Six Vancouver Babies Spark Controversy over Blood
We've not seen their faces. We don't know their names, neither the two infants who died, nor their four siblings who remain in intensive care in Vancouver at B.C. Women's and Children's Hospital; each so small they could sleep in the palm of a hand, so frail they teeter on the abyss. Their parents, too, are a mystery - save for one salient fact: they are JEHOVAH'S WITNESSES. This alone defines them. It is enough to pillory them in the court of public opinion.
Their ages, their occupations, the address of their home in the Fraser Valley are beyond public reach. Did they prepare a home nursery for these sextuplets, the first to be born alive in Canada? Do they have other children? Has the family had a moment these last crazy weeks for a funeral for their two dead children? They're "overwhelmed," the hospital said of the parents after the births. Who can blame them? Everyone, it seems.
This nameless, faceless family has inspired a spiritual, ethical, and legal debate of an intensity rarely seen in British Columbia, among the most secular of provinces in an increasingly secular nation. Last week, the machinery of the provincial government moved, without benefit of a court hearing, to apprehend two infant sons and a daughter long enough to give them blood transfusions - possibly saving their lives; certainly violating God's prohibition on the use of blood, as defined by their church.
The father, in a court affidavit, accused the province of "violating" his children. The very idea was so painful the parents fled the hospital, he said. "We took our immense sadness and grief and tried to console each other in private." Premier Gordon Campbell said the government has an obligation to apprehend the babies to protect their lives. "We act, I think, with the children's best interests in mind," he said. "We will continue to do that."
Shane Brady, an Ontario lawyer acting for the family on behalf of the church, says the issue has little to do with religion and nothing to do "with a right to let their children die." The courts have struck a difficult balance. The Supreme Court of Canada ruled in 1995, in a similar case of a government-ordered transfusion for a premature Witness infant at Toronto's Hospital for Sick Children, that religious freedom does not include the right to deny life-saving medical treatment to a child. The court also said, however, that before parents are deprived of their fundamental rights, they must have "reasonable notice" of a hearing before a judge, "where conflicting evidence may be presented."
Brady said the B.C. government seems swayed by the knee-jerk public response to the plight of the sextuplets. He cited a poll last week by Ipsos Reid showing 86 per cent of British Columbians supported the government's actions. The family is deemed unworthy because they are Jehovah's Witnesses, he says. "Well, we don't profile people," he says. "We look at facts and make a reasoned decision. The government didn't give my clients an opportunity to do that, period." The case returns to court Feb. 23. The family wants an apology for the lack of a hearing, and a prohibition against future seizures. The battle lines are drawn. God, it would appear, is on everyone's side.
THE HOSPITAL: The babies - four boys, two girls - were born Jan. 5 and 6, some 15 weeks premature and averaging just 726 grams (1.6 lb.) each. The mother had spent the previous two weeks in hospital but the medical drama began for the family virtually from the time she learned she was pregnant, six times over. It's likely the multiple births are the result of a fertility treatment known as "superovulation." Such treatments, not addressed in church doctrine, are a matter of "personal choice," says Mark Ruge, director of information for the Watch Tower Bible Society, the national headquarters in Georgetown, Ont., for Canada's Witnesses.
The parents learned from the start the odds were against the delivery of six healthy babies. Half of babies born at 24 or 25 weeks will die in hospital, and many of the survivors will have severe lifelong handicaps, they were told. Doctors said the mother could abort some of the fetuses at 12 weeks to give the remainder a better chance at life and health, a process called "selective reduction." She was offered the option again at 18 weeks. Later, she was given the chance not to have the babies resuscitated at birth. Each time she refused. "As Jehovah's Witnesses," said the father, "we believe that to have aborted any of our sextuplets would be a profound disregard for life and violation of God's law."
