Last updated September 26, 2026
The Jehovah's Witness Advance Medical Directive, sometimes called a “blood card,” records a person’s treatment choices for use if they cannot speak for themselves. This article traces the evolution of the Jehovah's Witness Advance Medical Directive and explains how the 2026 blood-policy changes affect informed consent, older directives, and current patient choices.
For a plain-language explanation addressed directly to current Jehovah’s Witnesses and their families, see AJWRB’s patient statement. Clinicians and family members may also download and print the PDF for someone who prefers paper or has limited access to digital information.
How the 2026 blood policy affects the advance directive
| Period | Organizational position | Directive implication |
|---|---|---|
| Before March 2026 | Older forms often expressed categorical refusals based on the policy then in force. | Read the actual words and date of the patient’s document; do not treat the illustrations below as current forms. |
| March 2026 | Decisions about using one’s own blood, including preoperative collection and storage, became matters of personal conscience.1 | Ask about autologous techniques separately. |
| September 2026 | The four main components of blood became matters of individual conscience. Transfusion of another person’s whole blood remains prohibited by organizational teaching.2 | Ask about red cells, white cells, platelets, and plasma individually; never infer acceptance from permission or refusal from religious identity. |
When will the Jehovah's Witness Advance Medical Directive be updated?
The public JW.org explanation says that an updated medical directive will be made available. It also says personal medical decisions generally need not be discussed with anyone beyond the healthcare agents named in the directive and that Hospital Liaison Committee assistance is available at the patient’s request.2
Patients who want to alter a signed directive should use the amendment or replacement process recognized where they live, notify their agent and care team, and make sure relevant records contain the current version. A note in a hospital record may help communicate preferences but may not replace a legally executed directive. Requirements differ by jurisdiction.
Jehovah's Witness blood cards and advance directives: historical examples
The documents below show how Witness blood instructions were communicated at different times. They are historical illustrations, not templates for a present-day decision or proof of what any individual patient now wants.
The older card’s sweeping refusal language reflected the teaching of its era. Later documents became more detailed as policies and treatment options changed. A 1961 Watchtower statement rejected blood in whole or fractional form; that history helps explain why an old signed refusal may differ from choices now permitted by organizational policy.4
Another older card was prepared for minors. Its presence in the historical record should not be confused with a current rule about a child’s treatment: capacity, parental authority, safeguarding obligations, and emergency treatment standards vary by place and circumstance.
How older documents were maintained
Earlier Witness blood cards were periodically renewed. A 2004 Kingdom Ministry notice addressed the shift toward an advance medical directive with a healthcare power of attorney in places where that form was available. A 1993 branch letter discussed problems with incomplete or outdated cards.56 These records illustrate the long-standing challenge of keeping a patient’s documented instructions accurate. They do not establish that every old directive is legally invalid or that every holder now wishes to change it.
Informed consent when a patient can speak for themselves
Discuss choices directly with the patient in a setting that supports a voluntary, confidential answer. Ask whether they would like family, a healthcare agent, or the Hospital Liaison Committee present; respect their answer. Explain the proposed treatment and alternatives in understandable terms, then record acceptance or refusal for each relevant option. A patient may adhere fully to an older refusal, accept newly permitted options, or draw a different line. Religious affiliation alone cannot answer that question.
A practical review of the chart
- Identify every directive, healthcare power of attorney, treatment plan, and later statement; note dates and possible conflicts.
- Confirm decision-making capacity for the particular decision and speak privately when feasible.
- Document separate preferences for whole blood, the four main components, fractions, and relevant uses of the patient’s own blood, as the clinical situation requires.
- Record the discussion, the patient’s understanding, any new document, and whom the patient authorizes the team to contact.
Older advance directives when a patient cannot speak
The 2026 policy changes do not automatically revoke an existing refusal, and they do not establish consent to a newly permitted treatment. Review the actual directive, its date and scope, any later reliable evidence of the patient’s wishes, and the role of the legally authorized decision-maker. If the evidence conflicts or the situation is urgent, follow applicable law and institutional policy and seek prompt ethics or legal support. Do not assume that a family member’s or religious representative’s preference is the patient’s own decision.
