authorities," the Harvard Medical School Health Letter (November 1989) observed, "worry that A, B, C, and D are not the whole alphabet of hepatitis viruses; yet others may emerge." The New York Times (February 13, 1990) stated: "Experts strongly suspect that other viruses can cause hepatitis; if discovered, they will be designated hepatitis E and so on."
Are blood banks faced with more long searches for tests to make blood safe? Citing the problem of cost, a director of the American Red Cross made this disturbing comment: "We can’t just keep adding test after test for each infectious agent that might be spread."-Medical World News, May 8, 1989.
Even the test for hepatitis B is fallible; many still contract it from blood. Moreover, will people be satisfied with the announced test for hepatitis C? The Journal of the American Medical Association (January 5, 1990) showed that a year can pass before antibodies of the disease are detectable by the test. Meanwhile, people transfused with the blood may face ruined livers-and death.
[Box/Picture on page 11]
Chagas’ disease illustrates how blood carries disease to distant people. "The Medical Post" (January 16, 1990) reports that ‘10-12 million people in Latin America are chronically infected.’ It has been called "one of the most important transfusion hazards in South America." An "assassin bug" bites a sleeping victim in the face, sucks blood, and defecates in the wound. The victim may carry Chagas’ disease for years (meanwhile possibly donating blood) before developing fatal heart complications.
Why should that concern people on distant continents? In "The New York Times" (May 23, 1989), Dr. L. K. Altman reported on patients with posttransfusion Chagas’ disease, one of whom died. Altman wrote: "Additional cases may have gone undetected because [doctors here] are not familiar with Chagas’ disease, nor do they realize that it could be spread by transfusions." Yes, blood can be a vehicle by which diseases travel widely.
[Box on page 12]
Dr. Knud Lund-Olesen wrote: "Since . . . some persons in high-risk groups volunteer as donors because they are then automatically tested for AIDS, I feel that there is reason to be reluctant about accepting blood transfusion. Jehovah’s Witnesses have refused this for many years. Did they look into the future?"-"Ugeskrift for Læger" (Doctors’ Weekly), September 26, 1988.
[Picture on page 9]
The pope survived being shot. After leaving the hospital, he was taken back for two months, "suffering a great deal." Why? A potentially fatal cytomegalovirus infection from the blood he received
[Credit Line]
UPI/Bettmann Newsphotos
[Picture on page 12]
AIDS virus
[Credit Line]
CDC, Atlanta, Ga.

