This page is deliberately careful. It separates three things that are often run together: what a court decided, what happened to the patient, and what the medical evidence says about risk. It names individuals only as courts, reputable reporting or the organisation’s own publications already name them.
Last reviewed 19 September 2026
How to read this page. A court permitting a refusal, a court overriding a refusal, and a death are three different facts. Deaths have followed permitted refusals (Kosack, Yeatts, Martinez, Lindberg), an overridden refusal (Hughes, whose court-ordered, transfusion-supported chemotherapy did not achieve remission) and an adult’s own refusal (Gough). Patients have also survived after overrides (A.C., Re T; Re E survived as a minor and died after refusing blood as an adult). Nothing here finds that a transfusion would have saved any named person, and we do not make that claim. Where a clinician’s evidence on the point is on the record we quote it and attribute it: the pathologist at Emma Gough’s inquest said survival with a transfusion was ‘very strongly’ probable; the organisation’s own 1994 Awake! records that Lisa Kosack’s doctors testified to a 30 per cent chance of cure with transfusion-supported chemotherapy, and that Lenae Martinez’s doctors expected transfusion to prolong her life by ‘about three to six months’. Those are reported opinions, not our findings, and they are not the same as knowing what would have happened. Source: Shropshire Star, 7 April 2008Source: Awake!, 22 May 1994
Where the full judgment or law report could be opened (A.C. v Manitoba on the Supreme Court’s site; Re T in the All England Law Reports; Prince v Massachusetts at Cornell LII) the claim is verified; where it was read from a reproduction or summary, it is labelled supported. Living relatives of those named deserve the same care as the named individuals: no speculation about motives, no photographs.
In Malette v. Shulman (1990) the Ontario Court of Appeal held that a doctor who transfused an unconscious Witness despite her signed card committed battery, upholding $20,000 damages and affirming a competent adult's right to refuse. Source: Ontario Court of Appeal, 30 March 1990
30 March 1990 · pp.paras. 24, 44 · Robins J.A. · Ontario Court of Appeal (text reproduced by the Global Health & Human Rights Database)
“there was no reason not to regard this card as a valid advance directive. Its instructions were clear, precise and unequivocal and manifested a calculated decision to reject a procedure offensive to the patient's religious convictions.”
Doctor transfused an unconscious accident victim (30 June 1979) despite her Jehovah's Witness card; held to be battery; $20,000 general damages upheld.
Provenance and verification note for Ontario Court of Appeal, Malette v. Shulman (1990), 72 O.R. (2d) 417; 67 D.L.R. (4th) 321 (C.A.)
Confidence note. CanLII (official) returned 403; opened the reproduced judgment text on globalhealthrights.org. Facts corroborated by CanLII Connects and McGill Law Journal summaries in search results. Judgment date from secondary sources.
Scan provenance. Judgment text reproduced on globalhealthrights.org (Lawyers Collective / O'Neill Institute)
Notes. A court vindicating an adult's refusal; the patient survived.
Accessed. 19 September 2026 · Source ID.src-onca-1990-malette-v-shulman
30 July 1992 · pp.[1992] 4 All ER 649 at 652-653 · Lord Donaldson of Lymington MR, Butler-Sloss and Staughton LJJ · All England Law Reports (PDF reproduced by the Global Health & Human Rights Database)
“An adult patient who, like Miss T, suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered.”
'This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.' T (mother 'a fervent Jehovah's Witness') signed a refusal before a caesarean; the Court held 'there was no valid refusal of consent' and that the doctors were 'justified … by the principle of necessity'. 'Appeal dismissed. No order as to costs.'
Provenance and verification note for Court of Appeal (Civil Division), England and Wales, Re T (adult: refusal of medical treatment) [1992] 4 All ER 649; [1993] Fam 95
Confidence note. Opened the full law report (19 pp.); wording and disposition confirmed. BAILII blocked by a bot challenge.
Scan provenance. PDF of the All ER report hosted by globalhealthrights.org
2007 · pp.vol. 19, pp. 219-247 · David Ziebart · University of Buckingham Press
“E maintained his religious convictions throughout his life and on reaching the age of majority, refused all blood-based treatment and subsequently died.”
Quotes Ward J in Re E: the court 'should be very slow to allow a child to martyr himself'; boy of 15¾, 80-90% remission with blood products. Also quotes Lord Donaldson in Re T on the right of choice existing whether reasons are 'rational, irrational, unknown or even non-existent'.