Older research found variation in Witness patients’ expressed preferences, including in a study of pregnant patients’ healthcare proxies.7 Such studies support asking the individual; they cannot predict a particular patient’s choices or the prevalence of any view today.
Check the date of clinical guidance
Some detailed JW.org pages written for clinicians still describe the previous categorical restriction on the four primary components. Read their publication dates and compare them with the organization’s September 2026 public explanation before relying on them for current policy.28 AJWRB’s 2026 clinical guide provides a broader treatment overview.
For patients and families, the central task is to make their own informed choices and ensure that the people and records likely to matter in an emergency accurately reflect those choices.
References
- Jehovah’s Witnesses, 2026 Governing Body Update #2 (March 2026), on use of one’s own blood.
- Jehovah’s Witnesses, “How Do Jehovah’s Witnesses Show Respect for Life?” (2026), including the note on a forthcoming updated medical directive; see also the September 2026 announcement.
- September 18, 2026 congregation announcement obtained by AJWRB; interim instructions summarized in “Jehovah’s Witness Blood Policy 2026: Major Change.”
- The Watchtower, September 15, 1961, p. 559; compare the historical pocket card reproduced above.
- Our Kingdom Ministry, December 2004, historical notice reproduced above.
- December 1, 1993 branch correspondence, excerpt reproduced above.
- Gyamfi C, Berkowitz RL. “Responses by pregnant Jehovah’s Witnesses on health care proxies.” Obstetrics & Gynecology. 2004;104(3):541–544. doi:10.1097/01.AOG.0000135276.25886.8e.
- Jehovah’s Witnesses, “The Religious and Ethical Position on Medical Therapy and Related Matters”; compare its wording with reference 2.
Hi, thanks for this article, very helpful indeed. I hope all the work AJWRB is doing eventually has some effect on the JWs dropping this non-sensical and deadly doctrine.
I have 2 questions: You reference that 10-12% of JWs oppose the policy. What is your source for this? Thanks.
Also, you talk about the latest card and the legal status of it in the USA. Do Witnesses in the UK carry a similar card, or is it called something else? Thank you! All the best. Terri
We have provided the full references to the article. A durable power of attorney and advance legal directive are legally valid in the United States unless revoked, altered or signed under duress or coercion. As explained in our article, the majority of these documents will now be on the order of ten years old. We advise physicians to speak directly to the patient privately to verify their wishes. To the best of our knowledge, Jehovah’s Witnesses throughout the world carry an Advance Medical Directive.
Here is a link to download the UK version of the AMD card. Notice that it gives HLC’s consent to view a person’s medical records.
http://wwwb.fileflyer.com/view/i9CZkAy
Can I get the code to unlock the file?
I don’t believe there are any files requiring a code to unlock on the AJWRB website. Which article and file are you trying to unlock?
Acts 15:20 clearly states “abstain from … blood.” There are numerous scriptures in the Bible that support the idea that blood is sacret and should be avoided.
Furthermore, a plethora of studies show that blood transfusions are not only given unnecessarily, but that they actually increase morbidity and mortality in patients. In other words, blood transfusions aren’t good for you. Physicians in the US are most likely to administer blood, while European doctors have already evolved past using this old, outdated, 20th century method of treating patients and giving blood. The overall movement is towards less blood, not more, because blood is dangerous. It is dirty. It harms your immune system. I’m not a JW, but I would not want a blood transfusion either. I wash my hands after just shaking a strangers hand, why would I want to infuse a strangers blood into my body. Gross!!
Bennett-Guerrero, E., Zhao, Y., O’Brien, S., Ferguson, T. B., Peterson, E., Gammie, J., Song. H. (2010). Variation in use of blood transfusion in coronary artery bypass graft surgery. The Journal of the American Medical Association, 304(14), 1568-1575. doi:10.1001/jama.2010.1406.
