Article
Care
Creed
Easter
Trauma
1 min read

Understanding the power of blood

From hospitals to hymn books, it's significant for a reason.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A bag of blood connected to a drip.
Give blood.
Aman Chaturvedi on Unsplash.

With one billion molecules of oxygen packed into each of your 30 trillion red blood cells, blood is sometimes known as the red river of life. Countless lives have been saved through blood transfusion, but why, throughout history, across continents and cultures, has there been a special interest in the blood of one man crucified 2,000 years ago, believing it alone to have “wonder-working power”?  

Whether you are a newborn baby with half a pint of blood, or an adult with nearer nine pints, “what is certain is that you are suffused with the stuff”, writes author Bill Bryson in his book, The Body.  

Once thought to ebb and flow in waves like the sea, from the liver to other organs, having been heated in the heart, blood in fact flows in a network of vessels measuring some 60,000 miles, with the heart acting as pump, not heater. Cleverly conserved through a complex system of blood-clotting in the case of injury, blood is a precious resource that needs replacing if lost in large amounts. Victims of road traffic accidents can require up to fifty units of blood; significant amounts are needed for organ transplantation, severe burns or heart surgery. 

The first human blood transfusion in Britain, using blood from a lamb, was performed by Dr Richard Lower in 1667, given not to replace blood loss but to change character: could the old be made young, the shy be made sociable through blood transfusion? Apparently not.  

Safe transfusion awaited the discovery of blood types by Dr Karl Landsteiner in the early 20th century. Today, NHS Blood and Transplant deliver 1.4 million units of red cells to 260 hospitals each year for transfusion; about 85 million units are transfused worldwide, given to replace blood loss after accident, surgery, ulcer, ectopic pregnancy or for anaemia in cancer. Also used to boost blood cell numbers in malaria, sepsis, HIV, leukaemia and sickle cell anaemia, blood transfusion is now amazingly safe. Fatal reactions are extremely rare, “occurring only in one out of nearly two million transfusions”, writes physician Dr Seth Lotterman. “For comparison, the lifetime odds of dying from a lightning strike are about 1 in 161,000,” he adds. The risk of HIV infection has dropped dramatically, to less than one in seven million. 

History tells though of the danger of transmitting disease from the blood donor during transfusion. The World Health Organization recognises risk of infection with HIV, hepatitis, syphilis, malaria, and Chagas disease. The Contaminated Blood Scandal saw an estimated 30,000 people in the UK given blood transfusions and blood products infected with hepatitis C, hepatitis B and HIV. More than 3,000 people died as a result, and thousands more live with on-going health complications. For my final Christmas article for Readers Digest, I wrote on Stephen Christmas, a tireless campaigner for blood safety who lived with haemophilia and died in 1993, having contracted HIV through contaminated blood. 

I was a blood donor. However, I am now unable to donate blood or organs for the rest of my life since there is a possibility that my blood is ‘stained’, possibly with prion disease, after adopting embryos. The Blood Transfusion Service will not accept donations from women who have had various fertility treatments. 

And there’s another uncomfortable truth about blood donation – the NHS does not have enough blood, organs, tissues, platelets, plasma or stem cells to treat everyone who needs it. As a nurse, I remember caring for a man dying of liver cancer. Suffering from sudden, massive melaena (blood loss in black, tarry stools as a result of internal bleeding), he received emergency blood transfusion, with bag after bag of blood being infused, until the consultant called for the treatment to stop, because the bleed was too big – and blood supplies too scarce.  

Struggling to accept the stark reality of stained blood and dangerous shortages, I kept coming back to an old Sunday School song about blood, where absolute abundance and ultimate cleansing are instead promised. 

There is a fountain filled with blood 
   Drawn from Immanuel’s veins; 
And sinners, plunged beneath that flood, 
   Lose all their guilty stains. 

Gruesome and graphic in its imagery, but full of deeper meaning. And as a nurse, I’m accustomed to blood, sometimes lots of it. I’ve seen that man bleed out on the ward that night; I’ve attended a road accident, where a boy lost his leg – but not his life, because towels stemmed the massive flow of blood. I’ve raced a patient to the operating theatre after her aortic aneurysm burst within; I’ve stemmed arterial bleeding from the groin by applying prolonged pressure to the site punctured by a catheter during cardiac stenting. According to the World Health Organization, severe bleeding after childbirth is the leading cause of maternal mortality world-wide. Each year, about 14 million women experience postpartum haemorrhage resulting in about 70,000 maternal deaths globally.  

In the Bible, and in hymns of praise like this one, there is also no getting away from blood. “Like it or not, the Bible is a bloody book,” writes  Kyle Winkler. It runs through the book like a crimson thread. There’s a story of a woman bleeding for twelve years, until she touched the hem of Jesus’ garment and was healed.    

Elsewhere the Bible keeps returning to the idea of blood, shed in sacrifice, used to cleanse, save, and heal in a spiritual sense. In the Old Testament, animal blood was painted on doorposts at Passover as a sign of protection from judgment, and sprinkled ritually on the altar as a sacrifice for human sin, restoring relationship with God.  