Blood Vital For LIfe

Blood-Vital for Life
How can blood save your life? This no doubt is of interest to you because blood is linked to your life. Blood carries oxygen through your body, removes carbon dioxide, helps you adapt to temperature changes, and aids in your fight against disease.
The linkage of life to blood was made long before William Harvey mapped the circulatory system in 1628. The basic ethics of major religions focus on a Life-Giver, who expressed himself about life and about blood. A Judeo-Christian lawyer said of him: "He himself gives to all persons life and breath and all things. For by him we have life and move and exist."
People who believe in such a Life-Giver trust that his directions are for our lasting good. A Hebrew prophet described him as "the One teaching you to benefit yourself, the One causing you to tread in the way in which you should walk."
That assurance, at Isaiah 48:17, is part of the Bible, a book respected for ethical values that can benefit all of us. What does it say about human use of blood? Does it show how lives can be saved with blood? Actually, the Bible shows clearly that blood is more than a complex biologic fluid. It mentions blood over 400 times, and some of these references involve the saving of life.
In one early reference, the Creator declared: "Everything that lives and moves will be food for you. . . . But you must not eat meat that has its lifeblood still in it." He added: "For your lifeblood I will surely demand an accounting," and he then condemned murder. (Genesis 9:3-6, New International Version) He said that to Noah, a common ancestor highly esteemed by Jews, Muslims, and Christians. All humanity was thus notified that in the Creator’s view, blood stands for life. This was more than a dietary regulation. Clearly a moral principle was involved. Human blood has great significance and should not be misused. The Creator later added details from which we can easily see the moral issues that he links to lifeblood.
He again referred to blood when he gave the Law code to ancient Israel. While many people respect the wisdom and ethics in that code, few are aware of its serious laws on blood. For instance: "If anyone of the house of Israel or of the strangers who reside among them partakes of any blood, I will set My face against the person who partakes of the blood, and I will cut him off from among his kin. For the life of the flesh is in the blood." (Leviticus 17:10, 11, Tanakh) God then explained what a hunter was to do with a dead animal: "He shall pour out its blood and cover it with earth. . . . You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off."-Leviticus 17:13, 14, Ta.
Scientists now know that the Jewish Law code promoted good health. It required, for example, that excrement be deposited outside the camp and covered and that people not eat meat that carried a high risk of disease. (Leviticus 11:4-8, 13; 17:15; Deuteronomy 23:12, 13) While the law about blood had health aspects, much more was involved. Blood had a symbolic meaning. It stood for life provided by the Creator. By treating blood as special, the people showed dependence on him for life. Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God.
The Law repeatedly stated the Creator’s ban on taking in blood to sustain life. "You must not eat the blood; pour it out on the ground like water. Do not eat it, so that it may go well with you and your children after you, because you will be doing what is right."-Deuteronomy 12:23-25, NIV; 15:23; Leviticus 7:26, 27; Ezekiel 33:25.
Contrary to how some today reason, God’s law on blood was not to be ignored just because an emergency arose. During a wartime crisis, some Israelite soldiers killed animals and "fell to eating along with the blood." In view of the emergency, was it permissible for them to sustain their lives with blood? No. Their commander pointed out that their course was still a grave wrong. (1 Samuel 14:31-35) Hence, precious as life is, our Life-Giver never said that his standards could be ignored in an emergency.
BLOOD AND TRUE CHRISTIANS
Where does Christianity stand on the question of saving human life with blood?
Jesus was a man of integrity, which is why he is so highly regarded. He knew that the Creator said that taking in blood was wrong and that this law was binding. Hence, there is good reason to believe that Jesus would uphold the law about blood even if he was under pressure to do otherwise. Jesus "did no wrong, [and] no treachery was found on his lips." (1 Peter 2:22, Knox) He thus set a pattern for his followers, including a pattern of respect for life and blood. (We will later consider how Jesus’ own blood is involved in this vital matter affecting your life.)
Note what happened when, years after Jesus’ death, a question arose about whether someone becoming a Christian had to keep all of Israel’s laws. This was discussed at a council of the Christian governing body, which included the apostles. Jesus’ half brother James referred to writings containing the commands about blood stated to Noah and to the nation of Israel. Would such be binding on Christians?-Acts 15:1-21.
That council sent their decision to all congregations: Christians need not keep the code given to Moses, but it is "necessary" for them to "keep abstaining from things sacrificed to idols and from blood and from things strangled [unbled meat] and from fornication." (Acts 15:22-29) The apostles were not presenting a mere ritual or dietary ordinance. The decree set out fundamental ethical norms, which early Christians complied with. About a decade later they acknowledged that they should still "keep themselves from what is sacrificed to idols as well as from blood . . . and from fornication."-Acts 21:25.
You know that millions of people attend churches. Most of them would probably agree that Christian ethics involve not giving worship to idols and not sharing in gross immorality. However, it is worth our noting that the apostles put avoiding blood on the same high moral level as avoiding those wrongs. Their decree concluded: "If you carefully keep yourselves from these things, you will prosper. Good health to you!"-Acts 15:29.