“the cause of death was recorded initially as complications of profound anaemia, due to haemorrhage and complications of a twin delivery. She died on October 25. An inquest was opened on October 30”
Emma Gough gave birth to healthy twins at the Royal Shrewsbury Hospital.
“It is my view if she had received a transfusion the probability is very strongly in favour of the fact she would have survived.”
Consultant pathologist Dr Archibald Malcolm to coroner John Ellery; post-mortem haemoglobin 2.2 g/dL against about 14 in a healthy woman; Mrs Gough, 22, of Dawley, Telford, had signed an 'advance directive' refusing blood; died 25 Oct 2007 at the Royal Shrewsbury Hospital. The newspaper printed the haemoglobin figure as '2.2 milligrammes in 100 millilitres'; the site reports it as 2.2 (g/dL) without endorsing the unit as printed.
“But she had signed an advance directive saying she did not want a transfusion, a wish which was confirmed by her family when she was unconscious.”
Consultant gynaecologist Mr Oyesanya: had she received blood 'we would not be here today'; the family told him 'at least she remained faithful to her God'. The coroner's narrative verdict (reported elsewhere) was not opened.
Courts in England, Canada and the United States have taken different views of a mature minor’s refusal. Prince v. Massachusetts (1944), often cited, was not a transfusion case at all. Source: Supreme Court of the United States, 31 January 1944
Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.
Prince v. Massachusetts (1944), often cited in transfusion cases, concerned child labour and literature distribution, not medical treatment; its statement that parents are not free 'to make martyrs of their children' is at 321 U.S. 170. Source: Supreme Court of the United States, 31 January 1944
31 January 1944 · pp.321 U.S. at 170 · Rutledge J. · Legal Information Institute, Cornell Law School
“Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”
A child-labour / street literature distribution case involving a Witness aunt and her nine-year-old ward — not a transfusion case, though often cited in transfusion litigation.
Provenance and verification note for Supreme Court of the United States, Prince v. Massachusetts, 321 U.S. 158 (1944)
Confidence note. Quotation confirmed at Cornell LII; the page pin (321 U.S. at 170) is from the U.S. Reports citation and is not visible on the page opened.
Accessed. 19 September 2026 · Source ID.src-scotus-1944-prince
Lisa D. Kosack, 12, Oakville, Ontario, acute myeloid leukaemia; Judge David R. Main refused the Children's Aid Society/hospital application to authorise transfusions; she went home and died shortly afterwards.
No online copy located.
Provenance and verification note for Ontario Provincial Court (Family Division), Re L.D.K. (1985), 48 R.F.L. (2d) 164
Confidence note. Citation verified as real via the SCC's list of authorities in A.C. v Manitoba (official PDF opened). Case details from a discovery compilation (jwdivorces) and the organisation's own Awake! 22 May 1994 (lead-verified).
26 June 2009 · pp.para. 87; headnote · para. 87 · Abella J. (majority); Binnie J. dissenting · Supreme Court of Canada
“The more a court is satisfied that a child is capable of making a mature, independent decision on his or her own behalf, the greater the weight that will be given to his or her views when a court is exercising its discretion under s. 25(8).”
A.C., aged 14 years 10 months, admitted with lower GI bleeding from Crohn's disease; had signed an advance directive refusing blood; order of the applications judge dated 16 April 2006; the 'best interests' standard 'operates as a sliding scale of scrutiny'. 'Appeal dismissed, Binnie J. dissenting.' The list of authorities cites Re L.D.K. (1985), 48 R.F.L. (2d) 164 and Re A.Y. (1993), 111 Nfld. & P.E.I.R. 91.
Provenance and verification note for Supreme Court of Canada, A.C. v. Manitoba (Director of Child and Family Services), 2009 SCC 30, [2009] 2 S.C.R. 181
Confidence note. Opened the official SCC PDF (114 pp., bilingual); quotations and facts confirmed.
Scan provenance. Official SCC PDF of the reported judgment (S.C.R.), retrieved by curl
22 May 1994 · pp.9-15 · Watchtower Bible and Tract Society of New York, Inc.
“After a long, difficult night, at 6:30 a.m., September 22, 1993, Lenae fell asleep in death in the arms of her mother.”
