Abstract
Ontario’s Bill 178 proposing a Voluntary Blood Donations Act declares the offer or acceptance of payment for the donation of blood a legal offence and makes it subject to penalty. The bill reinvigorates a fundamental debate about the ethical problems associated with the payment of money for blood. Scarcity of blood donors is a recurring problem in most health systems, and monetary remuneration of the willingness to donate blood is regularly discussed—and sometimes practiced—as a means to overcome scarcity in blood. However, making blood an object of economic exchange has long aroused ethical concerns that often refer to the specific meaning of blood. From the perspective of a modern understanding of money as a metric of economic value, the exchange of money for blood—shed or given—is seen as ethically troubling, because it appears to imply a commensurability of the value of human life and economic wealth. In this paper, we begin with a general taxonomy of the types of arguments that speak in favour or against compensating donors for giving blood. We then describe the context in which the discussion about payment for blood arises, and of the specific aims and concerns that are brought forward in this context. This is used to reconstruct the normative background that supports the rejection of payment for blood as it is envisaged in Bill 178 and the aims of the proposal. We then argue that while a payment indeed changes the nature of a blood donation in an ethically considerable way, we do not believe that decisive arguments against the monetary remuneration of blood donations can be substantiated, at least not independently of assuming specific societal circumstances. Thus it may be possible to establish a stable and safe blood supply through just gratification while at the same time taking strong provisions against social disconnection, injustice, exploitation or heteronomy.
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Notes
A moral argument for the separation of different social spheres can be found in Walzer (1983, esp. chs. 3 & 4).
Whenever we speak of individuals who are dependent on receiving blood, we mean to include not only those who are in need of whole blood transfusions, but also those who depend on specific components of blood for therapy or the provision of pharmaceuticals. For a discussion of the general effects of the introduction of payment for blood donations on their safety and quantity see Rodriguez del Pozo (1994) and Fernández-Montoya (1997).
A person’s decision to give blood under economic pressure may be her own decision in the sense of the presence of a conscious intention to give blood. However, in a more demanding sense the person may be unable to identify with her decision, if she considers the motive of her action to give blood to be alien to her evaluative self-image.
We will not go into the discussion whether the harmful effects on society can in turn be translated into effects on the individual members of society. The central point here is that there may be a party—be it a collective or individual persons—besides the donors and recipients of blood that appears in the relevant ethical considerations.
One classic instance of this critique of a conversion of ends into means can be found in Marx’s analysis in the Comments on James Mill. See Quante (2011).
This distinction is obviously not to be identified with the distinction between categorical and contributory objections to paid blood donations. For, an intrinsic quality of an action may make it more or less commendable as a mere contributory reason. That an action is an instance of lying may make it intrinsically disfavourable, but may not be decisive reason against it, once it is granted that there are competing considerations—that it saves another person's life—to be taken into account.
See Strauss (2001).
It may be doubted that there are extrinsic categorical considerations. For this case one might think of consequences that are contingently linked to an action, and that render the conclusion unavoidable that the action is impermissible.
For simplicity's sake we only look at allogeneic donations, i.e., donations given to a blood bank, without having a specific recipient (e.g., the donor herself or a relative of hers) in mind.
Bill 178 (2014, 3.1.). Sentence 3.2. states the corresponding prohibition to accept payment for the donors.
WHO (2010, pp. 19–20).
WHO (2010) presupposes that „[paid] donors are vulnerable to exploitation and commercialization of the human body as they usually come from the poorer sectors of society and become paid blood donors due to economic difficulties.“ While this is probably true under many social circumstances, it would have to be shown that these circumstances actually apply in the case of the Canadian bill.
For this distinction see Archard (2002, pp. 93–94).
Bill 178 (2014, 1.3.).
Bill 178 (2014, 1.1.).
WHO (2010, p. 3) brings forward a similar argument that depends on the further recognition that “voluntary non-remunerated blood donors are the foundation of a safe, sustainable blood supply.”
Bill 178 (2014, 3.3).
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We would like to thank the two anonymous reviewers for their comments and critiques of the first submitted version of this paper.
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Derpmann, S., Quante, M. Money for Blood and Markets for Blood. HEC Forum 27, 331–345 (2015). https://doi.org/10.1007/s10730-014-9259-z
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DOI: https://doi.org/10.1007/s10730-014-9259-z