A 35-year-old man attempted suicide by a shotgun discharge to his abdomen. Although the patient had been awake, oriented, and conversing about baseball during the emergency medical services ride to the hospital, he made no mention of his religious beliefs. He is bleeding profusely when he arrives at the emergency room (ER). He is taken to the operating room (OR) for abdominal surgery to stop the bleeding and repair his damaged liver. He has lost a critical amount of blood and is under anesthesia when a call to the OR comes from an ER nurse who has been approached by the patient's family and given a Jehovah's Witness card signed by the patient. The card states: "NO BLOOD TRANSFUSION! As a God-fearing Christian and a believer in Jehovah's word, the Bible, I hereby demand that blood, in any way, shape or form, is NOT to be fed into my body; however, blood substitutes may be used in case of extreme loss of blood.".