The apostolic decree was long understood as binding. Eusebius tells of a young woman near the end of the second century who, before dying under torture, made the point that Christians "are not allowed to eat the blood even of irrational animals." She was not exercising a right to die. She wanted to live, but she would not compromise her principles. Do you not respect those who put principle above personal gain?
Scientist Joseph Priestley concluded: "The prohibition to eat blood, given to Noah, seems to be obligatory on all his posterity . . . If we interpret [the] prohibition of the apostles by the practice of the primitive Christians, who can hardly be supposed not to have rightly understood the nature and extent of it, we cannot but conclude, that it was intended to be absolute and perpetual; for blood was not eaten by any Christians for many centuries."
WHAT OF USING BLOOD AS MEDICINE?
Would the Biblical prohibition on blood cover medical uses, such as transfusions, which certainly were not known in the days of Noah, Moses, or the apostles?
While modern therapy employing blood did not exist back then, medicinal use of blood is not modern. For some 2,000 years, in Egypt and elsewhere, human "blood was regarded as the sovereign remedy for leprosy." A physician revealed the therapy given to King Esar-haddon’s son when the nation of Assyria was on the leading edge of technology: "[The prince] is doing much better; the king, my lord, can be happy. Starting with the 22nd day I give (him) blood to drink, he will drink (it) for 3 days. For 3 more days I shall give (him blood) for internal application." Esar-haddon had dealings with the Israelites. Yet, because the Israelites had God’s Law, they would never drink blood as medicine.
Was blood used as medicine in Roman times? The naturalist Pliny (a contemporary of the apostles) and the second-century physician Aretaeus report that human blood was a treatment for epilepsy. Tertullian later wrote: "Consider those who with greedy thirst, at a show in the arena, take the fresh blood of wicked criminals . . . and carry it off to heal their epilepsy." He contrasted them with Christians, who "do not even have the blood of animals at [their] meals . . . At the trials of Christians you offer them sausages filled with blood. You are convinced, of course, that [it] is unlawful for them." So, early Christians would risk death rather than take in blood.
"Blood in its more everyday form did not . . . go out of fashion as an ingredient in medicine and magic," reports the book Flesh and Blood. "In 1483, for example, Louis XI of France was dying. ‘Every day he grew worse, and the medicines profited him nothing, though of a strange character; for he vehemently hoped to recover by the human blood which he took and swallowed from certain children.’"
What of transfusing blood? Experiments with this began near the start of the 16th century. Thomas Bartholin (1616-80), professor of anatomy at the University of Copenhagen, objected: ‘Those who drag in the use of human blood for internal remedies of diseases appear to misuse it and to sin gravely. Cannibals are condemned. Why do we not abhor those who stain their gullet with human blood? Similar is the receiving of alien blood from a cut vein, either through the mouth or by instruments of transfusion. The authors of this operation are held in terror by the divine law, by which the eating of blood is prohibited.’
Hence, thinking people in past centuries realized that the Biblical law applied to taking blood into the veins just as it did to taking it into the mouth. Bartholin concluded: "Either manner of taking [blood] accords with one and the same purpose, that by this blood a sick body be nourished or restored."
This overview may help you to understand the nonnegotiable religious stand that Jehovah’s Witnesses take. They highly value life, and they seek good medical care. But they are determined not to violate God’s standard, which has been consistent: Those who respect life as a gift from the Creator do not try to sustain life by taking in blood.
Still, for years claims have been made that blood saves lives. Doctors can relate cases in which someone had acute blood loss but was transfused and then improved rapidly. So you may wonder, ‘How wise or unwise is this medically?’ Medical evidence is offered to support blood therapy. Thus, you owe it to yourself to get the facts in order to make an informed choice about blood.
[Footnotes]
Paul, at Acts 17:25, 28, New World Translation of the Holy Scriptures.
Similar prohibitions were later written in the Qur’an.
[Box on page 4]
"The precepts hereby set down in a precise and methodical manner [in Acts 15] are qualified as indispensable, giving the strongest proof that in the apostles’ minds this was not a temporary arrangement, or a provisional measure."-Professor Édouard Reuss, University of Strasbourg.
[Box/Picture on page 5]
Martin Luther pointed to the implications of the apostolic decree: "Now if we want to have a church that conforms to this council, . . . we must teach and insist that henceforth no prince, lord, burgher, or peasant eat geese, doe, stag, or pork cooked in blood . . . And burghers and peasants must abstain especially from red sausage and blood sausage."
[Credit Line]
Woodcut by Lucas Cranach
[Box on page 6]
"God and men view things in very different lights. What appears important in our eye is very often of no account in the estimation of infinite wisdom; and what appears trifling to us is often of very great importance with God. It was so from the beginning."-"An Enquiry Into the Lawfulness of Eating Blood," Alexander Pirie, 1787.
[Picture on page 3]
Medicine and the Artist by Carl Zigrosser/Dover Publications
[Picture on page 4]
At a historic council, the Christian governing body confirmed that God’s law on blood is still binding
[Picture on page 7]
Whatever the consequences, the early Christians refused to violate God’s law on blood
[Credit Line]
Painting by Gérôme, 1883, courtesy of Walters Art Gallery, Baltimore

