This paper is a commentary on Koplin’s “From Blood Donation to Kidney Sales”. While appreciative of his paper, it argues that an argument from social solidarity to a Titmussian donor system is problematic. It reviews weaknesses in Titmuss, discusses problems about Titmussian blood donation as a vehicle for solidarity, and explores problems about extending a Titmussian approach to organs.

Petersen and Lippert-Rasmussen argue that persons who decide to be organ donors should receive a tax break, and then defend their view against eight possible objections. However, they misunderstand the Titmuss-style concerns that might be raised against their proposal. This does not mean that it should be rejected, but, instead, that when it is reconfigured to meet the Titmuss-style charges against it, they should support legalizing markets in human organs rather than merely offering tax breaks to encourage their (...) donation. (shrink)

This article defends Richard Titmuss''s argument, and PeterSinger''s sympathetic support for it, against orthodoxphilosophical criticism. The article specifies thesense in which a market in blood is ``dehumanising'''' ashaving to do with a loss of ``imagined community'''' orsocial ``integration'''', and not with a loss of valued or``deeper'''' liberty. It separates two ``domino arguments''''– the ``contamination of meaning'''' argument and the``erosion of motivation'''' argument which support, indifferent but interrelated ways, the claim that amarket in blood is ``imperialistic.'''' Concentrating onthe first domino (...) argument the article considers theview that monetary and non-monetary meanings of thesame good can co-exist given the robustness of certainkinds of relationship and joint undertakings withinwhich gifts can figure. It argues that societalrelationships are vulnerable or permeable to theeffects of the market in a way that those constitutiveof the personal sphere are not.General, more broadly political questions remainunanswered but the core of Titmuss''s original andchallenging argument remains and can be presented ina defensible form. (shrink)

Many global and national systems of regulation of blood donors and donor compensation rely for intellectual support on Richard Titmuss’s views, represented in The Gift Relationship. Based on selective interpretation of data from the 1960s, Titmuss engineered an ethical view pertaining to donors and, in so doing, created not only ongoing stereotypes, but created a cause for followers to perpetuate misunderstandings about the nature of such donations. In many cases, donors are, in fact compensated, but regulatory systems persevere (...) in using definitional fig leaves in order to perpetuate an ongoing political goal of diminishing private sector participation in health care. However, in more recent works, including new views of critical sociology and evolutionary psychology, the Titmuss worldview has been turned upside-down. Evidence readily available today proves the safety of compensated donation and the lives saved by encouraging policies for both compensated and non-compensated donation. (shrink)

This article examines the influence of Emile Durkheim's sociology on Richard Titmuss, founder of the academic field of social policy. While operating in different environments and historical eras, they shared concerns about modernity's impact on contemporary societies, heightened by their experiences of living in periods of considerable political and socio-economic upheaval. Their social thought embraced crucial complementarities, and understanding these adds a previously under-explored dimension to Titmuss's influential analyses of Britain's post-war ‘welfare state’.

If unremunerated blood donors are willing to participate, and if the use of them is economical from the perspective of those collecting blood, I can see no objection to their use. But there seems to me no good reason, moral or practical, why they should be used. The system of paid plasmapheresis as it currently operates in the United States and in Canada would seem perfectly adequate, and while there may always be ways in which the safety and efficiency of (...) supply could be increased, there seems no reason whatever to think that there would be an improvement if the current system changed so as to rely entirely on unpaid donors. Further, given the adequacy of paid plasmapheresis, I could see no problem if the collection of whole blood were to take place on a similar, fully-commercial, basis. Such a view is controversial. To argue for it, this paper offers just one strand in a complex argument: a critique of Richard Titmuss’s Gift Relationship, which holds an iconic position in the critical literature on the paid provision of blood. As I conclude: all told, there seems no good basis for rejecting supply of whole blood for money—let alone the supply of blood plasma. (shrink)

