Refusal of blood transfusions

The refusal of blood transfusions is a religiously grounded practice most prominently associated with Jehovah's Witnesses, who decline transfusions of whole blood and its primary components, red cells, white cells, platelets and plasma, even in situations where physicians judge a transfusion necessary to save life. The refusal rests on their interpretation of biblical passages commanding abstention from blood: the instruction given to Noah, the prohibition in the Law of Israel against eating blood, and the decree of the early Christian council recorded in the Book of Acts that believers should "abstain from blood." Jehovah's Witnesses understand these as a standing command that extends to the taking of blood into the body by transfusion, and regard obedience to it as a matter of the deepest religious conviction, a mark of faithfulness to God that takes precedence over the prolonging of earthly life.

The practice has posed serious and much-debated questions at the intersection of religion, medicine, ethics and law, above all where it concerns the refusal of life-saving treatment, and most acutely where children are involved and parents decline transfusion on their behalf. Courts in many countries have generally upheld the right of competent adults to refuse treatment for themselves on religious grounds, while frequently intervening to authorise transfusion for minors against their parents' wishes, holding the child's life to override the parents' religious objection. The position has also spurred significant developments in medicine: the demand for alternatives has advanced the field of "bloodless" surgery and blood-conservation techniques, and Jehovah's Witnesses maintain liaison structures to work with medical staff. The practice stands as a notable case of a religious conviction that requires its adherents to accept grave risk rather than violate what they hold to be a divine command.

The refusal of blood has been tested most sharply in cases involving children, where the law generally does not allow a parent's religious conviction to override a minor's right to lifesaving treatment. Courts in the United States, Canada, the United Kingdom and elsewhere have repeatedly authorised hospitals to transfuse a Witness child over parental objection where physicians testified the child would otherwise die or suffer serious harm, treating the state's interest in the child's survival as outweighing the parents' religious liberty in that narrow circumstance, while generally respecting an adult Witness's own refusal for themselves even at the cost of life, on the settled principle that a competent adult may decline treatment. The position has had a documented effect on medicine well beyond the group that holds it.

Hospitals under pressure to treat Witness patients without transfusion built bloodless surgery programmes, developing techniques such as intraoperative cell salvage, that keeps the patient's own blood in a closed circuit and returns it to them, and pharmacological methods of reducing surgical blood loss, and these programmes are now offered to any patient who wants to avoid transfusion for medical or personal reasons, a case in which an ethical constraint aimed at a small community drove clinical innovation adopted well outside it. Hospital Liaison Committees, staffed by Witness elders and trained volunteers, work directly with treating physicians to identify acceptable alternatives case by case, which is the practical mechanism by which the position is negotiated with each hospital rather than argued as a blanket rule.