For years, the Jehovah's Witnesses' fiercely held belief that blood transfusions are contrary to God's will led to emotional and very public disputes, hospitals clashing with parents over whether to infuse sick children.
That long history of messy legal confrontations appears to be vanishing, however, amid changing approaches to the issue on both sides, health-care officials say.
The church's ban on accepting blood still stands, but some major pediatric hospitals have begun officially acknowledging the parents' unorthodox beliefs, while many Jehovah's Witnesses are signing letters recognizing that doctors may sometimes feel obliged to transfuse, they say.
As institutions show more respect toward parents' faith and try harder not to use blood, Witnesses often seem eager to avoid involving child-welfare authorities to facilitate transfusions, and more accepting that Canadian case law is firmly on the doctors' side, some hospital officials say.
"They get it that we're going to transfuse where it's medically necessary. They've lost that battle; they understand that," said Andrea Frolic, a bioethicist at McMaster Children's Hospital in Hamilton, Ont. "But it's kind of an affront to their community to involve child-welfare services where there aren't concerns about neglect, there aren't concerns about abuse. … Part of the thing was ‘Just go on and do it. Why do we need to involve CAS [Children's Aid Services]? It makes us feel like bad parents.' "
Ms. Frolic made a presentation on her hospital's two-year-old policy to the Canadian Society of Bioethics conference earlier this year and said several other children's hospitals are following similar approaches.
They include Sick Kids in Toronto and Montreal Children's Hospital.
To Calgary's Lawrence Hughes, an ex-Jehovah's Witness who fought a long court battle against the blood policy, the apparent changes are a sign that the Witnesses are fed up with the legal tussles, which he believes were unpopular with members and a strain on resources.
Mr. Hughes broke with the Witnesses, and the rest of his own family, when it tried to prevent his teenage daughter, Bethany, who died in 2002, from receiving a blood transfusion while being treated for cancer.
The turning point seemed to come in 2007, he argued. A Vancouver hospital had child-welfare officials seize some of the sextuplets born to a Jehovah's Witness couple that year so doctors could give them blood. The church's governing Watchtower Bible and Tract Society fought the move in a losing — and highly publicized — court battle.
"I think that did them in. They couldn't take it any more," said Mr. Hughes. "I've been contacted by people who used to be in my congregation, and they left because of this [blood ban]."
Mark Ruge, a spokesman for the Watchtower Society in Georgetown, Ont., said the church, which has branches throughout the world, has not altered its blood ban, though he said he could not account for the actions of individual families.
David Gnam, one of the Witnesses' lawyers who has handled many of the transfusion cases, also said there has been no official change in policy, though he is aware that some hospitals have patients sign forms.
"I've been involved in cases representing Jehovah's Witnesses patients and occasionally it's been in everybody's best interests to come to some sort of agreement between the parties," he said. "But that's just individual hospitals, doctors and patients."
Still, evidence suggests that the number of cases that end up before a judge has dropped significantly. The Canlii website, which catalogues many Canadian court decisions, includes nine separate child blood-transfusion rulings from 2000 to 2007, but just three in the five years since then.
The Witnesses' conviction that agreeing to transfusions of whole blood can lead to damnation, officially adopted in 1945, stems from various Bible verses that call on followers to "abstain from" blood.
Disputes arise when parents refuse transfusions on behalf of children below the age of consent. Hospitals in the past typically approached child-welfare authorities, who asked the courts for an order giving them temporary custody so they can ensure the transfusion is administered.
Toronto's Sick Kids now will go to "all lengths" to find alternatives to transfusing blood when Jehovah's Witnesses voice their opposition, said Rebecca Bruni, a bioethicist at the hospital. It also asks parents to sign a letter of understanding — drafted with the help of one of the church's hospital liaison committees — that says the institution recognizes their religious objections and will try to avoid transfusions if at all possible. The letter is not a consent form, but adds that where the child is at imminent risk of serious harm or death, medical staff will press ahead with the transfusion.
"What is beautiful about this is that it's a symbolic way of embodying respect and dignity and when we do this, we don't need to call Children's Aid, which can be messy and ugly."
McMaster Children's Hospital has a similar letter of understanding, recognizing that providing a blood transfusion can be traumatic when "it has potentially eternal consequences," said Ms. Frolic.
McGill Children's Hospital in Montreal has had such a protocol for about a decade, and found that it brought about a "real, significant drop" in conflicts, said Lori Seller, a clinical ethicist at the facility.
All the ethicists stress, as well, that some Jehovah's Witnesses do not agree with the blood ban, but are anxious that their green light to transfusion be kept confidential.
"Some families are really more concerned about other Jehovah's Witnesses finding out they consented to the blood transfusion," said Ms. Seller.