The article profiles four young people: Lenae Martinez, 12, Fresno, California, leukaemia — recorded as having died on 22 September 1993; the New York seventeen-year-old, 17, New York City, inflammatory bowel disease — ‘Crystal never needed blood, and none was ever transfused’; Lisa Kosack, 12, Toronto, acute myeloid leukaemia — ‘She died peacefully at home, in the loving arms of her mother and father’; E.G., 17, Chicago, leukaemia — ‘Ernestine had no further transfusions, and she did not die from her leukemia.’ E.G. (par. 59) was transfused once under a trial-court order 'in spite of her vigorous protests'; the Illinois Appellate Court and the Illinois Supreme Court then upheld her right to refuse (pars. 60-61), and the article records that she 'had no further transfusions, and she did not die from her leukemia' (par. 63).
Provenance and verification note for Awake!, Youths Who Have ‘Power Beyond What Is Normal’
Confidence note. Opened on the Watchtower Online Library on 19 September 2026; names, ages, places and outcome sentences confirmed from the article text.
Notes. Together with the first article, the issue names six young people: three recorded as having died and three recorded as alive at the time of writing.
Accessed. 19 September 2026 · Source ID.src-g-1994-0522-power-beyond-normal
“should be very slow to allow a child to martyr himself”
Boy of 15¾ with leukaemia; treatment with blood products offered an 80-90% chance of remission; he and his parents refused; Ward J authorised treatment. He later refused blood on reaching majority and died.
No online copy located.
Provenance and verification note for High Court (Family Division), England and Wales, Re E (A Minor) (Wardship: Medical Treatment) [1993] 1 FLR 386
Confidence note. Judgment not opened (paywalled/unreported online). Wording and outcome taken from Ziebart, Denning Law Journal 2007 (opened) and the Law & Religion UK note (opened), which agree.
2007 · pp.vol. 19, pp. 219-247 · David Ziebart · University of Buckingham Press
“E maintained his religious convictions throughout his life and on reaching the age of majority, refused all blood-based treatment and subsequently died.”
Quotes Ward J in Re E: the court 'should be very slow to allow a child to martyr himself'; boy of 15¾, 80-90% remission with blood products. Also quotes Lord Donaldson in Re T on the right of choice existing whether reasons are 'rational, irrational, unknown or even non-existent'.
21 December 2021 · Elijah Z. Granet · Law & Religion UK
“Once a young person becomes an adult, decisions about whether to accept or reject medical treatment become theirs absolutely, but before that age the court must act upon its objective assessment of the young person's best interests”
Quoting E & F (Minors: Blood Transfusion) [2021] EWCA Civ 1888; also cites Ward J's 'very slow to allow an infant to martyr himself'.
19 July 1993 · Wells J. · Newfoundland & Prince Edward Island Reports
“(judgment not opened) — described as ruling the boy 'a mature minor whose wish to receive medical treatment without blood or blood products is to be respected'”
Adrian Yeatts, 15, St. John's; lymphoma/leukaemia; Child Welfare sought court-ordered transfusions and was refused; he died 13 Sept 1993.
No online copy located.
Provenance and verification note for Supreme Court of Newfoundland (Unified Family Court), Re A.Y. (1993), 111 Nfld. & P.E.I.R. 91; 348 A.P.R. 91
Confidence note. Citation verified via the SCC list of authorities; the CHILD Inc. newsletter (opened) gives 'In re Adrian Yeatts, 111 Nfld. & P.E.I.R. 91 (Nfld. Unified Fam. Ct. 1993)'; death and dates corroborated by Awake! 22 May 1994 (lead-verified). The quoted ruling wording is from secondary summaries.
26 June 2009 · pp.para. 87; headnote · para. 87 · Abella J. (majority); Binnie J. dissenting · Supreme Court of Canada
“The more a court is satisfied that a child is capable of making a mature, independent decision on his or her own behalf, the greater the weight that will be given to his or her views when a court is exercising its discretion under s. 25(8).”
A.C., aged 14 years 10 months, admitted with lower GI bleeding from Crohn's disease; had signed an advance directive refusing blood; order of the applications judge dated 16 April 2006; the 'best interests' standard 'operates as a sliding scale of scrutiny'. 'Appeal dismissed, Binnie J. dissenting.' The list of authorities cites Re L.D.K. (1985), 48 R.F.L. (2d) 164 and Re A.Y. (1993), 111 Nfld. & P.E.I.R. 91.