The church would have been involved from the earliest stages of pregnancy. Virtually every region of the country has a "hospital liaison committee" of church elders and members. In addition to checking hospitals two or three times a week for any Jehovah's Witness patients, they conduct visitations and apprise medical staff of acceptable therapies and bloodless alternatives. Critics say they also run interference against inappropriate treatment sought by church members or ordered by doctors. Witness doctrine is also driven home by a SWAT team of lawyers, capable of arriving with remarkable speed and litigious ferocity. The Vancouver hospital itself has a bioethics committee of health professionals, ethicists and lawyers, as well as parental and spiritual representatives. The need for transfusions, standard treatment for most premature babies, was certainly on the agenda.
The babies, from birth, have been treated in the hospital's neonatal intensive care unit, and protected by privacy laws and by a faith known for its secrecy. Even the deaths of two of the babies (apparently of complications not related to the need for transfusions) weren't confirmed until they were revealed in court documents last week. What happened to the family these past weeks and months was either the act of a loving church or a coercive cult. Like so much in this case, it's a question of faith, a matter of interpretation.
SARAH'S STORY: Sarah Bahris of Vernon, B.C., is a bright, articulate Grade 11 student, alive with the possibilities life has to offer. She's following the sextuplets case in Vancouver; it raises disturbing memories. Just over two years ago, at age 14, she was diagnosed with a rare form of bone cancer - a huge test for a young girl born into the Jehovah's Witness faith.
"I was scared of death," she says. "Who wouldn't be?" As her condition worsened and chemotherapy took its toll, doctors in the same hospital where the sextuplets are being treated pressed her to accept a blood transfusion. She refused, insisting to this day it was her own decision; not that of her parents, her church, or the many Witnesses who visited to offer support. "God gave us free will so we can choose what we want to do with our lives," she says, "and if we want to serve Him or not."
The province stepped in, winning a court order to force a transfusion if doctors deemed it necessary. She left for Ontario. She fled, abetted by the church, lawyers for B.C. said. Bahris says she went "for a second opinion." B.C. lawyers took the fight to Ontario courts. Brady, retained by the church to act on Sarah's behalf, filed an appeal. "The government had the same tactic in Sarah's case as they are doing here," Brady says of the sextuplets. "Hit and run." In a 2006 case similar to Bahris's, Brady waged an unsuccessful fight in the Manitoba courts to stop the forced transfusion of a 15-year-old girl who was bleeding internally from Crohn's disease. Brady had argued that as a "mature minor" she should have a say in her treatment. This week the provincial appeal court upheld the Manitoba government's right to force a transfusion.
In Bahris's case, the B.C. government negotiated a settlement allowing Bahris to be admitted to the Schneider Children's Hospital in New York, which specializes in so-called "bloodless" treatment. Her red cell count plummeted during chemotherapy but not to a point the doctor deemed dangerous. He prescribed rest instead of a transfusion. "Just don't do any cartwheels," he advised. "My goal was to get the best medical treatment, and to live," she says. "It happened to work out, which you can't always guarantee." Alternative treatments are out there, she says, "it just takes a little more effort."
Bahris says the court challenges added to her stress and shattered her trust in her B.C. doctors. "It's important to stay positive through everything no matter what medical issue you're dealing with, and it's really, really hard to do that when you have people around you trying to give you things that you don't want."
Bahris says she doesn't know the parents of the sextuplets but she can understand their pain. Obviously the babies can't make an informed choice, she says. "They are the parents' kids, they do have the right to make that decision for them." It's clear the parents wanted children, she says. "Why would they want to kill them?"
It has been a year and a half since her final treatment. She's just back from her regular three-month checkup. "I'm doing great," she says. She's thinking of a future as a dental hygienist. Or in nursing. Or law, she adds with a chuckle. "Law could be good."
