This chapter presents a case study of a 41-year-old female with hepatitis C cirrhosis complicated by hepato-pulmonary syndrome. Adults with appropriate decision-making capacity express their autonomy through the informed consent process. Physicians demonstrate respect for the autonomy of competent patients by accepting their informed decisions, whether or not they consent to medical treatment. Key questions arise in most cases involving Jehovah's Witnesses (JWs) and others who refuse certain types of treatment on religious or other grounds. Due to strongly-held beliefs, most practicing JWs patients refuse transfusion of blood and many blood products. Respect for patient autonomy is the primary ethical principle applied in the United States, while the principle of beneficence is more strongly held in many other countries. Respect for autonomy supports the concept that adult, competent patients have the right to refuse blood transfusions, as well as any other therapy.