What does God require of you?

How to Use This Brochure
This brochure is designed as a Bible study course. How is it to be used? We suggest the following program: At the beginning of each lesson, there are questions. In parentheses after each question, you will find the numbers of the paragraphs in which the answers are found. Read the questions through first. Think about them. Then read each paragraph, and look up the scriptures in your Bible. When you have finished a lesson, go back to the questions and try to recall the Bible’s answer to each question. When you have finished the whole brochure, go back and review all the questions.
Lesson 1
How You Can Find Out What God Requires
What important information is contained in the Bible? (1)
Who is the Bible’s author? (2)
Why should you study the Bible? (3)
1. The Bible is a precious gift from God. It is like a letter from a loving father to his children. It tells us the truth about God-who he is and what he stands for. It explains how to cope with problems and how to find true happiness. The Bible alone tells us what we must do to please God.-Psalm 1:1-3; Isaiah 48:17, 18.
2. The Bible was written by some 40 different men over a period of 1,600 years, beginning in 1513 B.C.E. It is made up of 66 little books. Those who wrote the Bible were inspired by God. They wrote his thoughts, not their own. So God in heaven, not any human on earth, is the Author of the Bible.-2 Timothy 3:16, 17; 2 Peter 1:20, 21.
3. God made sure that the Bible was accurately copied and preserved. More Bibles have been printed than any other book. Not everyone will be happy to see you studying the Bible, but do not let that stop you. Your eternal future depends on your getting to know God and doing his will despite any opposition.-Matthew 5:10-12; John 17:3.
Lesson 2
Who Is God?
Who is the true God, and what is his name? (1, 2)
What sort of body does he have? (3)
What are his outstanding qualities? (4)
Should we use images and symbols in our worship of him? (5)
What are two ways we can learn about God? (6)
1. People worship many things. But the Bible tells us that there is only one TRUE God. He created everything in heaven and on earth. Because he gave us life, he is the only One we should worship.-1 Corinthians 8:5, 6; Revelation 4:11.
2. God has many titles but has only one name. That name is JEHOVAH. In most Bibles, God’s name has been removed and has been replaced with the titles LORD or GOD. But when the Bible was written, the name Jehovah appeared in it some 7,000 times!-Exodus 3:15; Psalm 83:18.
3. Jehovah has a body, but it is not like ours. "God is a Spirit," says the Bible. (John 4:24) A spirit is a form of life that is much higher than ours. No human has ever seen God. Jehovah lives in heaven, but he can see all things. (Psalm 11:4, 5; John 1:18) What, though, is the holy spirit? It is not a person like God. Rather, it is God’s active force.-Psalm 104:30.
4. The Bible reveals Jehovah’s personality to us. It shows that his outstanding qualities are love, justice, wisdom, and power. (Deuteronomy 32:4; Job 12:13; Isaiah 40:26; 1 John 4:8) The Bible tells us that he is also merciful, kind, forgiving, generous, and patient. We, like obedient children, should try to imitate him.-Ephesians 5:1, 2.
5. Should we bow down or pray to images, pictures, or symbols in our worship? No! (Exodus 20:4, 5) Jehovah says that we must worship only him. He will not share his glory with anyone or anything else. Images have no power to help us.-Psalm 115:4-8; Isaiah 42:8.
6. How can we get to know God better? One way is by observing the things he has created and thinking deeply about what they tell us. God’s creations show us that he has great power and wisdom. We see his love in all that he has made. (Psalm 19:1-6; Romans 1:20) Another way we can learn about God is by studying the Bible. In it he tells us much more about the kind of God he is. He also tells us about his purpose and what he wants us to do.-Amos 3:7; 2 Timothy 3:16, 17.
[Pictures on page 5]
We learn about God from creation and from the Bible
Lesson 3
Who Is Jesus Christ?
Why is Jesus called God’s "firstborn" Son? (1)
Why is he called "the Word"? (1)
Why did Jesus come to earth as a man? (2-4)
Why did he perform miracles? (5)
What will Jesus do in the near future? (6)
1. Jesus lived in heaven as a spirit person before he came to earth. He was God’s first creation, and so he is called the "firstborn" Son of God. (Colossians 1:15; Revelation 3:14) Jesus is the only Son that God created by himself. Jehovah used the prehuman Jesus as his "master worker" in creating all other things in heaven and on earth. (Proverbs 8:22-31; Colossians 1:16, 17) God also used him as His chief spokesman. That is why Jesus is called "the Word."-John 1:1-3; Revelation 19:13.