LAWRENCE'S STORY: Lawrence Hughes, a 55-year-old Calgary architectural technician, dates his loss of faith as a Witness almost to the day his 16-year-old daughter Bethany was diagnosed with acute myeloid leukemia. It was late afternoon, Feb. 13, 2002. "We were told then by the local hospital liaison of Jehovah's Witness that the Watch Tower Society had already dispatched lawyers, they're on their way to Calgary to represent us. Shane Brady was one of them." He imagines the pressure on the B.C. parents. "They're in a dilemma," he says quietly. He remembers Witnesses standing guard in shifts in his daughter's hospital room, choking the corridor, pressing religious tracts on the family. Hughes says Watch Tower representatives promised Bethany her resistance would be celebrated in the church publication Awake! That magazine, in the mid-1990s, fed a thirst for martyrdom with a cover showing the smiling photos of 26 "Youths Who Put God first," by dying after refusing treatment.
The stakes - this family will know, as Hughes knows - are enormous. "They believe if they [allow] blood transfusions Jehovah God is going to destroy them at Armageddon," he says. The more immediate repercussions of being "disfellowshipped" are no less terrifying. Should they disobey their church they face the prospect of caring for those fragile infants without support. "They would lose their family, all their friends and their faith because they'd be kicked out," says Hughes. "I mean, what's left?"
It was Hughes, as Bethany's condition worsened, who broke with his wife, Arliss, and the wishes of his daughter, and precipitated a hearing to make her a ward of the province. It paved the way for more than three dozen transfusions. Her health improved for a time. His world fell apart. He was shunned by his church, and estranged from his wife. His own daughter would call him an apostate. Bethany's health deteriorated and the province relinquished custody. She died in September 2002 while receiving alternative treatment, doses of arsenic, sanctioned by the church. Lawrence and Arliss have since divorced.
Calgary lawyer Vaughn Marshall assisted Hughes in some of his legal proceedings. "When people are going through times of incredible stress they often take great comfort in turning to their religion," Marshall says. "In this case, it's that very religion that created the most damage and stress in their lives." Juliet Guichon, a specialist in medical bioethics at the University of Calgary, followed the Hughes case in court. "All the Jehovah's Witnesses were on one side and he sat on the other, absolutely alone," she recalls. "It was heartbreaking. He was weeping and praying. In the cafeteria at lunch he was at the table all by himself."
Hughes had joined the church in his 30s, at a vulnerable point in his life. "The package they sell you is pretty good: live forever on a paradise earth. Who'd refuse that?" He and Arliss had just moved to Calgary, and the church provided an instant family. Hughes pours his hurt and anger into working with the ex-Witnesses dedicated to discrediting the church's theology. "Tens of thousands of people have died because of this blood policy," he says. "Hundreds of thousands will die in the future if nothing is done about it."
BLOOD DOCTRINE: Aside from the occasional high-profile blood transfusion case, the only time most Canadians give any thought to Jehovah's Witnesses is at that un-godly hour in the morning when they come, Bible in hand, knocking at the door. You wouldn't think it would win them many friends. Yet for decades Witnesses were the fastest-growing religious group in North America. Starting with about 50,000 followers in the 1930s, there are now more than 6.5 million Witnesses who actively preach worldwide, with another estimated 10 million "inactive" adherents. In Canada the group has 108,000 baptized members, about one-fifth of them in British Columbia. By some estimates, the U.S. arm of the church brings in roughly US$1 billion a year in revenue. The steep rise in membership has showed signs of levelling off, but Witnesses are still adding faithful while conventional churches wipe the dust from their pews.
Born out of a Bible study group in Pittsburgh in the 1870s, Witnesses lay claim to the one true form of Christianity and equate all other religions and secular society with the devil. The group also believes Jesus returned to earth invisibly in 1914, and that Armageddon is just around the corner. They refuse to salute any flag or go to war, which has at times put them in the crosshairs of both the Canadian and U.S. governments. But it is Witnesses' objection to blood transfusions, first set down in 1945, that wins them the most attention these days.