Provenance and verification note for Supreme Court of Canada, A.C. v. Manitoba (Director of Child and Family Services), 2009 SCC 30, [2009] 2 S.C.R. 181
Confidence note. Opened the official SCC PDF (114 pp., bilingual); quotations and facts confirmed.
Scan provenance. Official SCC PDF of the reported judgment (S.C.R.), retrieved by curl
“In 1993 the Supreme Court of Newfoundland ruled 15-year-old Adrian Yeatts a “mature minor” and rejected Child Welfare's petition for court-ordered transfusions.”
Also: Dennis Lindberg 'died at Children's Hospital in Seattle' on 28 Nov 2007, 'had turned 14 in September'; Bethany Hughes 'after 80 chemotherapy treatments and 38 transfusions'.
22 May 1994 · pp.3-8 · Watchtower Bible and Tract Society of New York, Inc.
“I just could not live with myself if I am given blood.”
The article, narrated by his father, describes Adrian Yeatts of Newfoundland, Canada, aged 14, diagnosed with a fast-growing abdominal lymphoma in March 1993 and subsequently leukaemia. Newfoundland’s Supreme Court (Justice Robert Wells) held in July 1993 that he was a mature minor whose refusal of blood would be respected. He was baptised in a hospital physiotherapy tank on 12 September 1993 and the article records that he died the next day. A boxed item describes a bloodless heart transplant for three-year-old the three-year-old in Ohio of Ohio in October 1993, reported a month later as doing well. The article also records the medical advice as the family reported it: Dr Jardine 'explained that a very aggressive chemotherapy program with blood transfusions was the only way Adrian could possibly live'; 'chemotherapy was started, without the transfusions'; and it closes by saying that he rejected transfusions 'that could conceivably have extended his present life'.
22 May 1994 · pp.9-15 · Watchtower Bible and Tract Society of New York, Inc.
“After a long, difficult night, at 6:30 a.m., September 22, 1993, Lenae fell asleep in death in the arms of her mother.”
The article profiles four young people: Lenae Martinez, 12, Fresno, California, leukaemia — recorded as having died on 22 September 1993; the New York seventeen-year-old, 17, New York City, inflammatory bowel disease — ‘Crystal never needed blood, and none was ever transfused’; Lisa Kosack, 12, Toronto, acute myeloid leukaemia — ‘She died peacefully at home, in the loving arms of her mother and father’; E.G., 17, Chicago, leukaemia — ‘Ernestine had no further transfusions, and she did not die from her leukemia.’ E.G. (par. 59) was transfused once under a trial-court order 'in spite of her vigorous protests'; the Illinois Appellate Court and the Illinois Supreme Court then upheld her right to refuse (pars. 60-61), and the article records that she 'had no further transfusions, and she did not die from her leukemia' (par. 63).
Provenance and verification note for Awake!, Youths Who Have ‘Power Beyond What Is Normal’
Confidence note. Opened on the Watchtower Online Library on 19 September 2026; names, ages, places and outcome sentences confirmed from the article text.
Notes. Together with the first article, the issue names six young people: three recorded as having died and three recorded as alive at the time of writing.
Accessed. 19 September 2026 · Source ID.src-g-1994-0522-power-beyond-normal
“on September 22, 1993, a second child of Jehovah's Witnesses parents died at Valley Children's Hospital in Fresno. That child's named was Lenae Martinez.”
States the hospital treated the 12-year-old as a 'mature minor' and did not seek a court order.
6 September 2002 · Dawn Walton · The Globe and Mail
“Bethany Abigail Hughes, the Calgary teenager whose fight against government-imposed blood transfusions landed her in court and divided her family, died yesterday after a seven-month battle with leukemia. She was 17.”
Diagnosed in February 2002 with acute myeloid leukaemia; 'about 38 blood transfusions but no decent prospect for recovery'; Alberta argued successfully that she was not mature enough to decide.
10 April 2002 · Kent J. · Alberta Court of Queen's Bench (summary on vLex)
“freedom of religion is not absolute and may properly give way to an order...in a child's best interests”
Appeal from apprehension and treatment orders for Bethany Hughes (16, acute myeloid leukaemia) dismissed; the court found she could not make a free, informed choice owing to undue influence.
25 May 2009 · Alberta Court of Appeal (summary on vLex)
“dismissed the father's appeal”
Lawrence Hughes's action against the Watch Tower Society, its lawyers and doctors (misrepresentation, deceit) failed; 'there was no genuine issue to be tried' on causation; 'Bethany understood her medical situation and options'.
