The Ethics of Bloodless Medicine

Amanda Schaffer in The New Yorker:

Pennsylvania Hospital, in downtown Philadelphia, was Colonial America’s first hospital, founded in 1751 by Benjamin Franklin and the physician Thomas Bond. For much of its history, the hospital’s staff treated conditions from pneumonia to gangrene and headaches with aggressive bloodletting, a practice that may have originated in ancient Egypt, and that persisted for millennia, despite the scarcity of evidence that it cured patients of disease. Benjamin Rush, who was a co-signer of the Declaration of Independence and practiced at Penn Hospital in the late eighteenth and early nineteenth centuries, was known by colleagues as the Prince of Bleeders. His enthusiasm arose from the belief that “all disease arose from excitation of blood vessels, which copious bleeding would relieve,” according to the author Douglas Starr. “If the patient fainted, so much the better, for it meant that the harsh measures were taking effect.” During the yellow-fever outbreak of 1793 in Philadelphia, Rush reportedly treated more than a hundred patients a day with bloodletting; years later, the provost of the University of Pennsylvania recalled that “his house was filled with the poor whose blood, from want of a sufficient number of bowls, was often allowed to flow upon the ground.”

Widespread blood transfusion, by contrast, is less than a century old. Yet it, too, was popularly adopted without rigorous testing of when, exactly, it benefitted patients. Just as early practitioners accepted the virtues of draining blood away, most mid-twentieth-century doctors took it on faith that infusing more was better. On a warm Saturday in April, however, more than a hundred Jehovah’s Witnesses gathered in the auditorium at Penn Hospital to learn about a program in bloodless medicine, in which patients choose to forego transfusion under all circumstances, and instead receive, in the course of their care, a range of treatments designed to build up their own red-blood-cell counts and painstakingly conserve as much of their blood as possible. Jehovah’s Witnesses object to transfusion because they believe that scriptural passages forbid it. But the attendant reasoning—that an individual’s singular qualities, life and soul, are carried in blood—does not fall so far outside of the mainstream imagination. When we get hurt as kids, the first thing we notice is whether it’s bleeding. Blood rushing down an arm or a leg is a badge of honor. But blood also gives us away, revealing embarrassment when it rushes to the face, or lust when it rushes elsewhere. If we are sick or pregnant or dying, the proof is in our blood, more often than in our sweat or tears or spit. If we don’t know what’s wrong with us, we expect our blood to provide an answer. Blood symbolizes murder, birth, passion, danger, and conquest, as when hunters drink from a slain animal. Martian blood is never red like ours. Vampires can’t survive without sucking the lifeblood from people. In movies, when a drop of blood trickles from a wounded hero’s nose we know he is about to keel over. Blood is how we learn what our bodies can and cannot take. Patricia Ford has led the bloodless-medicine program at Penn since 1998.

More here.