Blood Majority? Transfusion, Language, and the Law in the Age of Hobby Lobby

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Both the SCOTUS Hobby Lobby Opinion and Dissent point a warning finger at Jehovah’s Witnesses’ stance on blood transfusion. But what do we mean when we talk about religious objections to blood transfusion like those of the Jehovah’s Witnesses? What does this specific objection regarding blood show us about how we might want to think about the intersection of law and bodies?

You should read my whole piece on Jehovah’s Witnesses and blood transfusions below, but…

…I do want to say this much up-front: What we say about women’s reproductive rights is never divorced from our cultural and religious background, but to assume this background as settled and to assume that religious preferences themselves are somehow settled affairs means cheating ourselves. Respecting the law and respecting religion means understanding that neither is ever stable and we should not try to solve cultural conflicts by pretending they are fixed.

Yesterday, the Supreme Court of the United States (SCOTUS) ruled in its case Burwell v. Hobby Lobby Stores. The split 5-4 decision in favor of Hobby Lobby reads in part that, “The contraceptive mandate, as applied to closely held corporations, violates RFRA,” the Religious Freedom Restoration Act (“Opinion of the Court” 49). As the NPR summary puts it:

The Supreme Court has ruled that family owned and other closely held companies can opt out of the Affordable Care Act’s provisions for no-cost prescription contraception in most health insurance if they have religious objections.

The owners of the Hobby Lobby chain of arts and crafts stores and those of another closely held company, Conestoga Wood Specialties Corp., had objected on the grounds of religious freedom.

The ruling affirms a Hobby Lobby victory in a lower court and gives new standing to similar claims by other companies.

In her dissent, Justice Ruth Bader Ginsburg asked:

Would the exemption the Court holds RFRA demands for employers with religiously grounded objections to the use of certain contraceptives extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus); and vaccinations (Christian Scientists, among others)? According to counsel for Hobby Lobby, “each one of these cases . . . would have to be evaluated on its own . . . apply[ing] the compelling interest-least restrictive alternative test.” Tr. of Oral Arg. 6. Not much help there for the lower courts bound by today’s decision. (“Dissenting” 34)

Now, obviously this is not the space for a political or legal debate. The list of potential potential objections certainly reflects an awareness that the concept of “religiously grounded objection” is much, much broader  if applied to the multi-cultural, multi-faith reality of the U.S. I won’t go into any of these things, but when SCOTUS mentions blood transfusion…well, there is something we need to talk about.

The Jehovah’s Witnesses (JW) stance on blood transfusion comes up several times in both Opinion and Dissent. It seems to be an immediate go-to example lawyers have when health and religious rules clash. However, what is that stance? The answer requires a bit of history…and that is exactly the problem with the way SCOTUS and many others use the JW transfusion stance, as I will elaborate below.


I. The Jehovah’s Witnesses Stance

The official JW outlet website by the Watch Tower Bible and Tract Society of Pennsylvania explains the stance in this way:

The fundamental answer is that Jehovah’s Witnesses do not accept blood. We firmly believe that God’s law on blood is not open to reform to fit shifting opinions. Still, new issues arise because blood can now be processed into four primary components and fractions of those components. In deciding whether to accept such, a Christian should look beyond possible medical benefits and risks. His concern should be what the Bible says and the potential effect on his relationship with Almighty God.

The key issues are quite simple. As an aid to seeing why that is so, consider some Biblical, historical, and medical background.

Jehovah God told our common ancestor Noah that blood must be treated as something special. (Genesis 9:3, 4) Later, God’s laws to Israel reflected the sacredness of blood: “As for any man of the house of Israel or some alien resident . . . who eats any sort of blood, I shall certainly set my face against the soul that is eating the blood.” By rejecting God’s law, an Israelite could contaminate others; thus, God added: “I shall indeed cut him off from among his people.” (Leviticus 17:10) Later, at a meeting in Jerusalem, the apostles and older men decreed that we must ‘abstain from blood.’ Doing so is as vital as abstaining from sexual immorality and idolatry.—Acts 15:28, 29.

What would “abstaining” have meant back then? Christians did not consume blood, whether fresh or coagulated; nor did they eat meat from an unbled animal. Also ruled out would be foods to which blood was added, such as blood sausage. Taking in blood in any of those ways would violate God’s law.—1 Samuel 14:32, 33.