“In 1993 the Supreme Court of Newfoundland ruled 15-year-old Adrian Yeatts a “mature minor” and rejected Child Welfare's petition for court-ordered transfusions.”
Also: Dennis Lindberg 'died at Children's Hospital in Seattle' on 28 Nov 2007, 'had turned 14 in September'; Bethany Hughes 'after 80 chemotherapy treatments and 38 transfusions'.
28 November 2007 · Associated Press · The Daily Herald (Everett, WA)
“Skagit County Superior Court Judge John Meyer denied a motion by the state to force the boy to have a blood transfusion”
Dennis Lindberg, 14, died 'Wednesday night at Children's Hospital and Regional Medical Center in Seattle'; his birth parents 'believe their son should have had the transfusion and suggested he had been unduly influenced by his legal guardian'.
“In 1993 the Supreme Court of Newfoundland ruled 15-year-old Adrian Yeatts a “mature minor” and rejected Child Welfare's petition for court-ordered transfusions.”
Also: Dennis Lindberg 'died at Children's Hospital in Seattle' on 28 Nov 2007, 'had turned 14 in September'; Bethany Hughes 'after 80 chemotherapy treatments and 38 transfusions'.
26 June 2009 · pp.para. 87; headnote · para. 87 · Abella J. (majority); Binnie J. dissenting · Supreme Court of Canada
“The more a court is satisfied that a child is capable of making a mature, independent decision on his or her own behalf, the greater the weight that will be given to his or her views when a court is exercising its discretion under s. 25(8).”
A.C., aged 14 years 10 months, admitted with lower GI bleeding from Crohn's disease; had signed an advance directive refusing blood; order of the applications judge dated 16 April 2006; the 'best interests' standard 'operates as a sliding scale of scrutiny'. 'Appeal dismissed, Binnie J. dissenting.' The list of authorities cites Re L.D.K. (1985), 48 R.F.L. (2d) 164 and Re A.Y. (1993), 111 Nfld. & P.E.I.R. 91.
Provenance and verification note for Supreme Court of Canada, A.C. v. Manitoba (Director of Child and Family Services), 2009 SCC 30, [2009] 2 S.C.R. 181
Confidence note. Opened the official SCC PDF (114 pp., bilingual); quotations and facts confirmed.
Scan provenance. Official SCC PDF of the reported judgment (S.C.R.), retrieved by curl
“Although the Supreme Court ruled against the girl, it ordered that the government of Manitoba cover her legal costs, estimated to be in excess of $450,000.”
A 2026 review in Archives of Disease in Childhood collected nineteen English judgments concerning children of Witnesses and blood and offers guidance to clinicians. Source: Archives of Disease in Childhood, 2026 The Court of Appeal said in 2021 that once a young person becomes an adult, decisions about whether to accept or reject treatment ‘become theirs absolutely’. Source: Law & Religion UK (blog), 21 December 2021
What the medical evidence shows
The literature does not support either simple story. In elective surgery with modern patient blood management, Witness patients’ short-term outcomes are broadly comparable to other patients’; in massive haemorrhage and profound anaemia, the excess risk is large.
In a retrospective cohort of 300 surgical patients who declined red-cell transfusion for religious reasons (operated 1981-1994), no deaths occurred at post-operative haemoglobin 7.1-8.0 g/dL (upper 95% CI 3.7%; 9.4% had a morbid event), but 34.4% (95% CI 18.6-53.2%) died at 4.1-5.0 g/dL; after adjustment, the odds of death rose about 2.5-fold for each g/dL fall. Later cohorts treated with modern patient blood management (2003-2012; 2008-2021) report lower overall mortality at haemoglobin of 8 g/dL or below (8.2% and 3.1%) with the same graded relationship (adjusted odds ratio 1.82 per g/dL for death; 1.48 per g/dL for death or morbidity). Source: Transfusion, July 2002Source: Transfusion, 2014Source: Transfusion, 2024
July 2002 · pp.42(7):812-818 · Carson JL, Noveck H, Berlin JA, Gould SA · AABB / Wiley
“In patients with a postoperative Hb level of 4.1 to 5.0, 34.4 percent (95% CI, 18.6-53.2%) died”
300 of 2,083 patients declining RBC transfusion for religious reasons (1981-1994) had post-op Hb ≤ 8 g/dL; 0 deaths at 7.1-8.0; odds of death rose 2.5× per g/dL fall. PMID 12375651.