Brice, R. (2013). Doctors trained to order “unnecessary” blood transfusions. The World Today. Retrieved from http://www.abc.net.au/worldtoday/content/2013/s3766574.htm
Ferraris, V. A., Davenport, D. L., Saha, S. P., Austin, P. C., Zwischenberger, J. B. (2012) Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Archives of Surgery, 147(1), 49-55. Retrieved from http://www.uthsc.edu/Internal/syllabus-consult/transfusion_minimal_blood.pdf
Halabi, W. J., Jafari, M. D., Nguyen, V. Q., Carmichael, J. C., Mills, S., Pigazzi, A., Stamos, M. J. (2013). Blood transfusion in colorectal cancer surgery: incidence, outcomes, and predictive factors: an american college of surgeons national surgical quality improvement program analysis. The American Journal of Surgery, 206(6), 1024-1033. doi:http://dx.doi.org/10.1016/j.amjsurg.2013.10.001
Meredith, K. G., May, H. T., Bair, T. L., Anderson, J. L., Horne, B. D., Tandar, A., . . . Muhlestein, J. B. (2006). Abstract 3912: Blood transfusions are associated with worse outcomes compared to no transfusion in patients with similar degrees of anemia and hematocrit decline while undergoing coronary angiography. American Heart Association 114:II_841. Retrieved from http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_841
Merrit. R, Banerjee, A., Granger, C., Newby, K., Califf, R., Harrington, R. (2005, November 23). U. S. heart patients receive more transfusions than international patients. Duke Clinical Research Institute. Retrieved from https://www.dcri.org/research/news/2005-news-archives/u.s.-heart-patients-receive-more-transfusions-than-international-patients
Rao, S., Jollins, J., Harrington, R., Granger, C., Newby, K., Linblad, L., Piper, K., . . . Moliterno, D. (2004, November 3). Blood transfusions increase mortality of hospitalized heart patients. Duke Medicine News and Communications. Retrieved from http://corporate.dukemedicine.org/news_and_publications/news_office/news/8185
Religion and Ethics Newsweekly for Public Broadcasting Service (Betty Rollin). (2013, July 12). Bloodless Surgery [video]. Available from http://www.pbs.org/wnet/religionandethics/2013/07/12/july-12-2013-bloodless-surgeries/19167/
Rohde, J. M., Dimcheff, D. E., Blumberg, N., Saint, S., Langa, K. M., Kuhn, L., Hickner, A., Rogers, M. A. M. (2014, April 2). Health Care-associated infection after red blood cell transfusion – a system review and meta-analysis. The Journal of the American Medical Association, 311(13), 1317-1326. doi:10.1001/jama.2014.2726
Williams, S. C. P. (2013, Spring) Against the flow – what’s behind the decline in blood transfusions? Stanford Medicine. Retrieved from http://stanmed.stanford.edu/2013spring/article5.html#hdr
Whenever the Bible speaks of the misuse of blood it is always in the context of eating it as food and more specifically when the life of an animal has been taken. Transfusion of blood or blood components cannot be demonstrated to be the the equivalent of eating blood. Additionally, no life is taken to provide the blood or blood components that are transfused. Simply stated, the Bible has nothing to say about the modern medical use of blood products which are liquid tissue transplants and the equivalent of organ transplants. The obvious paradox Watchtower policy creates for Jehovah’s Witnesses is that all blood products are in fact permitted if sufficiently fractionated.
It is true that blood products have been overused in times past and that much can be accomplished through the practice of blood conservation medicine – something AJWRB endorses. On the other hand, it is also true that in some situations there are few, or at times no, alternatives to transfusion of blood or blood components. We believe that all Jehovah’s Witnesses should have a free and informed choice in regards to their medical care without control or interference from the Watchtower Society.
Apparently you know nothing about what intravenous feeding is, same as blood transfusions is feeding
Are they mechanically alike? Yes. Both are liquids infused directly into a vein to bypass normal bodily entry points.
Are they biologically alike? No. One is fuel (food); the other is a liquid organ transplant (blood cells).
