The medical community generally knows that Jehovah's Witnesses refuse blood transfusions. Jehovah's Witnesses reject red and white blood cells, platelets, and plasma, even at the cost of their lives, but they accept so called minor fractions such as albumin and globulin as a personal choice.1 The church organisation, the Watchtower Society, introduced the policy on refusal of blood in 1945. Since 1961 the church has enforced it by “disfellowshipping” or expelling un-repentant members who wilfully accept prohibited blood components. Other members are then instructed by the church to ostracise and shun the expelled individual. Internal dissidents have criticised this practice, which they feel coerces those who have divergent views on this issue and compromises autonomous decision making in medical care. 2 3 I analyse the recently publicised changes in this policy from a bioethical viewpoint to help understand the impact of this controversial policy on clinical practice.4