Provenance and verification note for Transfusion, Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion
Confidence note. Abstract opened via the Europe PMC REST API (PubMed blocked on cookies).
Provenance and verification note for Transfusion, An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion
2024 · pp.64:1198-1206 · Seeber P, Trentino KM, Murray K, Lucas M · AABB / Wiley
“Of these, five (3.1%) patients died in hospital within 30 days”
159 of 2,841 admissions (2008-2021, Gotha, Germany) with nadir Hb ≤ 8; each gram decrease associated with 1.48× composite morbidity/mortality. PMID 38716878.
Provenance and verification note for Transfusion, A further update on mortality and morbidity in patients with very low hemoglobin levels who decline blood transfusion
A single-centre New York series (391 deliveries over 11 years) recorded two maternal deaths among Witness women, a rate of 512 against 12 per 100,000 live births (risk ratio 44, 95% CI 9-211; the interval is wide because it rests on two deaths). A Dutch nationwide case-note study (deaths 1983-2006) reported a maternal mortality ratio of 68 per 100,000 among Witnesses: a six-fold increase overall and 130-fold for death from major obstetric haemorrhage, and a 3.1-fold increase in serious morbidity from haemorrhage (14 v 4.5 per 1,000). The abstract gives no confidence intervals and the estimate rests on a small number of deaths. Source: American Journal of Obstetrics and Gynecology, 2001Source: BJOG: An International Journal of Obstetrics & Gynaecology, 2009
“There were 2 maternal deaths among the women who were Jehovah's Witnesses, for a rate of 512 maternal deaths per 100,000 live births versus 12 maternal deaths per 100,000 live births (risk ratio, 44; 95% CI, 9-211).”
2009 · pp.116(8):1103-1108 · Van Wolfswinkel ME, Zwart JJ, Schutte JM, Duvekot JJ, Pel M, Van Roosmalen J · Wiley
“Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage”
Nationwide case-note study 1983-2006 (mortality) and 2004-2006 (morbidity); MMR 68 per 100,000. PMID 19515150.
Provenance and verification note for BJOG: An International Journal of Obstetrics & Gynaecology, Maternal mortality and serious maternal morbidity in Jehovah's witnesses in The Netherlands
In elective and inpatient settings with patient blood management, matched studies and meta-analyses find Witnesses' short-term mortality similar to that of patients who accept transfusion (cardiac surgery: 2.6% v 3.6%, not significant, 2016; pooled odds ratio 1.13, 95% CI 0.74-1.73, 2023). One Johns Hopkins cohort reported lower unadjusted mortality (0.7% v 2.7%), but after risk adjustment bloodless care was not an independent predictor of death or morbidity. The 2016 meta-analysis authors caution that 'the suboptimal quality of available studies prevents conclusive results'. None of these studies includes uncontrolled haemorrhage. Source: Transfusion, 2014Source: Transfusion, 2016Source: Current Problems in Cardiology, 2023
The organisation’s position or later explanation: The organisation cites bloodless-medicine outcomes in its FAQ.
2014 · pp.54(10 Pt 2):2668-2677 · Frank SM, Wick EC, Dezern AE, Ness PM, Wasey JO, Pippa AC, Dackiw E, Resar LM · AABB / Wiley
“Overall, mortality was lower in the bloodless group (0.7%) than in the control group (2.7%; p = 0.046), primarily attributed to the surgical subgroup.”
Propensity-matched retrospective case-control (294 bloodless v 1,157 control) at Johns Hopkins; after risk adjustment bloodless care 'was not an independent predictor of the composite adverse outcome'. PMID 24942198.
Provenance and verification note for Transfusion, Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies
Provenance and verification note for Current Problems in Cardiology, Cardiac Surgery in Jehovah's Witnesses Patients and Association With Peri-Operative Outcomes: A Systematic Review and Meta-Analysis
JW.org’s FAQ describes the statement that many Witnesses, including children, die each year from refusing blood as a myth and ‘totally unfounded’, says such patients ‘usually fare as well as or better than those who do accept transfusions’, citing cardiac-surgery and blood-management literature in footnotes, and adds that ‘no one can say for certain that a patient will die because of refusing blood or will live because of accepting it’. The organisation publishes no statistics of its own on deaths following refusal. In 1994 its own magazine recorded three deaths among six named young people and framed the deaths of youths over blood as continuing. Source: JW.org Frequently Asked Questions, 19 September 2026Source: Awake!, 22 May 1994
Myth: Many Witnesses, including children, die each year as a result of refusing blood transfusions. Fact: This statement is totally unfounded. Surgeons regularly perform such complex procedures as heart operations, orthopedic surgery, and organ transplants without the use of blood transfusions. Patients, including children, who do not receive transfusions usually fare as well as or better than those who do accept transfusions. In any case, no one can say for certain that a patient will die because of refusing blood or will live because of accepting it.
