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Health Care Analysis
Erschienen in: Health Care Analysis 4/2014

01.12.2014 | Original Article

Challenging the Moral Status of Blood Donation

verfasst von: Paul C. Snelling

Erschienen in: Health Care Analysis | Ausgabe 4/2014

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Abstract

The World Health Organisation encourages that blood donation becomes voluntary and unremunerated, a system already operated in the UK. Drawing on public documents and videos, this paper argues that blood donation is regarded and presented as altruistic and supererogatory. In advertisements, donation is presented as something undertaken for the benefit of others, a matter attracting considerable gratitude from recipients and the collecting organisation. It is argued that regarding blood donation as an act of supererogation is wrongheaded, and an alternative account of blood donation as moral obligation is presented. Two arguments are offered in support of this position. First, the principle of beneficence, understood in a broad consequentialist framework obliges donation where the benefit to the recipient is large and the cost to the donor relatively small. This argument can be applied, with differing levels of normativity, to various acts of donation. Second, the wrongness of free riding requires individuals to contribute to collective systems from which they benefit. Alone and in combination these arguments present moral reasons for donation, recognised in communication strategies elsewhere. Research is required to evaluate the potential effects on donation of a campaign which presents blood donation as moral obligation, but of wider importance is the recognition that other-regarding considerations in relation to our own as well as others’ health result in a range not only of choices but also of obligations.
Fußnoten
1
A recent NHS advertisement has a boy explaining what he is not worried about. ‘But I am worried about Dad smoking. I’m worried that my Dad will die.’ Available at http://​www.​youtube.​com/​watch?​v=​BmUtR8DcMAc&​feature=​related (This and all urls last accessed on 9th August 2012).
 
2
I do not include the obligation to pay taxes which funds, in part, other people’s health care.
 
3
Smoking, Health and Social Care (Scotland) Act 2005; Health Act 2006. Justification for the legislation was the harm principle as reported in the House of Commons Select Committee report [46], but see also Coggon [20, 21] for a discussion of the ban applied to prisoners in Rampton Hospital where prisoners’ own health was also a factor.
 
4
See R v. Dica 3 A11 ER 593.
 
5
The advice contained in the NHS leaflet was ‘Do not go into your GP surgery or local accident and emergency department unless you are advised to do so or you are seriously ill, because you might spread the illness to others. Ask a flu friend to go out for you.’ Available at http://​www.​direct.​gov.​uk/​prod_​consum_​dg/​groups/​dg_​digitalassets/​@dg/​@en/​documents/​digitalasset/​dg_​177903.​pdf.
 
6
He actually uses the terms ‘easy’ and ‘abstruse’.
 
7
I do not mean to suggest that individuals choose to donate or not to donate for reasons which are exclusively moral [71]. The issue is highly complex, influenced by many social and psychological factors. The Theory of Planned Behaviour suggests that moral values are influential in determining the attitudes and subjective norms preceding an intention to donate [36], but it would be as significant an error to see donation exclusively in terms of moral reasons as it would be to ignore them altogether.
 
8
Some, notably those of the Jehovah’s Witness faith, regard blood donation as morally forbidden, but I do not consider that here as I am interested in blood donation within a system of therapeutic use of blood and blood products which those who regard its use in this way stand outside.
 
9
There are separate organisations covering England, Scotland, Wales and Northern Ireland, though the English organisation also covers North Wales. Unless stated, references are to websites and documents from the (English) National Blood Service, part of the NHS Blood and Transplant Authority.
 
10
This argument is derived from Titmuss’ [90] important work. Three arguments for the preference of voluntary donation are (1) Commercial supply reduces voluntary donation in the ‘crowding out effect’ (2) paid blood is inherently unsafe, and (3) there is a risk of exploitation and harm to poor donors who sell blood through economic necessity. Empirical evidence for these positions is scant [33]. For a more detailed examination of Titmuss’s work, see Sykora [88], and for a critique see Rapport and Maggs [74].
 
11
The full text of article 20 of directive 2002/98/EC is ‘Member States shall take the necessary measures to encourage voluntary and unpaid blood donations with a view to ensuring that blood and blood components are in so far as possible provided from such donations.’ (see Farrell [32] for a review of blood safety in the EU).
 
12
Stewart and Lynch [86, p. 600] report the legal case of Mrs U where undue influence requires ‘…something more than pressure’, but it is unclear whether the DH is using the phrase in a legal or everyday sense.
 
13
DOMAIN is a European project that focuses on good donor management. Funded by the European Union, 18 blood organisations from 18 countries are members, including the four UK organisations.
 
14
Available at http://​www.​blood.​co.​uk/​video-audio-leaflets/​tv-radio-ads/​). This advertisement is not currently being aired but it remains available on the blood transfusion website.
 
15
The previous campaign in the UK used celebrities who identified individuals who had helped them or a relative in the past. For example the chef Gordon Ramsay, says that ‘without this man I would have died from a ruptured spleen.’ (available at http://​collection.​europarchive.​org/​tna/​20090605173026/​http://​blood.​co.​uk/​pages/​video_​06.​htm.
 