Thank you Adriano for your very informative and documented reply . Providing references to case work and respected literature available to everyone is what prevents maligning of RECOMENDATIONS by the governing body of Jehová witnesses. All individual have the opportunity to choose whether they will comply with the recommendation or not. They are not pressured or forced to choose against their will. J.P. Houston, TX.
The Governing Body of Jehovah’s Witnesses is doing far more than making “recommendations” about blood. They have established very complex, detailed policy on it’s use. The policy is so complex that it requires special committees of elders to explain it to both Jehovah’s Witnesses and doctors. Even then most remain confused about what is permitted, what is forbidden, and what the reasoning behind the rules is. This includes the HLC themselves, members of which were involved in the establishment of AJWRB. In addition, simply stating that individuals “have the opportunity to choose” does not make it so. The idea that JW’s “are not pressured or forced to chose against their will” is very disingenuous. It would be like saying you have a choice when a robber points a gun at you and demands your wallet. What choice do you have in the situation? Perhaps you had a free choice at the time you joined the Watchtower and got baptized. However, what if you later came to learn about all of the problems with the Watchtower’s policy and no longer support it? Do you have a free choice not to follow the policy or to even question the policy? The answer is certainly not. It is even worse for those who were raised as JW’s. With the Watchtower pushing baptism on children and teenagers long before they have fully developed brains and critical thinking ability they end up being forced to support a policy they never had a chance to understand. If they do happen to figure out the truth and don’t want to follow or support the policy what are their choices? They depend on their JW family for support. They don’t want to lose the only friends they have, and their family and the congregation expect them to comply. If they don’t comply an announcement will be made that they are no longer Jehovah’s Witnesses and they will be shunned. Any who refuse to shun them will also be shunned. This is an incredible amount of pressure. If they have a condition that requires blood the level of duress all but eliminates any illusion of choice. https://www.ajwrb.org/the-h-l-c-perspective
I’m not a J W, so I’m curious why you don’t respond to the medical and scientific citations listed by Adriano, instead of attacking his religious beliefs?
I have no dog in this fight about JW and religious beliefs. Bible is very clear that the original sin was judgement. All choices are conscience. We all pay the cost of our choice. A personal religious choice is equally as valid as a patriot sacrifice. I personally am not going to die for old bankers fighting over oil, while standing under a colorful sheet blowing in the wind, but to each their own beliefs.
I would like to see you include in your science a balanced perspective on the greed and filth of pharma companies.
Bayer (BAYRY) just paid “tens of millions” of dollars to end a three-decade long scandal in which the company sold HIV-contaminated blood products to haemophiliacs, thousands of whom later died of AIDS
3 decade. Did you read that or did you dkip past it because of a conflict of interest?
Based on the latest findings of mRna shots also called “covid vaccines” and persistent spike proteins causing blood clots, I’m curious on the science of cleaning volunteered blood of these prion spikes.
The red crosses immense profit from volunteered blood is also something worth reviewing to provide a balanced perspective do people can make an informed decision and then be respected to make the own bodily autonomous decisions without being judged.
Just respected.
Interestingly, Watchtower policy permitted the use of blood products that were contaminated by the AIDS virus. The vast majority of these cases involved hemophiliacs who received clotting factors from large pools of donated plasma. The risks of using any blood products must be balanced with the potential benefits. Physicians are well aware of the risks and benefits.
https://www.ajwrb.org/blood-transfusions-what-are-the-risks
https://www.ajwrb.org/physicians/risks-of-avoiding-necessary-blood-transfusions
I gather that the yearly card dispersement, with the accompanying signing before two witnesses at the book study has been done away with? And replaced by the one-time signing of a POA and advance legal directive which is valid forever unless specifically revoked, as the article explained. I doubt that the average JW understands the legal implications of carrying this card around, and that it can mean death unless the patient is conscious and can modify or revoke the document. I don’t understand why the organization would not want to make sure yearly that everyone is on board. For your safety, don’t carry this card in your wallet! My husband and I were at that ’92 assembly, and dutifully carried our updated cards for years, even at the risk of dying with four little children who needed us.
