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I have been following with interest the series of articles in the Journal of Medical Ethics on the subject of Jehovah's Witnesses and the refusal of blood transfusions. There are a couple of aspects which have not been covered and which I would like to raise.

Most of the discussion has centred around adult Jehovah's Witnesses. However, where children are involved the issues become more complex and emotive. I feel that there is a need to examine the rights and responsibilities of parents in the making of life and death decisions on behalf of their children. Also, there is the question of the extent to which the child should be consulted.

If the decision is made to give a child a blood transfusion against his or her parents' wishes, the long term psychological effect on the child should also be taken into account. Depending upon the age of the child, he may also have strong views on the subject as a result of the teaching he has received.

In Jehovah's Witness publications, the administration of an unwanted transfusion is likened to assault or rape. Taking blood is presented as disobedience to a very important divine command. Consequently, it is worth considering how children/teenagers may view this treatment and also how they may view themselves after having (albeit unwillingly) broken God's law as they see it.

So, while the medical personnel involved may be convinced they have saved the child's life, at the same time consideration needs to be given to the differing perspective of the child himself, his family and his religious community. I wonder whether there have been any studies done of the long term psychological effects on those who received transfusions as children.

Another aspect which has not been covered in the discussion to date is the feelings of the nurses involved in the administration of the transfusion. Traditionally, paediatric nurses have worked with parents in caring for their children while in hospital. Therefore, handling a situation in which the wishes of the parents and child are being overridden is difficult. I read the report of a case in which the nurse administering the transfusion was convinced that it was necessary to save the child's life. At the same time, she was deeply distressed by the obvious distress of the child and his parents. This highlights the need for support for nurses in such situations.

I feel that the discussion in the Journal of Medical Ethics has been very helpful in highlighting the variety of views current among Jehovah's Witnesses on the subject of treatments containing blood. I hope that it will help to make both doctors and Jehovah's Witness patients more aware of the options open to them. Translating this into the best possible care for each individual Witness patient may be more difficult, but this is certainly a step in the right direction.