16
The webpage of the united States organisation ‘Blood centres for the Pacific’ is www.​bloodheroes.​com and the system of small rewards for donation in the form of tee shirts and restaurant vouchers is known as ‘hero rewards’.
 
17
Driver [28] argues that it is possible for an obligatory act to be considered praiseworthy, and gives some examples to show that some obligatory acts are more praiseworthy than others that are supererogatory.
 
18
This is in contrast to acts of donation where the recipient is known or later identified, for example living kidney donation.
 
20
And at the risk of expressing ‘shallow gratitude’ [6] for the modest success of writing this paper, I am happy to thank and acknowledge him in return.
 
21
BBC Media Action is BBC’s International charity. It ‘is using media and communication to provide access to information and create platforms to enable some of the poorest people in the world to take part in community life, and to hold those in power accountable’ http://​www.​bbc.​co.​uk/​mediaaction/​what_​we_​do/​governance_​and_​rights
 
23
Thanks to Dr Sabita Menon for the translation.
 
25
Using data from the Ministry of health and Family Welfare. http://​cdsco.​nic.​in/​html/​BloodList.​html.
 
26
And of course it is no accident that the individual is an appealing child. Singer [79] discusses studies which show that the propensity to donate money is increased when the focus is on one rather than many beneficiaries, and of course the opposite effect was well known in perhaps apocryphal quotation attributed to Stalin; ‘The death of one man is a tragedy. The death of millions is a statistic.’
 
27
An advertisement feature from Florida includes an interview with a doctor who suggests that blood donors have a reduced risk of cancer. The suggestion is that blood donors tend to be individuals who also consult their doctors more often, but the clear implication is a causal effect between giving blood and reduced chance of contracting cancer. Even if a more generous interpretation is allowed, this film remains a direct claim of the personal benefits of blood donation. (available at http://​www.​youtube.​com/​watch?​v=​8MNmeLaVLdM).
 
28
And for Kantianism (see [4].
 
30
And the Human Tissue (Scotland) Act 2006.
 
31
The free riding of the dead person is retrospective, that is the claim is that he would have accepted an organ.
 
32
It is this latter provision which forms the minimal normative expectation in the NHS Constitution (DH [26] ‘You should ensure that those closest to you are aware of your wishes about organ donation’.
 
33
A thin version of this would be presumed consent, currently in force in some countries and being introduced in Wales [30]. True enforceability would mean removal of organs even in the face of refusal to consent from relatives and prior to death from the deceased. This is seldom suggested; but see Fabre [31].
 
34
In order to prevent free-riding Jarvis [52] offered the ‘modest proposal’ that only those individuals signed up as organ donors should be eligible to receive them. A more modest version of this modest proposal, that those willing to donate should be prioritised for receipt [29, 91] avoids the potential to waste organs, and has attracted, in the US, some public support [83], and was enacted in Israel in 2008 [54].
 
35
There is heightened interest in the concept of solidarity, and the arguments from beneficence and justice that I have offered could be presented within this framework. Further analysis is warranted elsewhere (see [72, 76].
 
36
Emphasis in original.
 
37
In the US in 1978, a man dying from leukaemia asked a judge to compel his cousin to donate bone marrow to save his life, and in refusing the request the judge left the cousin in no doubt that his refusal was ‘morally indefensible’ [85]. Regarding the act of donation of bone marrow as an obligation presents some difficulties, not least because, as in this case, of the complications of the Rule of Rescue [60] and family obligations.
 
39
It would be going too far to suggest that you ought not have a tattoo because it interferes with your opportunity to donate.
 
40
This analysis will differ for different acts of donation. Signing up to the bone marrow donation register will be of little value if I find a trivial reason not donate on the one occasion in 20 years when I am asked to make good on my intentions.
 
41
Who followed Ross [77].
 
42
According to the Cabinet Office [16, p. 4] the cabinet office team has ‘strong links’ to Professor Richard Thaler, co-author of ‘Nudge’.
 
43
There are however, differences in the stated motivations between its theory and practice. The UK Government’s aim is to find ‘intelligent ways to encourage, support and enable people to make better choices for themselves’ [16, p. 9], which sits uneasily with Thaler and Sunstein’s [89 p. 40] view that ‘framing works because people tend to be somewhat mindless, passive decision makers.’
 
44
There are seldom media stories explaining that treatment has to be curtailed because of insufficient supply, so it is assumed that despite occasional pressure the current system, including the advertisements, meets the needs placed upon it, though blood donation organisations would doubtless prefer the problem of having too many donors rather than too few [17]. As I write this there is some concern about the potential for shortages over the olympic summer resulting in more targeted approaches to individual donors.
 
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Metadaten
Titel
Challenging the Moral Status of Blood Donation
verfasst von
Paul C. Snelling
Publikationsdatum
01.12.2014
Verlag
Springer US
Erschienen in
Health Care Analysis / Ausgabe 4/2014
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-012-0221-4

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