The Big Question: Who are the Jehovah's Witnesses, and why do they refuse blood transfusions?

Why ask now?

Because Emma Gough, a 22-year-old mother has just died in a Shrewsbury hospital hours after giving birth to twins. She was a Jehovah's Witness (JW) and had refused a blood transfusion. There are 130,000 JWs in the UK, and almost seven million worldwide. Their numbers have almost doubled in 20 years.

Believers – who include the tennis stars Venus and Serena Williams, model Naomi Campbell, and singers Prince and Michael Jackson – routinely sign forms before hospital treatment insisting on no transfusions. They say the Bible forbids them.

What exactly do they believe?

Jehovah's Witnesses grew out of the American Adventist tradition, who thought the world was about to end. The Adventist movement began in 19th century America when a Protestant farmer named William Miller predicted the second coming of Christ would happen on 22 October 1844. When it didn't – a non-event which became known as The Great Disappointment – the Millerites fragmented into various factions, including the Seventh Day Adventists. The JWs grew from this culture. (In 1966 they said the world would, probably, end in 1975, which set back the movement's growth for three years, but it recovered.)

The JWs accept the Bible as scientifically and historically accurate and interpret much of it literally. They reject ideas they can't extrapolate from the Bible. So they reject standard Christian doctrines like the idea that Jesus was God, that he died on a cross, that he was physically resurrected, that souls live after death, that Hell exists etc. Ideas they do find in the Bible lead them to reject gambling, masturbation, abortion, homosexuality and excessive public displays of affection.

So what is with all the knocking on front doors?

The movement was founded by a a chap called Charles Taze Russell in 1879. he called his followers "Bible Students". An emphasis on house-to-house preaching began in 1922 and they changed their name to the Jehovah's Witnesses (after Isaiah 43:10) in 1931.

The idea is that JWs are "in the world but not of it". So they live and work among the general community, and send their children to state schools, but every member spends at least 70 hours a month on door-to-door missionary activity. They have no professional clergy; all baptised members are considered ordained ministers.

In 2005 Jehovah's Witnesses around the world spent over 1.2 billion hours on missionary work, handing out their magazine, Watchtower. Published in 161 languages it has an average print run of 27 million, making it the largest circulation magazine in the world.

So why are they such figures of fun?

No one likes having their evening's telly interrupted. But it's more than that. Their publicly-flaunted separatism irks or angers others. They don't fit in. They refuse to celebrate Christmas. They don't vote at elections. They decline to salute flags or sing nationalist songs. In the First World War in Britain, Canada and the USA they refused to fight and their American leaders got 20 year sentences for treason. In Nazi Germany they refused to say Heil Hitler and denounced the swastika as idolatrous. Half of them were sent to concentration camps where their purple triangle badges indicated they could be released if they recanted their religion. Few did. Half of them died there. In the US, three quarters of all conscientious objectors were JWs. In Britain they were tarred and feathered. So it goes on. Today they are persecuted in Russia, Uzbekistan, Belarus, and Cuba.

Why don't other religions stick up for them?

Because they have gone out of their way to be rude about them. They have their own, rather eccentric, translation of the Bible and rubbish everyone else's beliefs as "mere human speculations or religious creeds". They have routinely described the Roman Catholic Church as a "semiclad harlot reeling drunkenly into fire and brimstone". Then there are "the so-called Protestants" and the "Yiddish" clergy "like foolish simpletons" participating in "the world empire of false religion". I could go on. They do. They are not exactly big on inter-faith.

What's the situation with child abuse?

Not good. They take Deuteronomy 19:15 literally, which demands two witnesses to a crime (not easy in cases of abuse). And they cite 1 Corinthians 6:1-11 – "Does anyone of you that has a case against the other dare to go to court before unrighteous men, and not before the holy ones?" – to justify trying to deal with criminals with courts of elders rather than courts of law. A Panorama investigation reported they have an internal list of 23,720 reported abusers which they keep private. Studies in the US suggest they have four times more sexual assaults on children than the Catholic Church.

So where does blood fit in?

They cite four biblical texts (Genesis 9:4, Leviticus 17:12-14, Acts 15:29 and Acts 21:25). They say these mean that blood, the life-force, belongs to God and is not there for human use. They believe it a sin to eat not just black pudding but also to eat the flesh of animals that have not been properly bled.

And they extend the ban to transfusions. They won't even allow someone's blood to be stored before an operation and then used after it to replace their own blood loss. Blood is not to be stored; it is to be poured out and returned to God. Some JWs even reject dialysis or cell salvage on these grounds. Some will not accept red cells, white cells, platelets or plasma, but accept "fractions" made from these components.

There is a philosophical problem here. When a substance is broken down into components does the original remain? Some 90-96 per cent of blood plasma consists of water. The remainder is albumin, globulins, fibrinogen and coagulation factors. JWs say these may be used, according to conscience, but only if taken separately. Opponents say is like outlawing a ham and cheese sandwich but allowing the eating of bread, ham and cheese separately.

They are criticised for other inconsistencies. Blood fraction products are only available because of blood donation – a practice JWs condemned as unethical.

But didn't they change their policy a few years back?

No. In 2000 the church council announced that it would no longer expel members who had willingly had a blood transfusion. But only because by doing so they had excommunicated themselves.

Many JWs still carry a signed and witnessed advance directive card absolutely refusing blood in the event of an accident. And the church's website still carries alarmist material about the dangers of transfusions in transmitting Aids, Lyme Disease and other conditions. It also exaggerates the effectiveness of alternative non-blood medical therapies.

What do doctors think?

The British Association of Anaesthetists guidelines insist that the wishes of the patient must normally be paramount. US doctors take a similar view; they know giving blood to someone who does not want it could get them sued – one of the busiest trauma hospitals in Florida even has a blanket policy of refusing to treat JWs.

Other countries, like France, take a more dirigiste view. And a landmark case in Dublin recently ruled that doctors were right to give a woman blood during childbirth because the right of her child to have a mother over-ruled her own right to refuse the blood.

There are even more subtle dilemmas to come. One asks whether doctors are obliged to give chemotherapy, which is normally accompanied by a blood transfusion, to patients who insist on having it without the blood, without which it is highly likely to fail. As medicine advances things are likely to get more, rather than less, tricky.