Read literally, Levitical law is a dietary restriction as practiced by many Jews and Muslims. A firm stance on ingesting blood by the JW is thus not unusual in the Judeo-Christian context. It seems unlikely that SCOTUS would ever have to rule on health and hygiene regulations, since a federal court dismissed such a case already. Also, cases of kosher or halal regulation would not extend to the employees’ diet.

Generally speaking, the analogy of food and birth control is bogus, but in the case of the JW stance on blood transfusions, it intersects because the literal and metaphorical readings of scripture rub up against each other. The question is what “abstaining” means, or what constitutes ingestion. This already complicated question becomes even more complicated as blood transfusions become viable:

As transfusions of whole blood became common after World War II, Jehovah’s Witnesses saw that this was contrary to God’s law—and we still believe that. Yet, medicine has changed over time. Today, most transfusions are not of whole blood but of one of its primary components: (1) red cells; (2) white cells; (3) platelets; (4) plasma (serum), the fluid part. Depending on the condition of the patient, physicians might prescribe red cells, white cells, platelets, or plasma. Transfusing these major components allows a single unit of blood to be divided among more patients. Jehovah’s Witnesses hold that accepting whole blood or any of those four primary components violates God’s law. Significantly, keeping to this Bible-based position has protected them from many risks, including such diseases as hepatitis and AIDS that can be contracted from blood.

Infusing the blood stream with other blood to the JW is ingestion or non-abstinence. Once blood products are transfused, the “major components” are declared by dogma and ruled out. Note also the moral under-tone that seems to align adherence to Biblical dietary restrictions with freedom from disease…a very problematic association in itself, given the other kinds of regulations in the Pentateuch.

JW are far from ignorant of current hematology. Indeed, their religious stance seems to launch into conversation and philosophical conversations I see as rather enlightened and sophisticated, given the prevailing ignorance around liquid tissues and hematology in the general population–especially transfusin-free medicine is obviously attractive to JW. But even a publication intended for the general readership illustrates the depth of consideration:

However, since blood can be processed beyond those primary components, questions arise about fractions derived from the primary blood components. How are such fractions used, and what should a Christian consider when deciding on them?

Blood is complex. Even the plasma—which is 90 percent water—carries scores of hormones, inorganic salts, enzymes, and nutrients, including minerals and sugar. Plasma also carries such proteins as albumin, clotting factors, and antibodies to fight diseases. Technicians isolate and use many plasma proteins. For example, clotting factor VIII has been given to hemophiliacs, who bleed easily. Or if someone is exposed to certain diseases, doctors might prescribe injections of gamma globulin, extracted from the blood plasma of people who already had immunity. Other plasma proteins are used medically, but the above mentioned illustrate how a primary blood component (plasma) may be processed to obtain fractions.*

Just as blood plasma can be a source of various fractions, the other primary components (red cells, white cells, platelets) can be processed to isolate smaller parts. For example, white blood cells may be a source of interferons and interleukins, used to treat some viral infections and cancers. Platelets can be processed to extract a wound-healing factor. And other medicines are coming along that involve (at least initially) extracts from blood components. Such therapies are not transfusions of those primary components; they usually involve parts or fractions thereof. Should Christians accept these fractions in medical treatment? We cannot say. The Bible does not give details, so a Christian must make his own conscientious decision before God.

It is for one remarkable that medical technology itself is by no means vilified, but only the specific results evaluated. However, this creates a maze of decisions for the true believer. Fractioning what Leviticus sees as one substance, one closed and definable thing means fractioning attitudes and the rules themselves. Laws can only apply when the referent is clear and defined–hence the long boiler-plates of contracts. When, to put it in Saussurean terms, the signifier and signified turn out to be one signifier and many components of the signified, the linguistic stability assumed in the reference deteriorates. “Should Christians accept these fractions in medical treatment?” is in my view more than a rhetorical question. It is an indicator of how in the absence of a clear institution, the Protestant spirit of individual exegesis may threaten long-held beliefs…even of Protestant groups themselves. In the face of medical technology and scientific research, the collective position is a mere indicator of an individual desire for truth and stable meaning:

Some would refuse anything derived from blood (even fractions intended to provide temporary passive immunity). That is how they understand God’s command to ‘abstain from blood.’ They reason that his law to Israel required that blood removed from a creature be ‘poured out on the ground.’ (Deuteronomy 12:22-24) Why is that relevant? Well, to prepare gamma globulin, blood-based clotting factors, and so on, requires that blood be collected and processed. Hence, some Christians reject such products, just as they reject transfusions of whole blood or of its four primary components. Their sincere, conscientious stand should be respected.