“Because no official mortality data are available, researchers have attempted to estimate the potential impact of the policy using published clinical studies and epidemiological extrapolation.”
Estimates about 1,220 excess deaths worldwide in 2016 and about 33,246 for 1961-2016, from 8,132,358 publishers × 15 transfusion-requiring cases per 1,000 per year × 1% excess mortality (rounded down from an observed 1.4%).
Provenance and verification note for AJWRB.org (Advocates for Jehovah's Witness Reform on Blood), Estimating Mortality: Epidemiological Extrapolations of Faith-Based Blood Restrictions (page 'Jehovah's Witnesses and Blood – Tens of Thousands Dead in Hidden Tragedy')
Confidence note. Page opened; the figures are an advocacy group's extrapolation, not a count. Label as an estimate with its method whenever used.
Notes. A campaigning organisation’s estimate, used here only as an example of the figures in circulation and labelled unverified.Earlier URL redirects here.
Accessed. 19 September 2026 · Source ID.src-ajwrb-2026-0723-mortality-estimate
July 2002 · pp.42(7):812-818 · Carson JL, Noveck H, Berlin JA, Gould SA · AABB / Wiley
“In patients with a postoperative Hb level of 4.1 to 5.0, 34.4 percent (95% CI, 18.6-53.2%) died”
300 of 2,083 patients declining RBC transfusion for religious reasons (1981-1994) had post-op Hb ≤ 8 g/dL; 0 deaths at 7.1-8.0; odds of death rose 2.5× per g/dL fall. PMID 12375651.
Provenance and verification note for Transfusion, Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion
Confidence note. Abstract opened via the Europe PMC REST API (PubMed blocked on cookies).
2009 · pp.116(8):1103-1108 · Van Wolfswinkel ME, Zwart JJ, Schutte JM, Duvekot JJ, Pel M, Van Roosmalen J · Wiley
“Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage”
Nationwide case-note study 1983-2006 (mortality) and 2004-2006 (morbidity); MMR 68 per 100,000. PMID 19515150.
Provenance and verification note for BJOG: An International Journal of Obstetrics & Gynaecology, Maternal mortality and serious maternal morbidity in Jehovah's witnesses in The Netherlands
Figures such as ‘thousands’ or ‘tens of thousands’ appear in journalism and advocacy. The best-documented estimate comes from an advocacy group and is an extrapolation from assumed rates, not a count. We record it with its method, labelled unverified, so that readers can judge it for what it is.
“Because no official mortality data are available, researchers have attempted to estimate the potential impact of the policy using published clinical studies and epidemiological extrapolation.”
Estimates about 1,220 excess deaths worldwide in 2016 and about 33,246 for 1961-2016, from 8,132,358 publishers × 15 transfusion-requiring cases per 1,000 per year × 1% excess mortality (rounded down from an observed 1.4%).
Provenance and verification note for AJWRB.org (Advocates for Jehovah's Witness Reform on Blood), Estimating Mortality: Epidemiological Extrapolations of Faith-Based Blood Restrictions (page 'Jehovah's Witnesses and Blood – Tens of Thousands Dead in Hidden Tragedy')
Confidence note. Page opened; the figures are an advocacy group's extrapolation, not a count. Label as an estimate with its method whenever used.
Notes. A campaigning organisation’s estimate, used here only as an example of the figures in circulation and labelled unverified.Earlier URL redirects here.
Accessed. 19 September 2026 · Source ID.src-ajwrb-2026-0723-mortality-estimate
What can be said with confidence is narrower: named individuals have died after refusing blood in circumstances documented by courts, coroners and the organisation’s own publications; peer-reviewed studies find sharply higher mortality in defined high-risk situations; and the products at issue in these cases have, since 18 September 2026, been personal decisions rather than prohibited: in the leukaemia cases, the red cells and platelets that the organisation’s own 1994 magazine records doctors proposing for Lenae Martinez, and in Emma Gough’s case the red cells and plasma products used to treat major haemorrhage. The other case records do not specify the products proposed. Source: Awake!, 22 May 1994Source: NHS (nhs.uk), 16 January 2025
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Medical decisions belong with you and your clinicians. If you are facing one now, the help page lists confidential support services, and the glossary explains the terms that clinicians and the organisation’s publications use differently.