2. God sent His Son to the earth by transferring his life to the womb of Mary. So Jesus did not have a human father. That is why he did not inherit any sin or imperfection. God sent Jesus to earth for three reasons: (1) To teach us the truth about God (John 18:37), (2) to maintain perfect integrity, providing a model for us to follow (1 Peter 2:21), and (3) to sacrifice his life to set us free from sin and death. Why was this needed?-Matthew 20:28.
3. By disobeying God’s command, the first man, Adam, committed what the Bible calls "sin." So God sentenced him to death. (Genesis 3:17-19) He no longer measured up to God’s standards, so he was not perfect anymore. Slowly he grew old and died. Adam passed on sin to all his children. That is why we also grow old, get sick, and die. How could mankind be saved?-Romans 3:23; 5:12.
4. Jesus was a perfect human just like Adam. Unlike Adam, though, Jesus was perfectly obedient to God under even the greatest test. He could therefore sacrifice his perfect human life to pay for Adam’s sin. This is what the Bible refers to as the "ransom." Adam’s children could thus be released from condemnation to death. All who put their faith in Jesus can have their sins forgiven and receive everlasting life.-1 Timothy 2:5, 6; John 3:16; Romans 5:18, 19.
5. When on earth Jesus cured the sick, fed the hungry, and calmed storms. He even raised the dead. Why did he perform miracles? (1) He felt pity for people who were suffering, and he wanted to help them. (2) His miracles proved that he was God’s Son. (3) They showed what he will do for obedient mankind when he rules as King over the earth.-Matthew 14:14; Mark 2:10-12; John 5:28, 29.
6. Jesus died and was resurrected by God as a spirit creature, and he returned to heaven. (1 Peter 3:18) Since then, God has made him a King. Soon Jesus will remove all wickedness and suffering from this earth.-Psalm 37:9-11; Proverbs 2:21, 22.
[Pictures on page 7]
Jesus’ ministry included teaching, performing miracles, and even offering up his life for us
Lesson 4
Who Is the Devil?
Satan the Devil-where did he come from? (1, 2)
How does Satan mislead people? (3-7)
Why should you resist the Devil? (7)
1. The word "devil" means someone who tells wicked lies about another person. "Satan" means an enemy or an opposer. These are terms given to God’s chief enemy. At first, he was a perfect angel in heaven with God. However, he later thought too much of himself and wanted the worship that rightly belongs to God.-Matthew 4:8-10.
2. This angel, Satan, spoke to Eve by means of a snake. By telling her lies, he got her to disobey God. Satan thus attacked what is called God’s "sovereignty," or position as the Most High. Satan questioned whether God rules in a worthy way and in the best interests of His subjects. Satan also brought into question whether any human would remain loyal to God. By doing this, Satan made himself God’s enemy. That is why he came to be called Satan the Devil.-Genesis 3:1-5; Job 1:8-11; Revelation 12:9.
3. Satan tries to trick people into worshiping him. (2 Corinthians 11:3, 14) One way he misleads people is through false religion. If a religion teaches lies about God, it really serves the purpose of Satan. (John 8:44) People who are members of false religions may sincerely believe that they are worshiping the true God. But they are really serving Satan. He is ‘the god of this world.’-2 Corinthians 4:4.
4. Spiritism is another way Satan brings people under his power. They may call upon spirits to protect them, to harm others, to foretell the future, or to perform miracles. Satan is the wicked force behind all these practices. To please God, we must have nothing to do with spiritism.-Deuteronomy 18:10-12; Acts 19:18, 19.
5. Satan also misleads people through extreme pride of race and the worship of political organizations. Some feel that their nation or race is better than others. But this is not true. (Acts 10:34, 35) Other people look to political organizations to solve man’s problems. By doing this, they are rejecting God’s Kingdom. It is the only solution for our problems.-Daniel 2:44.
6. Another way Satan misleads people is by tempting them with sinful desires. Jehovah tells us to avoid sinful practices because he knows they will harm us. (Galatians 6:7, 8) Some people may want you to join them in such practices. Remember, though, it is really Satan who wants you to do these things.-1 Corinthians 6:9, 10; 15:33.