There are blood alternatives that can be used instead of using blood for transfusion. Plenty of doctors use saline or ringer’s solution. Medical technology has advanced to synthetic blood and also the laser blood cauterization during surgery.
They do not feel coerced into carrying the card. They can leave the organization and start going to a church, synagogue or what have you. Most witnesses have people with whom they are friendly with at the workplace and grocery stores, etc… I was disfellowshipped from the organization of Jehovah’s Witnesses and I never felt coerced nor do I feel resentment or anything else. Blood does not have oxygen for 24 hours after it has been transfused. The one thing about the Witnesses is that you cannot just join like you can at Baptist churches, you have to go through training and then meet with elders to MAKE SURE this is what you truly want to do
I have a question regarding the no blood document. I have been asked by a few people who are associated with Jehovahs Wittnesses, but were told “you may not receive the no blood document unless you are baptized.” I am confused because Jehovahs law is to abstain from blood. How can non baptized people NOT receive the card when they believe in Jehovahs command? Wouldn’t that be considered a double standard? Wouldn’t that push fellow non baptized worshippers to be baptized when they feel they don’t have enough knowledge, or not ready to take the most important step in their life.
I ask because several individuals were asking me these questions and I have never gotten a clear explanation of the answer. Two of the ones who have asked are so broken inside. I ask in all humbleness to please help me to understand and know the answer. Thank you brothers.
Anyone can attain a No Blood Card provides by Jehovah’s Witnesses. As long as it’s filled out correctly it can be used by all.
I have medical conditions that won’t allow me to donate blood anymore. Redcross want except it nor will Lifesouth. I have lupus and RA. So I don’t feel it’s safe for others to use my blood. So where can I get some type of card with the information on it. Something legal.
I have a question, since it’s called DPA instead of just medical power of attorney does this mean the agent can also make financial decisions for the person they are acting as agent for, or is it ate toy for medical purposes?
Connie, you asked the right question.
Under the common law, a power of attorney becomes ineffective if its grantor dies or becomes “incapacitated,” meaning unable to grant such a power, because of physical injury or mental illness, for example, unless the grantor (or principal) specifies that the power of attorney will continue to be effective even if the grantor becomes incapacitated. This type of power of attorney is called “power of attorney with durable provisions” in the United States or “enduring power of attorney” elsewhere. In effect, under a durable power of attorney (DPA), the authority of the attorney-in-fact to act and/or make decisions on behalf of the grantor continues until the grantor’s death.
COMPLETE CONTROL. I guess their not going to lose another estate, i.e. Prince.
Hi there! Where can I get a No Blood Card from?
Thank you!
Jane
They are available through local Kingdom Halls of Jehovah’s Witnesses to baptized members.
I think this article is disgusting and presumptuous. I’m laying in the hospital right now with a hemoglobin of Less Than 3. I have been told by 5 doctors that I’m going to die within 24 hours and after two weeks I’m still here. I’ve kept my loyalty to Jehovah and obeyed his command to abstain from blood. If I do die by chance then I know that I will die with a clean conscience which is more valuable to me than anybody’s opinion. I know hundreds of witnesses and not one of them thinks it’s okay to take any sort of blood. As I said this article is very presumptuous. I have never felt more spiritually strong or more spiritually connected to my god Jehovah than I do right now. This isn’t the first time that I’ve had to deal with the blood issue in my family. Back in the late seventies my mother got down to around 4 in her hemoglobin and she was tested much more than I was. And my father explained to the doctors that if they forced her to have a blood transfusion that it would break her. And it would have broke her because remaining loyal was what she was holding on to.