Sources cited on this page
Show all 26 sources, in date order
Each opens a full record with links, provenance and a confidence note.
31 January 1944 · pp.321 U.S. at 170 · Rutledge J. · Legal Information Institute, Cornell Law School
“Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”
30 March 1990 · pp.paras. 24, 44 · Robins J.A. · Ontario Court of Appeal (text reproduced by the Global Health & Human Rights Database)
“there was no reason not to regard this card as a valid advance directive. Its instructions were clear, precise and unequivocal and manifested a calculated decision to reject a procedure offensive to the patient's religious convictions.”
30 July 1992 · pp.[1992] 4 All ER 649 at 652-653 · Lord Donaldson of Lymington MR, Butler-Sloss and Staughton LJJ · All England Law Reports (PDF reproduced by the Global Health & Human Rights Database)
“An adult patient who, like Miss T, suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered.”
19 July 1993 · Wells J. · Newfoundland & Prince Edward Island Reports
“(judgment not opened) — described as ruling the boy 'a mature minor whose wish to receive medical treatment without blood or blood products is to be respected'”
22 May 1994 · p.2 · Watchtower Bible and Tract Society of New York, Inc.
“In former times thousands of youths died for putting God first. They are still doing it, only today the drama is played out in hospitals and courtrooms, with blood transfusions the issue.”
“There were 2 maternal deaths among the women who were Jehovah's Witnesses, for a rate of 512 maternal deaths per 100,000 live births versus 12 maternal deaths per 100,000 live births (risk ratio, 44; 95% CI, 9-211).”
6 September 2002 · Dawn Walton · The Globe and Mail
“Bethany Abigail Hughes, the Calgary teenager whose fight against government-imposed blood transfusions landed her in court and divided her family, died yesterday after a seven-month battle with leukemia. She was 17.”
“the cause of death was recorded initially as complications of profound anaemia, due to haemorrhage and complications of a twin delivery. She died on October 25. An inquest was opened on October 30”
2009 · pp.116(8):1103-1108 · Van Wolfswinkel ME, Zwart JJ, Schutte JM, Duvekot JJ, Pel M, Van Roosmalen J · Wiley
“Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage”
26 June 2009 · pp.para. 87; headnote · para. 87 · Abella J. (majority); Binnie J. dissenting · Supreme Court of Canada
“The more a court is satisfied that a child is capable of making a mature, independent decision on his or her own behalf, the greater the weight that will be given to his or her views when a court is exercising its discretion under s. 25(8).”
2014 · pp.54(10 Pt 2):2668-2677 · Frank SM, Wick EC, Dezern AE, Ness PM, Wasey JO, Pippa AC, Dackiw E, Resar LM · AABB / Wiley
“Overall, mortality was lower in the bloodless group (0.7%) than in the control group (2.7%; p = 0.046), primarily attributed to the surgical subgroup.”
21 December 2021 · Elijah Z. Granet · Law & Religion UK
“Once a young person becomes an adult, decisions about whether to accept or reject medical treatment become theirs absolutely, but before that age the court must act upon its objective assessment of the young person's best interests”
2026 · pp.111(8):682-685 (17 July 2026) · Wheeler R, Formstone M · BMJ
“We present 19 judgments of English courts; all that we could find relating to the refusal of blood transfusion by or on behalf of children of Jehovah's Witness families.”
“Because no official mortality data are available, researchers have attempted to estimate the potential impact of the policy using published clinical studies and epidemiological extrapolation.”
19 September 2026 · Watch Tower Bible and Tract Society of Pennsylvania
“Myth: Many Witnesses, including children, die each year as a result of refusing blood transfusions. Fact: This statement is totally unfounded. Surgeons regularly perform such complex procedures as heart operations, orthopedic surgery, and organ transplants without the use of blood transfusions. Patients, including children, who do not receive transfusions usually fare as well as or better than those who do accept transfusions. In any case, no one can say for certain that a patient will die because of refusing blood or will live because of accepting it.”