7. Satan may use persecution or opposition to get you to leave Jehovah. Some of your loved ones may become very angry because you are studying the Bible. Others may make fun of you. But to whom do you owe your life? Satan wants to frighten you so that you will stop learning about Jehovah. Do not let Satan win! (Matthew 10:34-39; 1 Peter 5:8, 9) By resisting the Devil, you can make Jehovah happy and show that you uphold His sovereignty.-Proverbs 27:11.
[Pictures on page 9]
False religion, spiritism, and nationalism mislead people
[Picture on page 9]
Resist Satan by continuing to learn about Jehovah
Lesson 5
What Is God’s Purpose for the Earth?
Why did Jehovah create the earth? (1, 2)
Why is the earth not a paradise now? (3)
What will happen to wicked people? (4)
In the future, what will Jesus do for the sick? the elderly? the dead? (5, 6)
To share in the future blessings, what do you need to do? (7)
1. Jehovah created this earth so that humans could enjoy living on it forever. He wanted the earth always to be inhabited by righteous, happy people. (Psalm 115:16; Isaiah 45:18) The earth will never be destroyed; it will last forever.-Psalm 104:5; Ecclesiastes 1:4.
2. Before God made man, He chose one small part of the earth and made it into a beautiful paradise. He called it the garden of Eden. It was here that he put the first man and woman, Adam and Eve. God purposed for them to have children and fill the whole earth. Gradually they would have made the entire earth into a paradise.-Genesis 1:28; 2:8, 15.
3. Adam and Eve sinned by deliberately breaking God’s law. So Jehovah put them out of the garden of Eden. Paradise was lost. (Genesis 3:1-6, 23) But Jehovah has not forgotten his purpose for this earth. He promises to make it into a paradise, where humans will live forever. How will he do this?-Psalm 37:29.
4. Before this earth can become a paradise, wicked people must be removed. (Psalm 37:38) This will happen at Armageddon, which is God’s war to end wickedness. Next, Satan will be imprisoned for 1,000 years. This means that no wicked ones will be left to spoil the earth. Only God’s people will survive.-Revelation 16:14, 16; 20:1-3.
5. Then Jesus Christ will rule as King over this earth for 1,000 years. (Revelation 20:6) He will gradually take sin away from our minds and bodies. We will become perfect humans just as Adam and Eve were before they sinned. Then there will be no more sickness, old age, and death. Sick people will be cured, and old persons will become young again.-Job 33:25; Isaiah 33:24; Revelation 21:3, 4.
6. During Jesus’ Thousand Year Reign, faithful humans will work to turn the whole earth into a paradise. (Luke 23:43) Also, millions of dead ones will be resurrected to human life on the earth. (Acts 24:15) If they do what God requires of them, they will continue to live on earth forever. If not, they will be destroyed forever.-John 5:28, 29; Revelation 20:11-15.
7. God’s original purpose for the earth will thus succeed. Would you like to share in these future blessings? If so, you need to keep learning about Jehovah and obeying his requirements. Attending meetings at the local Kingdom Hall of Jehovah’s Witnesses will help you to do so.-Isaiah 11:9; Hebrews 10:24, 25.
[Picture on page 10]
Paradise lost
[Pictures on page 11]
After Armageddon, earth will be made into a paradise
Lesson 6
What Is the Kingdom of God?
Where is the Kingdom of God located? (1)
Who is its King? (2)
Do others share in ruling with the King? If so, how many? (3)
What shows that we are living in the last days? (4)
What will God’s Kingdom do for mankind in the future? (5-7)
1. When he was on earth, Jesus taught his followers to pray for God’s Kingdom. A kingdom is a government that is headed by a king. God’s Kingdom is a special government. It is set up in heaven and will rule over this earth. It will sanctify, or make holy, God’s name. It will cause God’s will to be done on earth as it is done in heaven.-Matthew 6:9, 10.
2. God promised that Jesus would become the King of His Kingdom. (Luke 1:30-33) When Jesus was on earth, he proved that he would be a kind, just, and perfect Ruler. When he returned to heaven, he was not enthroned as King of God’s Kingdom right away. (Hebrews 10:12, 13) In 1914, Jehovah gave Jesus the authority He had promised him. Since then, Jesus has ruled in heaven as Jehovah’s appointed King.-Daniel 7:13, 14.