Can taxation and the redistribution of wealth through the welfare state be conceived as a modern system of circulation of the gift? But once such a gift is institutionalized, regulated and sanctioned through legal mechanisms, does it not risk being perverted or corrupted, and/or not leaving room for genuinely altruistic motives? What is more: if the market’s utilitarian logic can corrupt or ‘crowd out’ altruistic feelings or motivations, what makes us think that the welfare state cannot also be a source (...) of corruption? To explain the standard answers to the abovementioned questions as well as their implications I will first re-examine two opposing positions assumed here as paradigmatic examples of other similar positions: on the one hand, Titmuss’s work and the never-ending debate about it; on the other, Godbout’s position, in-so-far as it shows how Titmuss’s arguments can easily be turned upside down. I will then introduce and reinterpret Einaudi’s “critical point” theory as a more complex and richer anthropological explanation of the problems and answers considered herein. Through the analysis of these paradigmatic positions I will develop two interrelated arguments. 1) The way these problems are posed as well as the standard answers to them are: a) subject to fallacies: the dichotomy fallacy and the fallacy of composition; b) too reductive and simplistic: we should at least try to clarify what kind of ‘gift’ or ‘corruption’ we are thinking about, and who or what the ‘giver’, the ‘corrupter’, the ‘receiver’ and/or the ‘corrupted’ party are. 2) The answers to these problems cannot be found by merely following a theoretical approach, nor can they be merely based on empirical evidence; instead, they need to take into account the forever troublesome, ambiguous and unpredictable matter of human freedom. (shrink)

ABSTRACT The late Richard Titmuss made a persuasive case against allowing the sale of human blood in his book, The Gift Relationship. His arguments have been developed further by Peter Singer in recent articles. While the issues of quantity and quality of blood under market and non‐market systems have received much attention, the moral and political aspects of the Titmuss‐Singer case have gone relatively unexamined. First, I question their claim that a donation‐only system promotes greater freedom, which rests (...) on a confusion of liberty and opportunity. Next, I consider reasons for doubting their view that altruism is fostered significantly more under the non‐market approach. Finally, I survey recent developments in the quantity‐quality debate and possible implications of the blood controversy for national health care. (shrink)

In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss’ arguments against a number of criticisms and respond to claims that Titmuss’ work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss’ arguments are more resilient than many advocates of (...) organ markets suggest, and more relevant to the debate than is commonly appreciated. (shrink)

There are some things money literally cannot buy. Invariably transformable goods are such things because when they are exchanged for money, they become something else. These goods are destroyed rather than transferred in monetary exchanges. They mark out an impassable limit beyond which money and the market cannot reach. They cannot be for sale, in the strongest and most literal sense. Variably transformable goods are similar. They can be destroyed when offered or exchanged for money, but they differ in their (...) ability to sometimes emerge from financial transactions intact. -/- Analyzing transformable goods reveals informative and surprising results. Like other goods and commodities, they are agent relative, defined by the way particular agents value them. Inside the same transaction, a good could be transformable for one agent and not another, depending on how and what these agents value in the transaction. Applying this conceptual framework can reveal otherwise obscure facets of existing and future debates about the ethics and limits of markets. To demonstrate this, the framework is here applied to Richard Titmuss’s arguments about markets in blood, clarifying and illuminating some of his most confusing claims. Applying this framework to other debates may reveal even more striking results. (shrink)

In this article, I argue we have collective duties to people who suffer from kidney failure and these duties are best fulfilled through a government-monopsony market in kidneys. A government-monopsony market is a model where the government is the sole buyer, and kidneys are distributed according to need, not ability to pay. The framework of collective duties enables us to respond to several of the most pressing ethical and practical objections to kidney markets, including Cécile Fabre's objection that it is (...) unjust to be paid to do one's duty, Simon Rippon's objections that it is harmful to be pressured to sell a kidney and that a market is unfair, Richard Titmuss's crowding out objection, and Ronald Dworkin's objection that body parts should not be among the goods we owe each other. (shrink)

Acts of helping others are often based on mixed motivations. Based on this claim, it has been argued that the use of a financial reward to incentivize organ donation is compatible with promoting altruism in organ donation. In its report Human Bodies: Donation for Medicine and Research, the Nuffield Council on Bioethics uses this argument to justify its suggestion to pilot a funeral payment scheme to incentivize people to register for deceased organ donation in the UK. In this article, I (...) cast a sceptical eye on the above Nuffield report's argument that its proposed funeral payment scheme would prompt deceased organ donations that remain altruistic . Specifically, I illustrate how this scheme may prompt various forms of mixed motivations which would not satisfy the report's definition of altruism. Insofar as the scheme produces an expectation of the reward, it stands diametrical to promoting an ‘altruistic perspective’. My minimal goal in this article is to argue that altruism is not motivationally compatible with reward as an incentive for donation. My broader goal is to argue that if a financial reward is used to incentivize organ donation, then we should recognize that the donation system is no longer aiming to promote altruism. Rewarded donation would not be altruistic but it may be ethical given a persistent organ shortage situation. (shrink)

