The Jehovah's Witness (JW) members abstain from receiving blood transfusions or blood product infusions because these treatments are considered an extension of life. A JW who incurs significant thermal injury requires a protocol defining good clinical practices in life-threatening predicaments acceptable to JW members to avoid legal proceedings. Assessment of religious commitment, competency, family resources, and respect for the patient's refusal of treatments is required. Detailed documentation of the patient's position is necessary. Medical management should include standard critical care measures, blood conservation, restricted laboratory work, utilization of pediatric blood collection tubes, nonblood plasma expanders, erythropoietin administration, iron supplements, and aggressive nutritional support with appropriate surgical conservation measures during skin grafting procedures. With conservative management, a positive outcome can be attained without recourse to the legal system.