How I Treat Pediatric Hematology-Oncology Patients from Families Identifying as Jehovah's Witnesses

Caring for pediatric hematology-oncology patients from families identifying as Jehovah's Witnesses presents opportunities to align clinical and ethical care considerations, particularly regarding blood transfusion refusal. Although transfusion avoidance is often presumed, patient and family preferences are heterogeneous and influenced by individual conscience, cultural context, and interpretation religious guidance. This article explores practical approaches to transfusion‑averse care through three illustrative cases. The first involves an adolescent with relapsed Hodgkin lymphoma considering autologous hematopoietic cell transplantation, highlighting tensions between emerging autonomy, deeply held beliefs, and standard‑of‑care oncology practices. The second examines an infant with severe aplastic anemia, illustrating intrafamilial disagreement, the role of surrogacy and delegation of consent, and circumstances justifying legal intervention to protect a child's best interests. The third case involves chronic transfusions and underscores the longitudinal nature of decision-making. We review the doctrinal framework underlying the cases, emphasize the importance of assessing the depth and personal ownership of beliefs, and outline evidence‑based strategies to reduce transfusion exposure, including anemia mitigation, bleeding prophylaxis, and blood conservation techniques. The article also addresses ethical thresholds, use of preemptive court orders, and communication practices that preserve trust and minimize moral distress. Thoughtful, proactive, and individualized care (grounded in ethical humility, data‑driven assessment, and interdisciplinary collaboration) can honor religious beliefs while maintaining safe, patient‑centered outcomes.