2. Nice to Know:
In the 1870s Charles Taze Russell led members of a Bible-based religious community to form an adventist group that believed that society was so fundamentally flawed that it was about to end in Armageddon, the final battle between God and Satan. Their only chance of survival into a new life depended on strict adherence to precise rules of conduct that emphasize living a pure lifestyle (refusing cigarettes and illicit drugs, although tolerating alcohol), refusing all participation in military service, in political movements, and in nationalistic activities such as pledging allegiance to a national flag; even contact sports are forbidden. Many of these beliefs were based on literal interpretations of the Bible, including belief in the actual presence of Satan in the world as the cause of all social injustice. There can be no ultimate cure for human disease in this flawed world. Evil will cease only after Armageddon, and only believers will be saved.
The question of whether or not Jehovah's Witnesses are a Christian sect is hotly debated; you will find some comments in Wikipedia and elsewhere on the web.
Transplantation may be acceptable, as long as blood is removed from the organ to be transplanted. However, transplantation procedures undertaken without access to rescue blood transfusions place Jehovah’s Witness patients at significant risk of death if complications arise (Boggi U, et al. Kidney and pancreas transplants in Jehovah’s Witnesses: ethical and practical implications. Transplantation Proceedings 2004; 36:501-502.). However, various perioperative measures can avoid the need for rescue transfusion, making the outcome for transplantation in Jehovah’s Witnesses comparable to that of other patients (Figueiro J, et al. Simultaneous pancreas-kidney transplantation in Jehovah’s Witness patients. Clinical Transplantation 2003; 17:140-143).
If the patient steadfastly refuses transfusion, you should accede to the extent that your own moral conviction allows you. Use other therapies as long as these do not confer greater risk. If this is impossible for you, you may need to stabilize the patient and refer them to a colleague. In an emergency situation and when there are no advance directives and the patient cannot make their wishes known, it is defensible to perform whatever procedure is necessary to stabilize the patient. But always check, because Witness patients carry "no blood cards"; if signed, dated and witnessed these are to be taken as authority and you cannot override them. Where possible, communicate with the patient, and document every decision you take. (Guidelines based on an excellent chapter on Jehovah's Witness bioethics by O. Muramoto in The Cambridge Textbook of Bioethics, ed: PA Singer and AM Viens, Cambridge UP, 2008)
The Jehovah's Witness position is complex and is modified from time to time; individual Witness members may be unclear as to precisely what the rules are; there are differences in perspective between individual members, and the rules are likely to evolve in future years, so you are well advised to check with authorities. Finally, you should also try to separate the individual patient's personal perspective from that of his or her religion: you can support the patient in reaching an autonomous decision, but this does not necessarily mean obediently following the perceived dictates of their religion. They may have been guided by misinformation over the true policy of the Society, and respecting the autonomy of your patient as a person does not necessarily mean you must respect them as a member of a religious organization. Encourage the patient to contact the elders of their congregation for advice.