On Good Friday, Jesus himself shed (and sweat) his blood, sacrificing his life on the cross to “wash our souls” once and for all. Millions of Christians across the world take a sip of communion wine each Sunday in commemoration of this act. It’s a beautiful gift, coming with a promise that the shed blood will “preserve thy body and soul unto everlasting life”, through the forgiveness of sins. It’s no wonder then that churches love to sing about this blood. “Would you be free from the burden of sin? There's pow'r in the blood, pow'r in the blood,” goes one hymn, while another simply says, “Your blood has washed away my sin, Jesus, thank you”.  

“God’s intention for blood isn’t gory—it’s beautiful! And I’m certainly not offended or scared by it,” writes Kyle. “Rather than question how little blood I can get by with, I’d rather stand under the cross to be covered in all that I can get!” Thank God for the fountain of forgiveness that flows from Good Friday. 

  

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Article
Assisted dying
Care
Comment
Death & life
Suffering
5 min read

Why end of life agony is not a good reason to allow death on demand

Assisted dying and the unintended consequences of compassion.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A open hand hold a pill.
Towfiqu Barbhuiya on Unsplash.

Those advocating Assisted Dying really have only one strong argument on their side – the argument from compassion. People who have seen relatives dying in extreme pain and discomfort understandably want to avoid that scenario. Surely the best way is to allow assisted dying as an early way out for such people to avoid the agony that such a death involves?  

Now it’s a powerful argument. To be honest I can’t say what I would feel if I faced such a death, or if I had to watch a loved one go through such an ordeal. All the same, there are good reasons to hold back from legalising assisted dying even in the face of distress at the prospect of enduring or having to watch a painful and agonising death.  

In any legislation, you have to bear in mind unintended consequences. A law may benefit one particular group, but have knock-on effects for another group, or wider social implications that are profoundly harmful. Few laws benefit everyone, so lawmakers have to make difficult decisions balancing the rights and benefits of different groups of people. 

It feels odd to be citing percentages and numbers faced with something so elemental and personal and death and suffering, but it is estimated that around two per cent of us will die in extreme pain and discomfort. Add in the 'safeguards' this bill proposes (a person must be suffering from a terminal disease with fewer than six months to live, capable of making such a decision, with two doctors and a judge to approve it) and the number of people this directly affects becomes really quite small. Much as we all sympathise and feel the force of stories of agonising suffering - and of course, every individual matters - to put it bluntly, is it right to entertain the knock-on effects on other groups in society and to make such a fundamental shift in our moral landscape, for the sake of the small number of us who will face this dreadful prospect? Reading the personal stories of those who have endured extreme pain as they approached death, or those who have to watch over ones do so is heart-rending - yet are they enough on their own to sanction a change to the law? 

Much has been made of the subtle pressure put upon elderly or disabled people to end it all, to stop being a burden on others. I have argued elsewhere on Seen and Unseen that that numerous elderly people will feel a moral obligation to safeguard the family inheritance by choosing an early death rather than spend the family fortune on end of life care, or turning their kids into carers for their elderly parents. Individual choice for those who face end of life pain unintentionally  lands an unenviable and unfair choice on many more vulnerable people in our society. Giles Fraser describes the indirect pressure well: 

“You can say “think of the children” with the tiniest inflection of the voice, make the subtlest of reference to money worries. We communicate with each other, often most powerfully, through almost imperceptible gestures of body language and facial expression. No legal safeguard on earth can detect such subliminal messaging.” 

There is also plenty of testimony that suggests that even with constant pain, life is still worth living. Michelle Anna-Moffatt writes movingly  of her brush with assisted suicide and why she pulled back from it, despite living life in constant pain.  

Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder. 

Despite the safeguards mentioned above, the move towards death on the NHS is bound to lead to a slippery slope – extending the right to die to wider groups with lesser obvious needs. As I wrote in The Times recently, given the grounds on which the case for change is being made – the priority of individual choice – there are no logical grounds for denying the right to die of anyone who chooses that option, regardless of their reasons. If a teenager going through a bout of depression, or a homeless person who cannot see a way out of their situation chooses to end it all, and their choice is absolute, on what grounds could we stop them? Once we have based our ethics on this territory, the slippery slope is not just likely, it is inevitable.  

Then there is the radical shift to our moral landscape. A disabled campaigner argues that asking for someone to help her to die “is no different for me than asking my caregiver to help me on the toilet, or to give me a shower, or a drink, or to help me to eat.” Sorry - but it is different, and we know it. Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder.  

In Canada, many doctors refuse, or don’t have time to administer the fatal dose so companies have sprung up, offering ‘medical professionals’ to come round with the syringe to finish you off. In other words, companies make money out of killing people. It is the commodification of death. When we have got to that point, you know we have wandered from the path somewhere.  

You would have to be stony-hearted indeed not to feel the force of the argument to avoid pain-filled deaths. Yet is a change to benefit such people worth the radical shift of moral value, the knock-on effects on vulnerable people who will come under pressure to die before their time, the move towards death on demand?  

Surely there are better ways to approach this? Doctors can decide to cease treatment to enable a natural death to take its course, or increase painkillers that will may hasten death - that is humane and falls on the right side of the line of treatment as it is done primarily to relieve pain, not to kill. Christian faith does not argue that life is to be preserved at any cost – our belief in martyrdom gives the lie to that. More importantly, a renewed effort to invest in palliative care and improved anaesthetics will surely reduce such deaths in the longer term. These approaches are surely much wiser and less impactful on the large numbers of vulnerable people in our society than the drastic step of legalising killing on the NHS.