Utilitarians, Jehovahs Witnesses and Blood Transfusions
Let us suppose that there is a middle aged man named Jeremy who presents at a hospital with aplastic anaemia and thus requires a bone marrow donation. Thankfully his daughter, Kim is a match. Doctors estimate that with the transplant, there is a 60% chance of recovery for Jeremy. Without the transplant, he will certainly die within two years. Jeremy turns up at the clinic and has an IV line connected to allow the transplant to take place.
Jeremy has been a committed Jehovah’s Witness for the past 25 years, and after the IV is inserted he tells his doctor that he should have made something clear — he will not accept the marrow transplant if it contains any blood whatsoever. Jeremy explains that this is because Jehovah’s Witnesses are commanded to ‘abstain from blood’, drawing support from the bible (Acts 15:28, 29; Deuteronomy 12:15, 16). Jeremy says he would rather die that\n act against his faith.
Jeremy’s doctor, Derek, is well aware that bone marrow will always contain some blood as it is impossible to remove completely. Derek also knows that accepting bone marrow transplants actually qualifies as a ‘conscience issue’ for Jehovah’s Witnesses — i.e. in cases of a conscience issue, the church leaves it up to individuals whether they will accept the treatment. Derek comes to the conclusion that a transplant remains in Jeremy’s best interests. In light of this, Derek assures Jeremy that the marrow contains no blood, and the transplant goes ahead.Jeremy has made it clear that a transfusion is “worse than death”. Derek is aware of this fact, as well as the fact that it is an impossibility to remove all blood from a marrow transplant. Derek believes that saving Jeremy is in his best interest and decides to lie to him anyway. Upon reading the scenario a utilitarian might on impulse think that Derek made the right choice and should save the life of Jeremy by lying to him about the situation. On further inspection however, a utilitarian would realise that there is a greater good that can be achieved from the situation.
From a utilitarian perspective pleasures are all qualitatively alike; however, they can be graded on the basis of intensity, length, certainty, temporal closeness, fruitfulness and purity. Furthermore, as a rule utilitarian, whereby scenarios build upon the framework for decision making, Derek decided to follow the general rule that the freedom of the individual would be in the best interests of the most parties, unlike an act utilitarian who would act differently because they are in charge of the scenario, Derek would have realised that following a rule that he would prefer others adhere to, was the way to go. If he were to save the individual in question, he could possibly jeopardise his career, and as in cases prior to this were a doctor had intervened, Derek now risks being disqualified as a valid medical practitioner. If the individual has clearly stated that “they would rather die, than receive blood” he would a) find their statement incredibly foolish and attempt to convince them otherwise b) If Derek was unable to change the mind of the individual and they truly would rather die, than he would not be producing the greatest good, for the individual, himself, the individual’s family, his family, and all those involved. Derek would likely be legally punished, and the individual would not be any happier.
Furthermore, the fact that there is a 40% chance of failure, only conflates the likelihood, that this act would not be morally well: if the act were to fail completely, then the individual would die anyway: AND Derek would have lied to them, as well as provided them with a pain worse than death “I would rather die than receive a blood transfusion”. Furthermore, the family would have expressed dissatisfaction with the fact that their family members wishes were not respected. An important tenet of the Jehovah witness religion is the fact that an individual should “abstain from blood” (Acts 15:28, 29)2. Whilst the situation is capable of producing the most desirable outcome from a utilitarian point of view, if no one were to find out that Derek was lying, it is also capable of producing the worst possible outcome. From a rule utilitarian perspective, one has to consider all implications of the act, unlike act utilitarianism in which each situation is assessed differently1. So, from a rule utilitarian point of view, to lie to him would be wrong, which is what Derek does. The possible consequences are too unpredictable and following a generalist rule to these kind of situations, in this case embodied by the law is the best approach. Ultimately the fact that as a general rule the consequences more consistently provide the greater good if the “rules” were followed is what should compel Derek not to lie to Jeremy. Hence from a rule utilitarians point of view Dereks actions are not likely to produce the greatest utility, good, or hapiness.
In summary, from a utilitarian perspective, the greatest good can be achieved, theoretically by lying to Jeremy (which is what Derek did) and him never finding out this was the case. Unfortunately, in reality, theory is not quite as relevant: It is exceedingly unlikely, if not approaching impossible, that he will never find out that blood is required for a transfusion, which means that the best decision that Derek can make is to tell Jeremy the truth, as a general rule. Rather than the situation being assessed on a case by case basis, where the doctor may or may not get away with it, from the perspective of a rule utilitarian, the “rule” of following the law, and NOT lying about a transfusion requiring blood makes the most sense.
References:
1. What is the difference between Rule Utilitarianism and Act Utilitarianism? Retrieved January 20, 2020, from https://philosophy.stackexchange.com/questions/10496/what-is-the-difference-between-rule-utilitarianism-and-act-utilitarianism
2. Rajtar, M. (2013, December). Bioethics and religious bodies: refusal of blood transfusions in Germany. Retrieved January 17, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/23538204
3. (n.d.). Retrieved January 20, 2020, from https://www.siue.edu/~evailat/i-mill.html
4. Q1: Could I rationally act on my maxim in the PSW? (n.d.). Retrieved January 20, 2020, from https://www.csus.edu/indiv/g/gaskilld/ethics/kantian ethics.htm
