The therapeutic use of blood dates back to antiquity. However, only in the early 20th century did scientists discover various blood types and develop workable transfusion techniques and blood-banking methods. Large-scale use of blood transfusions first took place on the battlefields of World War II, and Americans flocked to blood drives to do their part for wounded troops.

In succeeding decades, scientists continued to hone technologies to test, store and administer blood, learning both from medical successes and failures how to improve outcomes. As understanding of the complex properties of blood advanced, doctors have been able to separate blood into major and minor fractions for targeted use in treating specific conditions. They have worked to produce effective blood screening tests to detect blood-borne illnesses, tracking systems to eliminate human error, and blood-conservation methods to circumvent chronic donor-blood shortages and transfusion-related complications.

Despite the fact that advances in blood technologies have been credited with saving countless lives, the blood industry has also had its share of difficulties and negative press. In the 1980s and 1990s, headlines announced numerous lawsuits brought by victims of tainted-blood scandals and transfusion-matching errors. For instance, by 1985, about 47 percent of Canadian hemophiliacs became infected with HIV from contaminated coagulants. A jittery public read about similar scandals in France, Switzerland and Germany. Such incidents fueled widespread fears about the integrity of the blood supply because of new forms of hepatitis, West Nile virus, Chagas' disease, Lyme disease and Mad Cow disease. Scientists continue to improve screening tests for such diseases and have greatly reduced the risks.

As doctors worked to cope with these medical challenges, they found an unlikely partner in Jehovah's Witnesses. In previous years, headlines often reported about Witnesses and doctors locked in battle over the right to determine treatment. Witnesses sought good medical care, but they flatly refused blood transfusions for themselves and their children on religious grounds, even if critically sick or injured. Doctors, not wishing to be deprived of an important treatment option, sometimes refused to treat or operate on Witnesses. In cases of life-threatening illness or injuries, judges often issued emergency court orders, allowing doctors to override patient objections and transfuse if necessary. Witnesses too went to court, arguing for patient autonomy and the patient's right of informed consent. This tension between medical science and religious conviction created ethical dilemmas for medical professionals and Witness patients alike.

The blood-supply crises of the 1980s and 1990s, however, coincided with a marked easing of tensions between the medical profession and Witness patients. Forced by the HIV epidemic and blood shortages to seek alternatives to transfusions of donated blood, doctors found the Witnesses willing to test new therapies and surgical techniques that would maximize the body's own blood-producing capacity and minimize blood loss during surgery. Doctors to date have successfully performed a wide variety of treatments and surgical procedures without blood, including open-heart surgery and organ transplants. Medical studies have demonstrated the therapeutic benefits of blood-conservation strategies, prompting some doctors and surgeons to recommend the use of less or no blood for all their patients. As of 2006, there are 142 hospitals and over 100,000 doctors in the United States that offer some version of bloodless treatment to all patients regardless of religious beliefs. (See "Blood Conservation Strategies" on page 28)

In pursuing their own rights, Jehovah's Witnesses played a crucial role in securing for all adults the right to choose treatment options and to refuse certain types of medical care. Critical situations still arise in which doctors consider blood an indispensable treatment. Patients' rights allow adult Witnesses to refuse potentially life-saving transfusions. However, legally doctors have the right to administer blood to minor children.

On an organizational level, the Witnesses have worked proactively to build a better working relationship with doctors and hospital administrators by setting up liaison committees that direct Witness patients to hospitals willing to use bloodless technology.

Religion and Medicine

While secular society may feel that religious opinions on health matters overreach personal freedom and autonomy, world religions have historically taken ethical positions on health, dietary and medical issues. Religious views toward new technologies are often cautious at first and then moderate over time. For example, in the early 20th century, numerous religious communities objected to small-pox vaccinations. When doctors began experimenting with human organ transplants in the late 1960s, major religions, including Catholicism, Judaism and Islam, issued warnings against the practice. Some objected because the procedure involved cutting an organ from a living body; others, like the Witnesses, viewed transplantation as a form of cannibalism. Although the practice has now gained acceptance by most religions, certain branches of the Jewish and Muslim faiths continue to disagree over the issue of transplants.

The rapid advance of medical research continues to pose new religious dilemmas over life and death. Religious thinkers have been forced to consider scientific technology when dealing with such theological issues as defining the moment of conception and the moment of death. Questions relating to fertility, contraception, abortion and stem-cell research will likely be the focus of religious debates for a long time to come.

The Bible, Blood, and Blood Transfusions

Jehovah's Witnesses refuse to take in blood or its major components primarily for religious reasons: blood is sacred and should only be used as God designates. Witnesses base their position on an interpretation of Bible texts that prohibit the taking of blood into the body for the purpose of sustaining the body's functions. They refer to the following Biblical passages:

Genesis 9:3-4: "Every moving animal that is alive may serve as food for you….Only flesh with its soul--its blood--you must not eat."

Leviticus 17:14: "You must not eat the blood of any sort of flesh, because the soul of every sort of flesh is its blood."

Acts 15:29: "Keep abstaining … from blood."

Although the first two passages refer to blood taken as food, the Witnesses argue that the prohibition includes intravenous transfusions, which may bypass the digestive system but still nourish the body. This would include use of the patient's own pre-stored blood.

The official organizational position rejects the taking in of whole blood or its four major components, namely, red blood cells, white blood cells, plasma, and platelets. However, advancements in blood technology have enabled doctors to fractionate these components even further, extracting elements such as clotting factors, immune globulin, and hemoglobin. In cases of treatments involving such blood derivatives, individual Jehovah's Witnesses are allowed to decide for themselves which blood fractions, if any, are personally acceptable. This difference of opinion is tolerated within the congregation, and each Witness is encouraged at all times to carry a legally-executed document stating his or her choices.

What About Organ Transplants?

Like other religions, Jehovah's Witnesses at first considered organ transplants as morally wrong, equivalent to cannibalism. However, beginning in 1980, Jehovah's Witnesses were told they should decide for themselves whether receiving an organ or tissue transplant was acceptable or not. The organ unquestionably contains blood, which is why some Witnesses will refuse it. But other Witnesses rationalize that the intent is to receive the organ, not the residual blood that remains in it.