While growing up near Lynchburg, Virginia, a young Desmond Doss nearly kills his younger brother Hal. This experience and his Seventh-day Adventist upbringing reinforce Desmond's belief in the commandment: Thou shalt not kill. Years later, Doss takes a man injured by a car to the hospital and meets a nurse, Dorothy Schutte. They enter into a relationship and Doss tells her of his desire to do medical work.

At the outbreak of World War II, Doss is motivated to enlist in the Army. His father, a troubled World War I veteran, is deeply upset by the decision. Because he is a conscientious objector, Doss intends to serve as a combat medic. Before leaving for Fort Jackson, South Carolina, he asks for Dorothy's hand in marriage and she accepts.

Doss is placed under the command of Sergeant Howell. He excels physically but becomes an outcast among his fellow soldiers for refusing to handle a rifle and train on Saturdays. Howell and Captain Glover attempt to discharge Doss for psychiatric reasons but fail. Howell then torments Doss by putting him through grueling labor, intending to get Doss to leave of his own accord. Despite being beaten one night by his fellow soldiers, he refuses to identify his attackers and continues training.

They complete basic training and are released on leave, during which Doss intends to marry Dorothy, but his refusal to carry a firearm leads to an arrest for insubordination. Dorothy visits Doss in jail and tries to convince him to plead guilty so that he can be released without charge but Doss refuses to compromise his beliefs. At his trial, Doss pleads not guilty but before he is sentenced, his father barges into the tribunal with a letter from a former commanding officer stating that his son's pacifism is protected by an Act of Congress. The charges against Doss are dropped, and he and Dorothy are married.

Doss' unit is assigned to the 77th Infantry Division and deployed to the Pacific theater. During the Battle of Okinawa, Doss' unit is informed that they are to relieve the 96th Infantry Division, which was tasked with ascending and securing the Maeda Escarpment ("Hacksaw Ridge

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