For Witnesses, the roots of the ban are laid out in five Biblical passages which date back around 2,500 years. For instance, Acts 15: 22-29 states, "You are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from sexual immorality." Boiled down, the verses amount to a few dozen words. But thousands have died abiding them. "The creator knows more about blood than anybody else," says Ruge, "because he made the stuff." Those who choose to be transfused with whole blood are, by extension, non-believers who will be destroyed at Armageddon. Those transfused against their will, such as the surviving sextuplets, are free from any church sanction.
Over time, though, the group's opposition to blood has transcended the theological and strived for the scientific. Witnesses gather articles from prestigious medical journals that they say show effective alternatives to transfusions. These are distributed to doctors. Witnesses have hitched their anti-blood policy to the emerging field of "bloodless surgery." By conserving blood during operations and employing new technologies, some hospitals minimize the need for transfusions. Dr. Brian Muirhead, a Winnipeg-based anesthesiologist and chairman of Physicians and Nurses for Blood Conservation, says patients can survive with lower blood counts than previously thought. "The biggest problem right now is the lack of education in medical schools," he says. "Doctors are still practising the way they did 30 or 40 years ago when it comes to blood transfusions." In the last decade, he says, he's conducted elective surgery on about 100 Witness patients and never lost one due to a lack of blood. It requires a lot of preparation, a luxury emergency-room patients can't afford.
"The average Jehovah's Witness knows 50 times more about blood and alternative treatments than the average Canadian," says Ruge. Indeed, largely as a result of Witnesses' persistence, bloodless surgery centres have sprung up across the United States. A blood products alternative program opened at the Winnipeg Health Sciences Centre, but it was more a response to past blood contamination scandals than religious appeasement. Bloodless techniques are gaining some recognition in Canadian law. A ruling in 2004 in the Court of Queen's Bench of Alberta revoked, after the fact, an apprehension and treatment order issued to transfuse a premature Jehovah's Witness infant, on the grounds that the parents were denied a fair hearing. The ruling by Madame Justice Adele Kent also came with a warning for government and the courts to shed their "paternalistic attitude." While a doctor's recommendations must always be a significant consideration, authorities, she wrote, "must be careful not to presume that the doctor has always recommended the only acceptable treatment, and that Jehovah's Witness parents are always wrong in denying their consent for treatment by way of blood products."
When it comes to premature infants though, the so-called "bloodless" options grow far more limited. Preemies often begin life with low hemoglobin levels, made worse by the battery of blood tests they must endure. Some specialist hospitals, to minimize the need for infant transfusions, accept lower hemoglobin levels and take smaller samples. The solutions are not a catch-all. And in extraordinary cases, such as premature sextuplets, hospital officials may simply decide the risks are just too high.
BLOOD FEUD: Biblical scholars like Michael Duggan, a professor at St. Mary's University College in Calgary, scratch their heads over how Witnesses interpret scriptures to back up their blood ban. "There's just nothing in Biblical literature that has anything to do with human blood," says Duggan, who studies the texts in their classical Hebrew. He says the verses act as a dietary guide, calling on followers to only eat meat that has been drained of blood. Nothing more. Adds Stephen Kent, a sociology professor at the University of Alberta who studies alternative religions, "Applying texts that were written millennia ago to conventional circumstances is dicey."
Theologians could endlessly debate Biblical interpretation. Witnesses are on far shakier ground with their ever-changing policies on medical treatments. There's no central repository of the group's rules. Instead, decisions are issued piecemeal through its Watchtower and Awake! publications. A host of medical procedures that are standard today were at one time banned, such as vaccinations, treatments for hemophiliacs and banking your own blood. Even organ transplants are allowed, where once they were deemed cannibalism.
The Witnesses' blood policy is in a fluid state. The group now allows its members to use substances derived from blood, or "blood fractions," such as albumin and immune globulins. The group has also started to allow blood to be taken out of a patient's body prior to operation, so that it can be used later, a common technique in "bloodless" surgery, a term critics say is more effective in easing Witnesses' consciences than in describing the reality of the procedures. Ruge admits there have been "refinements. [Fractions] are up to the individuals to decide for themselves," he says. "The Bible doesn't comment on fractions." Of course, as Ruge himself points out, the Bible doesn't comment on blood transfusions either.
