My first experience as a NICU nurse with a Jehovah's Witness family was in the 1970's. The baby had severe hydrops fetalis because his mother was Rh negative and had developed antibodies to the baby's Rh positive blood. This sensitization very likely occurred prior to the introduction of Rhogam.
The baby was so critically ill and so unlikely to survive that our neonatologist opted not to request a court order to permit him to transfuse the baby. He felt that it would cause unnecessary pain for the family without any benefit to the baby.
Since then, I've had the opportunity to discuss blood transfusion with several families who are Jehovah's Witnesses. Their responses vary.
The very young moms who have been raised in the faith tend to say, "I can't give consent, but you can get a court order, can't you?" Not always the case, but they often have to balance their concern for the baby with their relationship with relatives.
The physician's answer is always the same. "We'll try to avoid transfusing your baby, but we can get a court order if needed." Care for those babies isn't significantly different than for our other preemies. We try to avoid transfusions in all of them if we can. The one difference is that the babies for whom we need a court order get an appointed guardian who has to approve any transfusions. It's not simply left up to the physician once the court order is in place. The guardian, who is generally a hospital administrator, has to be convinced of the need. I've only seen one transfusion refused, but the guardians take their responsibility very seriously.
Older Jehovah's Witness families don't always have the hard-line belief that all transfusions are prohibited for all members of the faith. Some believe very strongly that transfusion is always wrong. Others believe that it would be wrong for them to have a transfusion, but that their baby is not yet in a position to make that choice. They, like our appointed guardians, want to be convinced that each transfusion is actually needed, but they will sign the consent form themselves. Retaining control is probably an important part of choosing that path.
While doing some background reading for this post, I discovered a web site titled Associated Jehovah's Witnesses for Reform on Blood. The site says that they have members who are or have been elders or members of Hospital Liaison Committees. They disagree with stated positions of the Watchtower on the use of blood and blood products and say that they hope to educate Jehovah's Witnesses on what they call inconsistencies in doctrine.
I don't share the Jehovah's Witness belief that it is a sin to use blood or blood products, but I do appreciate the technological advances that have resulted from medical and surgical attempts to minimize or avoid transfusions. Transfusions save lives, but they're not free of risk.