Five arguments are presented in favour of the proposal that people who opt in as organ donors should receive a tax break. These arguments appeal to welfare, autonomy, fairness, distributive justice and self-ownership, respectively. Eight worries about the proposal are considered in this paper. These objections focus upon no-effect and counter-productiveness, the Titmuss concern about social meaning, exploitation of the poor, commodification, inequality and unequal status, the notion that there are better alternatives, unacceptable expense, and concerns about the veto (...) of relatives. The paper argues that none of the objections to the proposal is very telling. (shrink)

The needs principle—that certain goods should be distributed according to need—has been central to much socialist and egalitarian thought. It is the principle which Marx famously takes to be that which is to govern the distribution of goods in the higher phase of communism. The principle is one that Marx himself took from the Blanquists. It had wider currency in the radical traditions of the nineteenth century. In the twentieth century it remained central to the mutualist form of socialism defended (...) by Tawney and Titmuss. The principle underlay the development and justification of the modern welfare state—thus the National Health Service is still founded upon the idea that the distribution of medical resources should be determined by medical need, not by ability to pay. One source of the power of the needs principle lies in the fact that it appears to be both a principle of justice and a principle of community or social solidarity. As a principle of justice it is offered as a corrective to the particular forms of unequal distributions of goods that can result from market transactions, and as a principle of community or social solidarity as a corrective to the possessive individualism taken to be the corollary of a market order. (shrink)

Should blood be bought and sold is in crude terms the question asked and answered by Richard Titmuss in his recent book The Gift Relationship. Dr Raymond Plant, a lecturer in philosophy at Manchester University, analyses Titmuss' arguments in a paper which we are printing in two parts. Titmuss has taken the provision of blood as his example of the gift relationship--and by extension that of health care generally. Dr Plant considers in turn each of Titmuss' (...) arguments that blood should not be a marketable commodity, the moral objections to which seem to be the erosion of freedom and of truth telling, the separation of society through the cash nexus, and its converse that the provision of health care is a means for the integration of society. Dr Plant also examines the views of other commentators on the Titmuss' theory of the value of a 'free' blood transfusion service and other medical care as a means of integration in society, and ends with his promise that in the second part of his paper he will examine Titmuss' principles not in terms of the market but rather as related to the principle of social justice. (shrink)

Are there worthwhile values and ideals which flourish in the procedures of the state but wither in the transactions of the market? Are there equitable and fulfilling social relationships which are nurtured in the economic sphere but crumble in the political world? There is clearly some truth in the claim that at least in certain circumstances market systems inculcate in people not only ‘honesty and diligence, but also sensitivity to the needs and preferences of others’ . On the other hand, (...) it is difficult to deny the appeal of a tradition of thought which attaches moral superiority to the non-market ideals and values epitomised in the gift relationship. Titmuss , for example, objected to treating blood as a commodity in part because it undermined the sense of fraternity or community which a system of voluntary blood donors enhanced. A contemporary statement of this position holds that gift values differ from commodity values in being ‘tokens of love, admiration, respect, honor, and so forth, and consequently lose their value when they are provided for merely self-interested reasons’. (shrink)

Since the early 1970s, Marcel Mauss’s Essai sur le Don, translated into English as The Gift in 1954, has been a standard reference in the social science and bioethical literature on the use of human body parts and substances for medical and research purposes. At that time, three social scientists—political scientist Richard Titmuss in the United Kingdom and sociologist Renée C. Fox working with historian Judith Swazey in the United States—had the idea of using this concept to highlight the (...) fundamental structure of the biomedical practices they were studying, respectively, blood donation, and hemodialysis and organ transplantation. The fact that these first applications of Mauss’s essay should emerge in English- rather than in French-speaking countries raises the question of what the translation of the essay, and notably of the word don as gift, may have to do with this fact. Reading Mauss in translation undoubtedly inspired a seminal approach to interpreting medical and research practices based on bodily giving. This article posits that something may have also been lost: a much broader concept of giving with unquestionable links to the Durkheimian concept of solidarity, which Mauss conceptualizes not only as an obligation but also as a liberty to give. (shrink)

If unremunerated blood donors are willing to participate, and if the use of them is economical from the perspective of those collecting blood, I can see no objection to their use. But there seems to me no good reason, moral or practical, why they should be used. The system of paid plasmapheresis as it currently operates in the United States and in Canada would seem perfectly adequate, and while there may always be ways in which the safety and efficiency of (...) supply could be increased, there seems no reason whatever to think that there would be an improvement if the current system changed so as to rely entirely on unpaid donors. Further, given the adequacy of paid plasmapheresis, I could see no problem if the collection of whole blood were to take place on a similar, fully-commercial, basis. Such a view is controversial. To argue for it, this paper offers just one strand in a complex argument: a critique of Richard Titmuss’s Gift Relationship, which holds an iconic position in the critical literature on the paid provision of blood. As I conclude: all told, there seems no good basis for rejecting supply of whole blood for money—let alone the supply of blood plasma. (shrink)

