Hospital visits by Jehovah's Witness elders, aimed at defending the right of members to refuse blood transfusions, are under scrutiny following the death of a 27-year-old Quebec woman earlier this month.
The family of Éloïse Dupuis, who died of a hemorrhage on Oct. 12, have complained that a Witness liaison committee who visited her in hospital influenced her decision not to have a blood transfusion.
One former Witness described the hospital liaison committees as "intimidating."
But their use is defended by the Canadian branch of the Jehovah's Witnesses, which says the committees are available at the patient's request to assist them and advocate for bloodless medical procedures.
"They are not surrogate decision makers for patients," the group's Canadian head office said in a statement.
"The assistance of HLCs is generally well received in the medical community and recognized as contributing to advances in bloodless medicine and surgery," the statement reads.
Coroner's probe into death
A Quebec coroner has opened an investigation into the death of Dupuis, a Jehovah's Witness who died of a hemorrhage on Oct. 12 at Hôtel-Dieu de Lévis Hospital near Quebec City after giving birth by caesarean section six days earlier.
The coroner will determine whether Dupuis's refusal to have a blood transfusion met the legal and medical standards of free and informed consent.
After her death, Dupuis's aunt, Manon Boyer, filed a complaint with police in Lévis, Que., alleging her niece was pressured into refusing consent by a Witness hospital liaison committee.
The committees are composed of trusted and respected elders who are dispatched to a hospital when a member is facing a blood transfusion decision, said former Witness Mark O'Donnell, who spent 46 years with the faith group before leaving in 2013.
Blood transfusions are forbidden under Jehovah's Witness doctrine, which holds that the Old and New Testaments command them to abstain from blood.
The elders provide information to families and attending medical staff on alternative treatments that don't require blood.
They also support Jehovah's Witness families "if the doctors begin pressuring patients or their legal representative to accept a blood transfusion," O'Donnell told CBC Montreal.
Blood transfusion recipients 'shunned'
While officially mandated not to interfere in a patient's decision on blood transfusions, O'Donnell said HLC elders are nonetheless committed to doing what they can to ensure blood doctrine is respected.
"The underlying Jehovah's Witness dogma [on blood] is the reason they are there," he said. "[The HLC] would do whatever they can to uphold what they perceive to be the will of the patient regarding a blood transfusion."
Accepting a blood transfusion is considered a "disassociation offence," O'Donnell said, and the presence of these elders is a reminder of that fact.
"Their mere presence is somewhat of an intimidation," he said.
Disassociation means a member would be considered as having broken with the faith group and result in their being "shunned" by the community, O'Donnell said.
"The fear is that Jehovah hates a person disloyal to him, and a way of being disloyal is to accept blood, which is sacred to God," he said.
According to O'Donnell, that leaves adherents facing a blood transfusion decision with a stark choice.
"You will either lose your life in God's eyes, or potentially die," he said.
Jehovah's Witness adherents have that fear instilled in them from an early age, he said.
"It's an inbred fear, and it lasted through my childhood and into my adult years."
Evidence of informed refusal, Quebec health minister says
Simon Picard, a Jehovah's Witnesses spokesman, told CBC Montreal the organization was confident the coroner's inquest will find that all medical and legal standards for free and informed consent were met.
"We're letting the inquiry take its course," he said.
Quebec's Health Minister Gaétan Barrette said evidence he's seen suggests Dupuis was "perfectly informed" and that the refusal to accept blood was her own.
"She was informed, she signed documents many times," Barrette told CBC Montreal's Daybreak earlier this week.
"She knew, and she made it clear, that if something was to happen, because of her religion she didn't want any transfusion."