Opposition to the Watch Tower doctrines on blood transfusions has come from both members and non-members. A group of dissident Witnesses known as Associated Jehovah’s Witnesses for Reform on Blood (AJWRB) states that there is no biblical basis for the prohibition of blood transfusions and seeks to have some policies changed.^[97] In a series of articles in the Journal of Medical Ethics US neurologist Osamu Muramoto, who is a medical adviser to the AJWRB, has raised issues including what he claims is coercion to refuse transfusions, doctrinal inconsistency, selective use of information by the Watch Tower Society to exaggerate the dangers of transfusions and the use of outdated medical beliefs.

Dissident Witnesses say the Society’s use of Leviticus 17:12 to support its opposition to blood transfusions^[98][99] conflicts with its own teachings that Christians are not under the Mosaic law.^[100][101] Theologian Anthony Hoekemaclaims the blood prohibited in Levitical laws was not human, but animal. He cites other authors^[102] who support his view that the direction at Acts 15 to abstain from blood was intended not as an everlasting covenant but a means of maintaining a peaceful relationship between Jewish and Gentile Christians. He has described as “absurd literalism” the Witnesses’ use of a scriptural prohibition on eating blood to prohibit the medical transfusion of human blood.^[103]

Osamu Muramoto has argued that the refusal by Jehovah’s Witnesses of “life-saving” blood treatment^[104] creates serious bio-medical ethical issues. He has criticized the “controlling intervention” of the Watch Tower Society by means of what he claims is information control and its policy of penalising members who accept blood transfusions or advocate freedom to choose blood-based treatment.^[101][104] He says the threat of being classified as a disassociated Witness and subsequently shunned by friends and relatives who are members coerces Jehovah’s Witnesses to accept and obey the prohibition on blood transfusions.^{[8][101][105]} In one particular case involving a Russian district court decision, however, the European Court of Human Rights (ECHR) found nothing in the judgments to suggest that any form of improper pressure or undue influence was applied. It noted: “On the contrary, it appears that many Jehovah’s Witnesses have made a deliberate choice to refuse blood transfusions in advance, free from time constraints of an emergency situation.” The court said: “The freedom to accept or refuse specific medical treatment, or to select an alternative form of treatment, is vital to the principles of self-determination and personal autonomy. A competent adult patient is free to decide … not to have a blood transfusion. However, for this freedom to be meaningful, patients must have the right to make choices that accord with their own views and values, regardless of how irrational, unwise or imprudent such choices may appear to others.”^[106]

Muramoto has claimed the intervention of Hospital Liaison Committees can add to “organisational pressure” applied by family members, friends and congregation members on Witness patients to refuse blood-based treatment. He notes that while HLC members, who are church elders, “may give the patient ‘moral support’, the influence of their presence on the patient is known to be tremendous. Case reports reveal JW patients have changed their earlier decision to accept blood treatment after a visit from the elders.” He claims such organizational pressure compromises the autonomy of Witness patients and interferes with their privacy and confidentiality. He has advocated a policy in which the Watch Tower organization and congregation elders would not question patients on the details of their medical care and patients would not disclose such information. He says the Society adopted such a policy in 1983 regarding details of sexual activity between married couples.^{[107][108][109]}

Watch Tower spokesman Donald T. Ridley says neither elders nor HLC members are instructed or encouraged to probe into the health care decisions of Witness patients and do not involve themselves in patient hospitalisations unless patients request their assistance. Yet Watchtower HLC representative David Malyon says he would respond to “sin” of Witnesses he is privy to by effectively saying “Are you going to tell them or shall I!”^[110] Nevertheless Ridley says Muramoto’s suggestion that Witnesses should be free to disregard Watch Tower scriptural teachings and standards is preposterous. He says loving God means obeying commandments, not disobeying them and hiding one’s disobedience from others.^[109][111]

Muramoto recommends doctors have a private meeting with patients to discuss their wishes, and that church elders and family members not be present, enabling patients to feel free of church pressure. He suggests doctors question patients on (a) whether they have considered that the Watch Tower Society might soon approve some medical practices they currently find objectionable, in the same manner that it has previously abandoned its opposition to vaccination and organ transplants; (b) whether Witness patients know which blood components are allowed and which are prohibited, and whether they acknowledge that those rulings are organizational policy rather than biblical teachings; and (c) whether they realize that although some Bible scriptures proscribe the eating of blood, eating and transfusing blood have entirely different effects on the body.^[112] English HLC representative David Malyon has responded that Muramoto’s suggested questions are an affront to coerce Jehovah’s Witnesses with “complicated philosophical inquisition” and, if used by doctors, would be “an abusive transformation of the medical role of succour and care into that of devil’s advocate and trickster”.^[110]