You’re saying that in the rules about comments you are not allowed to talk about religious websites or evengelical work when this article specifically is talking about Jehovah’s Witnesses. She bit hypocritical to me. Is someone afraid that there might be an arguable point from the scriptures? Or is it just someone’s need to control what they think people believe and want. I say if you’re allowed to bring it up then you should allow it in the comments to because that’s only fair. Split is obvious this article is not about being fair it’s about being judgemental so judge away and those of us who are remaining loyal will not be swayed bye speeches and innuendo
Hello Jess: If you are an adult and have read through the information on AJWRB and find it to be unconvincing and wish to follow the Watchtower’s partial blood transfusion ban, that is within your right. We are happy to publish your comments, and respect your right to choose. We have seen many JWs die over this issue and find the WT’s policy to be flawed and irrational. Where exactly in the Bible does in explain which parts of blood are OK and which are not? Why has the policy changed so many times over the decades? How can it be acceptable to use the single largest component protein of blood (hemoglobin) and this not be a blood transfusion, yet its forbidden to use a red cell? (A red cell is nothing more than a tiny doughnut shaped bag of hemoglobin). If you can make sense of this please inform us as to how you do so. I was a JW for the better part of four decades, the last as an elder. I was not able to make sense of it myself. Best wishes for your recovery.
A Superior Court judgement in Philadelphia on 7/18/2017 has confirmed that there is no medical training or body of knowledge for “bloodless medicine.” It is regular medicine minus use of blood products only.
The details of the case are worthy of study, and should affect the thinking of all card-carrying NO Blood JWs.
See:
http://www.pennlive.com/news/2017/07/court_nixes_lawsuit_by_family.html
http://www.pacourts.us/assets/opinions/Superior/out/J-A06045-17o%20-%2010317546621299938.pdf?cb=1
I am a nurse and one of Jehovah’s Witnesses for over 40 years. You are correct that hemoglobin is the major portion of the red blood cell. It has been written about as the subject to think about in your conscience with Jehovah. Since the main function of the red blood cell is to carry the hemoglobin and oxygen, the fact that the hemoglobin can now be separated from the red cell and stored easily does not really change its “position” shall we say. The hemoglobin is not now a “minor” fraction. It is still a major component. It is still behaving as the red cell would in the body. It’s current purpose is to keep you alive mostly in field emergencies until you can get to the hospital for a full transfusion. I will not take it and my DPA says that. My DPA is very thorough.
I am facing major surgery soon and i agree with Mary RN that i would refuse hemoglobin. To avoid confusion i think I’d rather “play it safe” so to speak with my God and just refuse any parts of a transfusion altogether. Since Mary is an RN and a JW with a thorough DPA in place i am just curious as to what she does find acceptable when it comes to transfusions. Also, if a nurse anesthesist became a JW, how would he or she probably react to being required to give blood to non-JWs or would they NOT be required in their job description? Thank you.
JW Doctors and medical professionals have had the Watchtower’s blessing to transfuse non-JWs since the 1960’s.
However, beginning in 2018 the Watchtower began quietly instructing JW medical professionals they would no longer
be permitted to prescribe or administer prohibited blood products.
As you may be aware, the Watchtower has repeatedly changed its position on Blood fractions since the 1950’s. There is nothing new about them. A reasonable question to ask is whether or not you believe Jehovah God would repeatedly change his position about blood fractions over and over sending such confusion about his will? Is that reasonable to believe? This links documents the many repeated changes over the past seven decades, and may help you to evaluate these questions. https://ajwrb.org/blood-vaccines-and-organ-transplants
In addition, it may be helpful for you to consider the manner in which Watchtower writers discussed matters of science back when the Watcthtower first developed its doctrine on blood transfusion. https://ajwrb.org/the-watchtower-on-science-and-medicine
Good evening, i am hoping you can help does the society have for download the medical refusal (blood) card for non witnesses? And if not is it ok to carry a full witness refusal card and if not what components of the card do i need to have the same effect.
many thanks in advance
The answer to your question is no.
Nancy – when they threaten to make sure none of your family or friends ever talk to you again, that is coercion. And no you cannot just leave, they will label you and take away your support group. That is a cult.
I ran into an issue following these steps, any suggestions?
Please provide additional details. Use the contact form if anonymity is required.
I had a quick question regarding the third point, could you clarify?
What is your question?