3. Jehovah has also selected some faithful men and women from the earth to go to heaven. They will rule with Jesus as kings, judges, and priests over mankind. (Luke 22:28-30; Revelation 5:9, 10) Jesus called these corulers in his Kingdom a "little flock." They number 144,000.-Luke 12:32; Revelation 14:1-3.
4. As soon as Jesus became King, he threw Satan and his wicked angels out of heaven and down to the locality of the earth. That is why things have become so bad here on earth since 1914. (Revelation 12:9, 12) Wars, famines, pestilences, increasing lawlessness-all these are part of a "sign" indicating that Jesus is ruling and that this system is in its last days.-Matthew 24:3, 7, 8, 12; Luke 21:10, 11; 2 Timothy 3:1-5.
5. Soon Jesus will judge people, separating them as a shepherd separates sheep from goats. The "sheep" are those who will have proved themselves his loyal subjects. They will receive everlasting life on earth. The "goats" are those who will have rejected God’s Kingdom. (Matthew 25:31-34, 46) In the near future, Jesus will destroy all goatlike ones. (2 Thessalonians 1:6-9) If you want to be one of Jesus’ "sheep," you must listen to the Kingdom message and act on what you learn.-Matthew 24:14.
6. Now the earth is divided up into many countries. Each has its own government. These nations often fight one another. But God’s Kingdom will replace all human governments. It will rule as the only government over the entire earth. (Daniel 2:44) Then there will be no more war, crime, and violence. All people will live together in peace and unity.-Micah 4:3, 4.
7. During Jesus’ Thousand Year Reign, faithful humans will become perfect, and the whole earth will become a paradise. By the end of the thousand years, Jesus will have done everything God asked him to do. Then he will hand the Kingdom back to his Father. (1 Corinthians 15:24) Why not tell your friends and loved ones about what God’s Kingdom will do?
[Picture on page 13]
Under Jesus’ rule, there will be no more hatred or prejudice
Lesson 7
Drawing Close to God in Prayer
Why is it important to pray regularly? (1)
To whom should we pray, and how? (2, 3)
What are proper subjects for prayer? (4)
When should you pray? (5, 6)
Does God listen to all prayers? (7)
1. Prayer is humbly speaking to God. You should pray to God regularly. Thus you can feel close to him as to a dear friend. Jehovah is so great and powerful, yet he listens to our prayers! Do you pray to God regularly?-Psalm 65:2; 1 Thessalonians 5:17.
2. Prayer is part of our worship. Thus, we should pray only to God, Jehovah. When Jesus was on earth, he always prayed to his Father, not to anyone else. We should do the same. (Matthew 4:10; 6:9) However, all our prayers should be said in the name of Jesus. This shows that we respect Jesus’ position and that we have faith in his ransom sacrifice.-John 14:6; 1 John 2:1, 2.
3. When we pray we should speak to God from our heart. We should not say our prayers from memory or read them from a prayer book. (Matthew 6:7, 8) We can pray in any respectful position, at any time, and at any place. God can hear even silent prayers said in our heart. (1 Samuel 1:12, 13) It is good to find a quiet place away from other people to say our personal prayers.-Mark 1:35.
4. What subjects can you pray about? Anything that might affect your friendship with him. (Philippians 4:6, 7) The model prayer shows that we should pray about Jehovah’s name and purpose. We can also ask for our material needs to be provided, for our sins to be forgiven, and for help to resist temptation. (Matthew 6:9-13) Our prayers should not be selfish. We should only pray for things that harmonize with God’s will.-1 John 5:14.
5. You may pray whenever your heart moves you to thank or praise God. (1 Chronicles 29:10-13) You should pray when you have problems and your faith is being tested. (Psalm 55:22; 120:1) It is appropriate to pray before you eat your meals. (Matthew 14:19) Jehovah invites us to pray "on every occasion."-Ephesians 6:18.
6. We especially need to pray if we have committed a serious sin. At such times we should beg for Jehovah’s mercy and forgiveness. If we confess our sins to him and do our very best not to repeat them, God is "ready to forgive."-Psalm 86:5; Proverbs 28:13.
7. Jehovah listens only to the prayers of righteous people. For your prayers to be heard by God, you must be trying your best to live by his laws. (Proverbs 15:29; 28:9) You must be humble when you pray. (Luke 18:9-14) You need to work at what you pray for. You will thus prove that you have faith and that you really mean what you say. Only then will Jehovah answer your prayers.-Hebrews 11:6.