Muramoto has claimed many Watch Tower Society publications employ exaggeration and emotionalism to emphasize the dangers of transfusions and the advantages of alternative treatments, but present a distorted picture by failing to report any benefits of blood-based treatment. Nor do its publications acknowledge that in some situations, including rapid and massive haemorrhage, there are no alternatives to blood transfusions.^[101][113] He claims Watch Tower Society publications often discuss the risk of death as a result of refusing blood transfusions, but give little consideration to the prolonged suffering and disability, producing an added burden on family and society, that can result from refusal.^[114] Attorney and former Witness Kerry Louderback-Wood^[115] also claims that Witness publications exaggerate the medical risks of taking blood and the efficiency of non-blood medical therapies in critical situations.^[116]

Douglas E. Cowan, an academic in the sociology of religion, has claimed that members of the Christian countercult movement who criticize the Watch Tower Society, make selective use of information themselves. For example, Christian apologist Richard Abanes wrote that their ban on blood transfusions, “has led to countless Witness deaths over the years, including many children.”^[117] Cowan wrote: “When the careful reader checks [Abanes’ footnote], however, looking perhaps for some statistical substantiation, he or she finds only a statistical conjecture based on 1980 Red Cross blood use figures.” Cowan also says Abanes omits “critical issues” in an attempt to “present the most negative face possible.” Cowan wrote that “the reader is left with the impression that the Watchtower Society knowingly presides over a substantial number of preventable deaths each year.”^[118]

Osamu Muramoto says the Watch Tower Society relies on discarded, centuries-old medical beliefs to support its assertion that blood transfusions are the same as eating blood.^[119] A 1990 Watch Tower brochure on blood quoted a 17th-century anatomist to support its view.^[120] Muramoto says the view that blood is nourishment—still espoused in Watch Tower publications^[121]—was abandoned by modern medicine many decades ago.^[101] He has criticized an analogy commonly used by the Society^[122] in which it states: “Consider a man who is told by the doctor that he must abstain from alcohol. Would he be obedient if he quit drinking alcohol but had it put directly into his veins?”^[119]Muramoto says the analogy is false, explaining: “Orally ingested alcohol is absorbed as alcohol and circulated as such in the blood, whereas orally eaten blood is digested and does not enter the circulation as blood. Blood introduced directly into the veins circulates and functions as blood, not as nutrition. Hence, blood transfusion is a form of cellular organ transplantation. And … organ transplants are now permitted by the WTS.”^[101] He says the objection to blood transfusions on the basis of biblical proscriptions against eating blood is similar to the refusal of a heart transplant on the basis that a doctor warned a patient to abstain from eating meat because of his high cholesterol level.^[123]

David Malyon, chairman of the English Hospital Liaison Committee in Luton, England, has claimed that Muramoto’s discussion of the differences between consuming blood and alcohol is pedantic and says blood laws in the Bible are based upon the reverence for life and its association with blood, and that laws should be kept in the spirit as much as in the letter.^[110]

Muramoto has described as peculiar and inconsistent the Watch Tower policy of acceptance of all the individual components of blood plasma as long as they are not taken at the same time.^[101] He says the Society offers no biblical explanation for differentiating between prohibited treatments and those considered a “matter of conscience”, explaining the distinction is based entirely on arbitrary decisions of the Governing Body, to which Witnesses must adhere strictly on the premise of them being Bible-based “truth”.^[101] He has questioned why white blood cells (1 per cent of blood volume) and platelets (0.17 per cent) are forbidden, yet albumin (2.2 per cent of blood volume) is permitted.^[101] He has questioned why donating blood and storing blood for autologous transfusion is deemed wrong, but the Watch Tower Society permits the use of blood components that must be donated and stored before Witnesses use them.^[124] He has questioned why Witnesses, although viewing blood as sacred and symbolizing life, are prepared to let a person die by placing more importance on the symbol than the reality it symbolizes.^[113]

Kerry Louderback-Wood alleges that by labeling the currently acceptable blood fractions as “minute” in relation to whole blood, the Watch Tower organization causes followers to misunderstand the scope and extent of allowed fractions.^[116]

Witnesses respond that the real issue is not of the fluid per se, but of respect and obedience to God.^[125][126] They say their principle of abstaining from blood as a display of respect is demonstrated by the fact that members are allowed to eat meat that still contains some blood. As soon as blood is drained from an animal, the respect has been shown to God, and then a person can eat the meat even though it may contain a small amount of blood.^[127] Jehovah’s Witnesses’ view of meat and blood is different from that of kosher Jewish adherents, who go to great lengths to remove minor traces of blood.^[128][129]