Surgical procedures in otolaryngology are often associated with the need for blood transfusions. Homologous blood transfusions carry risks and may be unacceptable to some patient groups. The Jehovah's Witness Society is known to many because of its stance on blood products. Refusal of potentially life-saving treatment creates ethical dilemmas for treating clinicians. Throughout the world, Jehovah's Witnesses have fought for the right to refuse blood products. This article examines the need for blood in otolaryngological procedures, surgical strategies to reduce blood loss, the beliefs of Jehovah's Witnesses regarding the acceptability of blood, and procedures and legal stances adopted when treating Jehovah's Witnesses.