Other Christians decide differently. They too refuse transfusions of whole blood, red cells, white cells, platelets, or plasma. Yet, they might allow a physician to treat them with a fraction extracted from the primary components. Even here there may be differences. One Christian may accept a gamma globulin injection, but he may or may not agree to an injection containing something extracted from red or white cells. Overall, though, what might lead some Christians to conclude that they could accept blood fractions?

“Questions From Readers” in The Watchtower of June 1, 1990, noted that plasma proteins (fractions) move from a pregnant woman’s blood to the separate blood system of her fetus. Thus a mother passes immunoglobulins to her child, providing valuable immunity. Separately, as a fetus’ red cells complete their normal life span, their oxygen-carrying portion is processed. Some of it becomes bilirubin, which crosses the placenta to the mother and is eliminated with her body wastes. Some Christians may conclude that since blood fractions can pass to another person in this natural setting, they could accept a blood fraction derived from blood plasma or cells.

Does the fact that opinions and conscientious decisions may differ mean that the issue is inconsequential? No. It is serious. Yet, there is a basic simplicity. The above material shows that Jehovah’s Witnesses refuse transfusions of both whole blood and its primary blood components. The Bible directs Christians to ‘abstain from things sacrificed to idols and from blood and from fornication.’ (Acts 15:29) Beyond that, when it comes to fractions of any of the primary components, each Christian, after careful and prayerful meditation, must conscientiously decide for himself.

Conscience becomes the determining authority in deciding what blood is and what abstinence is. In the face of contemporary physiology, the notion that the mother’s blood components would violate the fetus’ abstinence is so absurd that cracks appear in the monolithic “blood.”


II. Changing Dogma

However, despite its insistence on the stance as a reaction to changing times, even this account is only the synchronic display of faith–the display that SCOTUS references. This is by no means, however, a stable, unchanging definition of how JW should interact with blood. Critic of JW institutions and rules Paul Grundy explains in an exhaustive blog post on his site JWFacts.com that this stance did not arise organically.

For one, Grundy explains that Pauline writings and the New Testament in general undo exactly the works-based notion of Christianity that the JW publications advocate. If the point of Christianity is salvation through faith not works, then Mosaic Law, including its definitions of blood in food cannot matter. In relation to theology, eating blood is not entirely different from eating pork.

Also, however, the JW position on transfusion keeps evolving, leading to complicated manuals like this one:

Hospital Liaison Committee handout (2000). Source: JWFacts.com

So the effort to follow the words of Christ literally lead to a confusing clash between metaphor and material and a need to create new laws to ensure that only faith matters?

Let us return to the beginning. When SCOTUS fights the fight over religious positions on contraception, it references the JW stance on blood transfusion. But which one? Grundy points out that the JW had no position on the question until the 1920s. As Grundy puts it:

Originally Jehovah’s Witnesses were allowed vaccinations, transplants and blood. At various points in time during the 1900’s Jehovah’s Witnesses were forbidden all of the above. Now all of these are allowed once again in some shape or form. Though full blood transfusions and major blood fractions are still forbidden, technically 100% of the blood components are now allowed to be transfused in their broken down parts.

SCOTUS opinions are intended for the ages but famously overturned from one decade to the next, one century to the other. This allows laws to change with the times, just like the JW stance. The constant reference to this seemingly clear position, however, introduces a moment of radical doubt, of linguistic instability and dogmatic break-down into a debate that seeks to find a clear position in a confusing reality.

So when we talk about religious objections to blood transfusion like those of the Jehovah’s Witnesses we must for one keep in mind that these objections themselves are under constant revision, reinterpretation, and might be abolished altogether. The specific case of the JW also shows us that the desire for stability in the blood, a hope for holistic solidity in how we can view blood, seduces us to accept solutions that seem reasonable only because they answer this desire, but in no way restore the lost whole, the blood we fear and love.

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