Some time back there was a discussion of the Society's Advance Medical Directive/Release ("blood") card and whether JWs were coerced into carrying it. Here are the instructions from the January 1999 Our Kingdom Ministry on distribution of the card. I have highlighted portions...
SERVICE MEETINGS FOR JANUARY
Week Starting January 4
[...] 20 min: Making a Legal Choice for Nonblood Management of Health Care (Acts 15:28, 29). Talk by a qualified elder, based on question-and-answer guide that accompanies the Society's health-care durable power of attorney, or proxy, form and the sheet entitled "Information About the Society's Health-Care Durable Power of Attorney (DPA) Forms," both dated January 1997. Advance Medical Directive/Release card: Following this meeting, baptized Witnesses will be given a new card, and those with unbaptized minor children will receive an Identity Card for each child. These cards are not to be filled out tonight. They should be filled out carefully at home but NOT signed. Signing, witnessing, and dating of all cards will be done after the next Congregation Book Study, under the supervision of the book study conductor. Before signing, ensure that the cards are filled out completely. Those signing as witnesses should actually see the cardholder sign the document. By adapting language from this card to their own circumstances and convictions, unbaptized publishers may write out their own directive to use for themselves and their children. Durable power of attorney, or proxy, form: This has been prepared by the Society and is a more comprehensive health-care document that provides primary legal protection. Many doctors have reacted very favorably to this document because it contains detailed information needed to treat Witness patients effectively. Publishers who have not already filled out this form and who wish to do so can obtain a copy from the congregation secretary. (It is not necessary to fill out a new one each year. However, if a publisher has moved to another state, he would need to execute a new form in order for it to be effective in that state.) Additionally, if a durable power of attorney, or proxy, form has been executed, you should write on the front of the Advance Medical Directive/Release card, preferably in your own hand: "I have also executed a health-care power of attorney." Book study conductors should make a checklist to ensure that all assigned to their group have the assistance they need to fill out the Advance Medical Directive/Release card and durable power of attorney, or proxy, form. For the best legal protection, both documents should be filled out.
Is there any suggestion in these instructions that the card is "optional" for JWs? Based on your experience, how would one who declined to sign and carry a card be viewed? Would his book study conductor simply say, "Sure, I understand... no big deal"?