A national opt-out system of post-mortem donation of scarce organs is preferable to an opt-in system. Unfortunately, the former system is not always feasible, and so in a recent JME article we canvassed the possibility of offering people a tax break for opting-in as a way of increasing the number of organs available for donation under an opt-in regime. Muireann Quigley and James Stacey Taylor criticize our proposal. Roughly, Quigley argues that our proposal is costly and, hence, is unlikely to (...) be implemented, while Taylor contests our response to a Titmuss-style objection to our scheme. In response to Quigley, we note that our proposal’s main attraction lies in gains not reflected in the figures presented by Quigley and that the mere fact that it is costly does not imply that it is unfeasible. In response to Taylor, we offer some textual evidence in support of our interpretation of Taylor and responds to his favoured interpretation of the Titmuss-style objection that many people seem to want to donate to charities even if they can deduct their donations from their income tax. Finally, we show why our views do not commit us to endorsing a free organ-market. (shrink)

Next SectionFive arguments are presented in favour of the proposal that people who opt in as organ donors should receive a tax break. These arguments appeal to welfare, autonomy, fairness, distributive justice and self-ownership, respectively. Eight worries about the proposal are considered in this paper. These objections focus upon no-effect and counter-productiveness, the Titmuss concern about social meaning, exploitation of the poor, commodification, inequality and unequal status, the notion that there are better alternatives, unacceptable expense, and concerns about the (...) veto of relatives. The paper argues that none of the objections to the proposal is very telling. (shrink)

Critics of commodification object to sales but not gifts of some goods, such as human blood or human organs, on grounds that such trade wrongly coerces, morally corrupts, and crowds out altruism. This essay takes issues with each of these claims. It disputes Micheal Sandel’s claim that voluntary exchange coerces, arguing that he confuses what is unfair with what is unfree. It argues, where trade does create moral costs, that these costs should be weighed against the moral costs of trade (...) bans, such as the loss of human life, and the harms endemic to illegal markets. The essay also quarrels with Richard Titmuss’s The Gift Relationship, arguing that compensation for blood need not crowd out blood donation, that compensation does not preclude a charitable impulse, and that some important gift relationship posses elements of altruism and exchange.Ceux qui critiquent la marchandisation sont contre la vente mais pas contre le don de certains biens comme le sang ou les organes humains parce qu’un tel commerce exercerait une contrainte, corromprait morallement, et ne laisserait pas de place à l’altruisme. Ce papier traite de chacune de ces affirmations. Il consteste l’affirmation de Micheal Sandel selon laquelle l’échange volontaire exerce une contrainte, en suggérant qu’il confond ce qui injuste avec ce qui n’est pas libre. Si le commerce entraîne des coûts moraux, cet essai suggère que ces coûts devraient être comparés avec les coûts moraux associés aux interdictions de commerce tels que la perte de la vie humaine et ceux associés aux maux endémiques des marchés illégaux. Il critique aussi l’ouvrage de Richard Titmuss, “The Gift Relationship” en suggérant que les compensations monétaires en échange d’un don de sang n’évincent pas nécessairement le don de sang, qu’elles n’empêchent pas les impulsions charitables, et que d’importants actes de don comportent des éléments d’altruisme et d’échange. (shrink)

This paper argues that, for Richard Titmuss, the rationale of the gift relationship (TGR) as a national blood policy is to reconcile liberty with social justice in the provision of an essential health resource. Underpinned by a needs-based distributive principle, TGR provides a social space for a plurality of values in which to engage with and motivate people to voluntarily give blood and other body materials as a common good. This understanding of TGR as a value pluralistic framework and (...) its implications will be used to discuss the issue of using economic mechanisms to increase the supply of body materials or goods, including organs for transplantation. It is argued that, while TGR excludes a policy in which body goods are treated as private commodities and distributed primarily on the basis of achieving market efficiency, it is not in principle opposed to the use of material rewards, including financial ones, to motivate people to donate. (shrink)

: The topic of organ transplantation is examined from the perspective of three authors: Robert Bellah, Jeremy Rifkin, and Margaret Jane Radin. Introduced by reflections on the development of the justification of organ transplantation within the Roman Catholic community and the various themes raised by the historical study in Richard Titmuss's The Gift Relationship, the paper examines how and in what ways the possible commodification of organs will affect our society and the impacts this may have on the supply (...) of organs. (shrink)