Friday, March 20, 2009

Do you understand the lesson taught to Jonah?

Did you know that Jonah was fearful of preaching the destruction on a wicked city? That's why he was swallowed by a large fish. (You can read this account in Jonah.)
Jonah then did go back and preach destruction on the city - a warning message! But do you know what happened?
The people repented and turned back from their wicked way. Jonah, though, was angry. All he had gone through, he felt these people deserved destruction. Jonah 4:1 He even felt like he should have stayed home, rather than have preached the message of warning on the wicked.
Jonah 4:2, 3 He even asked to die! He had preached doom, and now it wouldn't happen. He may have felt embarrased, shame, or just upset he was swallowed by a fish for something that would never occur.
Jehovah God though, was not angry with Jonah, instead He asked him "Have you rightly became hot with anger?" Jonah 4:4 Did Jonah even answer, the bible record is silent.
The despondent prophet left Nineveh and head, not home, but eastward, where some mountains overlooked the region. He built a little shelter and settled in to wait and watch Nineveh. Perhaps he still clung to the hope of witnessing her destruction.
Overnight, Jehovah caused a bottle-gourd plant to sprout up. Jonah woke to see this luxuriant growth, with it's broad new leaves providing far more shade than his flimsy shelter ever could. His spirits lifted. "Jonah began to rejoice greatly." over the plant, perhaps thinking it was a blessing from God as a sign of His approval. However, Jehovah wanted to do more for Jonah than simply deliver him from the heat and from his own petulant anger. He wanted to reach Jonah's heart. So God used a worm to attack and kill the plant. Then he sent a parching east wind until Jonah began swooning away from the heat. Again the man's spirits plummeted, and he asked God that he might die. Jonah 4:6-8
Once again Jehovah God asked Jonah if he was rightly angry, this time over the death of the bottle-gourd plant. Instead of repenting, Jonah justified himself, saying "I have rightly become hot with anger, to the point of death." The stage was now set for Jehovah to drive home the lesson. Jonah 4:9
God reasoned with Jonah, saying that the prophet was feeling sorry over the death of a mere plant that had grown overnight, one that Jonah neither planted nor caused to grow. Then God concluded "For my part, ought I not feel sorry for Nineveh the Great city, in which there exist more than one hundred and twenty thousand men who do not at all know the difference between their right hand and their left, besides many domestic animals." Jonah 4:10,11 Do you see the depth of Jehovah's lesson? Jonah had done nothing for this plant, yet Jehovah was the source of life for Nineveh.

Did You Know? Abba

Why did Jesus in prayer address Jehovah as "Abba, Father?"
The Aramaic word "abba" can mean either "The Father" or "O Father". On each of the three occassions that the expression appears in the scriptures, it is part of a prayer and is used in reference to the heavenly Father, Jehovah. What signifigance does the word carry?
The International Standard Bible Encyclopedia states "In the colloquial speech of Jesus' time, abba was primarily used as a term of informal intimacy and respect by children to their fathers. It was an endearing form of address and among the first words a child learned. Jesus used this expression in a particularly fervent appeal to his Father. In the Garden of Gethsemane, just hours before his death, Jesus in prayer addressed Jehovah with the words "Abba, Father." Mark 14:36
"Abba" as a form of address to God is extremely uncommon in Jewish literature of the Greco-Roman period, doubtless because it would have appeared irreverent to address God with this familiar term, continues the above mentioned reference work. However, Jesus, use of this term in prayer is an indirect attestation of His extraordinary claim of intimacy with God, his Father. The other two scriptural occurences of Abba both in the writings of the apostle Paul indicate that first century christians also used it in their prayers. Romans 8:15, Galatians 4:6

A Sample Bible Reading Schedule

A Schedule you can try to follow each week. -You probably wouldn't read it all in one day.
(Just a sample, some people prefer reading cover to cover or reading in chronological order, either in the order in which the books were written, or in the order inwich events occured.

Monday: Read Action packed history - Genesis to Esther
Tuesday: Jesus Life and Teaching - Matthew to John
Wednesday: Early Christianity (Acts)
Thursday: Prophecy and moral guidance (Isaiah to Malachi, Revelation)
Friday: Moving Poetry and song ( Jobs, Psalms, Song of Solomon)
Saturday: Wisdom Living (Proverbs and Ecclesiates)
Sunday: Letters to the Congregations (Romans to Jude)

Make a schedule and check off what you read.
I personally make a schedule to follow on my calendar.

M - Genesis ch. 1 - 3 Tues - Genesis ch. 4 -6 and so on.

More Help with Bible Reading

Make the scriptures come to life!
Convert lists of names into family trees!
Created diagrams. For instance, as you read about a faithful character, connect that person's qualities and acts with the blessings he or she received. - Proverbs 28:20
Draw pictures to illustrate the account.
Draw a story board. A series of simple pictures to illustrate a sequence of events. Describe what's happening in each scene.
Build a scale model of structures, such as Noah's Ark
Read aloud with friends and family members. Suggestion: Assign each person to read the narration. Other take character parts.
Select an account, and turn it into a news story. Report the event from several perspectives including interviews with main characters and eye witnesses.
Take an account in which a character made an unwise decision and imagine a different ending. For example "Peter's Denial" How could have Peter acted better under pressure.
Watch or listen to recordings or Bible dramas.
Write your own drama, include lessons that can be learned from the account. Romans 15:4 Perform this drama with a small group of your friends.