A JW could sign a LoU and subsequently still fight a blood transfusion claiming it against his or her religious mores and akin to rape because LoUs do not affect the legal rights of either the JW or the hospital.
I still disagree with the claim that no change took place, even if it was not a recent change. It's not just about whether legal rights have been disclaimed or not. It's about what the HLCs are telling parents in conjunction with these forms. Everyone knows that the majority of parents will do what the HLC tells them, so that's a more important barometer of their official policy than whether legal rights are surrendered. The fact is that a couple of decades ago, it was commonplace for parents to force a court order, whereas now they will sign this letter and not pursue their legal rights, whether they formally waive them or not.