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Werth v. Taylor.

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Adult

Heart transplantation in Jehovah's Witnesses. An initial experience and follow-up.

More than 25 years of experience performing heart surgery on Jehovah's Witnesses has culminated in successful cardiac transplantation without administering blood products in five patients (mean age, 44.4 +/- 8.3 years) of this faith. The use of blood-conserving methods, iron supplementation, bone marrow-sparing maintenance immunotherapy, and brisk postoperative diuresis has added to the efficacy of cardiac transplantation in these patients. No perioperative deaths occurred, and early follow-up studies have shown that these patients have not been more susceptible to higher graft rejection rates due to the lack of pretransplant blood transfusions. As more Jehovah's Witnesses undergo heart transplantation in the future, comparison with other recipients who allow pretransplant blood transfusions may lead to a better understanding of rejection immunobiology. We conclude that cardiac transplants may be safely offered to Jehovah's Witnesses without fear of a uniformly poor outcome.

Adult

Donum Vitae: civil law and moral values.

The Instruction reminds us that reproductive medicine has become part of our social reality and as such justifies the intervention of public authorities. The Instruction suggests relevant principles which should guide appropriate legislation. This essay analyzes how far the French government has taken these fundamental principles into account.

Advisory Committees

Feeding of severely demented patients in institutions: interviews with caregivers in Israel.

In an exploratory, open-ended, and non-random study, 60 health care workers in nine long-term care institutions in Israel were questioned regarding their experiences, thoughts and feelings related to force feeding senile demented patients. The main findings were analysed according to an ethical decision-making model. Israeli care workers tended to ground their explanations in traditional Jewish sanctity of life ethics. Their actions as well as their emotional reactions seemed the logical outcome of this world view: patients were force fed and caregivers did not feel guilt for using force or accepting suffering, since they felt obliged to preserve life and thus their actions were right. They did feel ugly and upset about the situation. While most caregivers felt that force feeding was the only acceptable route in an institution, some suggested family home care where discretionary case by case ethics was seen as a viable alternative. This paper compares the Israeli interview results with those of the Swedish studies.

Attitude of Health Personnel