As more and more procedures are left up to Witnesses' "individual conscience," it threatens to create a schism in the organization. One group, the Associated Jehovah's Witnesses for Reform of Blood, claims 10 per cent of the total number of members oppose the blood policies. Other Witnesses are pushing for the courts in the U.S. to get involved. In 2005 Kerry Louderback-Wood, a lawyer in Florida, penned a lengthy report titled "Jehovah's Witnesses, Blood Transfusions, and the Tort of Misrepresentation," for the Journal of Church and State. She accuses the governing Watch Tower society of misleading members with its blood policy by twisting the research of historians, scientists and doctors. More importantly, she argues the Society's ever-changing blood policy leaves it open to lawsuits from followers who were misled and suffered as a result.
The plight of the sextuplets is just the latest outrage to inflame debate among ex-adherents on several Internet sites. One poster, using the pseudonym Lady Lee, describes her mother's participation in a Witness "underground," which flourished in Vancouver in the 1970s. Her mother, a nurse, as well as a Witness doctor delivered babies outside of hospitals when a blood issue was likely to arise. "I recall one baby, a boy, died and that's the last time I remember my mother doing one of those deliveries," she writes. "They even had an incubator with lights and all sorts of medical equipment that they stored/hid at our home. I wonder how many other secrets are withheld within the organization in the name of theocratic warfare."
THE LEGACY: When the parents of the sextuplets return to court in B.C. later this month, their lawyer is determined to steer the case away from issues of religious freedom, which has already proven to be a losing argument when a child's life hangs in the balance. "Take religion out of it," says Brady, who says the real issue is the denial of a constitutional right to a fair hearing. "We give it to criminals, they're innocent until proven guilty," he says. "It's even more so when there's parents and there's a medical debate, and obviously that's the case here. There's a medical debate among experts."
When the parents did get a hearing earlier this month, after the transfusions, the government immediately announced it was withdrawing its custody of the children. Brady says that's indicative of the government's weak case. However, Greg Brown, a lawyer for the British Columbia minister of children and family development, told the Provincial Court hearing that custody was surrendered "because the medical treatment has been provided." Letters from both parties outlining the medical cases for transfusions or alternative treatment were submitted to the court but haven't been made public.
What has yet to be fully canvassed are the reasons why the B.C. government refused to follow Supreme Court directives to give the parents a hearing before treatment. For at least two of the infants, the government has said the transfusions were urgently needed at times when courts weren't sitting. Brady denies there was an overriding medical emergency for any of the three who were transfused. What isn't clear is why the government could not have anticipated the eventual possibility of transfusions and started the hearing process in advance.
The case, then, is not as black and white as public opinion would indicate. Nor is the right to a fair hearing an issue limited to religious zealots. While Witnesses set themselves apart from the mainstream, it's a little recognized fact that the church has profoundly influenced the rights and lives of all Canadians and Americans. The litigious nature of the church has resulted in a series of landmark rulings over the past 60 years in Canada and some 43 victories in the U.S. Supreme Court. Many of the early Canadian cases sprang from attempts by Maurice Duplessis, the iron-fisted premier of a predominantly Catholic Quebec, to crush the rights of Witnesses to proselytize, criticize and distribute their literature. Witnesses had a vocal defender in Prairie populist John Diefenbaker. He included Witness victories defining the right to freedom of speech, assembly and religious expression in his Bill of Rights, the foundation of the current Charter of Rights and Freedoms.
Witnesses fought these cases for their own benefit, many as unpopular in their day as the furor over the plight of six frail babies. Still, says church spokesman Ruge, "If it wasn't for the Supreme Court victories in the States and in Canada, I really wonder what kind of a country we would have, how many rights we would have." Such freedoms have a price. In a Vancouver hospital it is paid in blood, by two grieving parents, and their four surviving infants.
Maclean's February 19, 2007