Skip to main content
SpringerLink
Log in

The Gift Relationship Revisited

  • Published:
HEC Forum Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. See, for further discussion, Shearmur (2001, 2007a, b); see also (Shearmur 2003, 2010).

  2. This paper draws on work undertaken for a larger project, over many years, including in archives at the Stanford University School of Medicine, and the NIH. I will limit the extent to which points are documented in order to keep notes to a manageable length. For a most interesting and informative guide to some of the history here, see Starr (1998).

  3. Arrangements were, in fact, much more complex than this; not least because of the existence of a large Community Blood Bank sector (see, for an overview, Drake et al. 1982). In addition, what I am here describing as the ‘Red Cross’ and ‘AABB’ systems did not completely match membership of the Red Cross and AABB networks.

  4. See letters from J. S. Hayhurst, Blood Bank of San Bernardino-Riverside Counties, San Bernadino, Calif., 25 March 1974 and J. Wesley Alexander and George W. Geisen, University of Cincinnati Medical Center, 30 April 1974, Folder 1.2, Box 1 of NLM MS C 393, National Library of Medicine, Bethesda, MD, USA.

  5. Perlmutter v. Beth David Hospital, 308 N. Y. 100, 123 N.E. 2d 792 (1954). See, for a useful survey of these issues from the perspective of the mid-1970s (Havighurst 1976).

  6. Notable, here, is his influence on the work of Singer (1973, 1977).

  7. Compare, for example, Anderson (1990); for the Titmuss connection, see especially p. 196.

  8. On Titmuss see, for example, Reisman (1977, 2001), and (Oakley 1966).

  9. See, for some of the story, Fontaine (2002).

  10. Karl Marx, Critique of the Gotha Programme; cf. https://www.marxists.org/archive/marx/works/download/Marx_Critque_of_the_Gotha_Programme.pdf. In Titmuss’s case, however, there is—in Fabian fashion—a backdrop of paid professionals who direct the program.

  11. Important criticisms of a Titmussian approach have been made by a variety of writers over the years, but what they add up to seems seldom to be appreciated. See, for example, Alchian et al. (1973), Sapolsky and Finkelstein (1977), Sapolsky (1989), Schwartz (1999), and (Healy 2006).

  12. Not least because of the way in which the Red Cross has, historically, been associated with wartime provision.

  13. For example, if there is a statistically higher rate of the injection of illegal drugs among a particular racial group in a particular area.

  14. For some interesting discussion of this, see Leveton et al. (1995).

  15. See National Library of Health Archives, U.S. Department of Health Education and Welfare, National Blood Policy Records 1969–1981.

  16. Personal recollection of discussion at a consultative meeting discussing Australian Blood Supply Policy, which had representation from patients’ groups.

  17. See, on this, Drake (1976). He also contributed on this theme to Drake et al. (1982) and was also an author or co-author of related studies published internally by the Department of Operations Research at MIT; see Goodrich (1977) and Drake (1978).

  18. See on this Anderson et al. (1999). On the sale of blood plasma see, e.g., Espeland (1984)  and  Kretzmann (1992).

  19. An experienced researcher in this field, in a personal communication, has mentioned that: "When [the researcher] studied blood donors in Poland, they had a system in which people could give for pay or for nothing in the same facility. [The researcher] talked to donors who said they sometimes did one and sometimes the other, depending on how much they needed the money."

  20. I should perhaps stress that I am all in favour of the existence and activities of such companies who on the face of it play a key role in saving lives. My point, in the text, is that it is not obvious why people should be expected to supply their raw material without payment.

  21. For its unavoidability if we wish to live in an economy with the extensive advanced division of labour, see Hayek (1997).

  22. He refers, in this context, to Rodriguez del Pozo (1994).

  23. I have found people who express surprise when told that blood is no longer purchased, while the ghost of the insurance/assurance arrangements still seems to live on in the basis of how people are encouraged to give blood in some areas of the U.S.

  24. It is striking that, for example, David Miller favours the artificial creation by the state of such arrangements as a moral basis for a national health service; see Miller (1995).

  25. See National Library of Health Archives, U.S. Department of Health Education and Welfare, National Blood Policy Records 1969–1981, MSC 393.

  26. From archive materials held at the Stanford University School of Medicine, Allen—who had done a lot of work on what he thought was the misuse of blood-replacement funding by a San Francisco community blood bank – was in correspondence with the California state officers who initiated this action.

  27. Radin (1996) is useful on this point.

  28. In addition, it is not clear that moral pressure on family members is a good basis on which to collect blood. (For example, people who have good reasons not to donate may be reluctant to have to explain these to members of their immediate family).

  29. See George W. Geisen and Eve Gorman, ‘Let’s Get on the Target’, delivered to the AABB Annual Meeting, Bar Harbour, Miami Beach, Florida, November 14th 1973, and also submitted as part of a response to the National Blood Policy Implementation Plan, MSC 393, Box 1, 1–5, No. 218; see National Library of Health Archives, U.S. Department of Health Education and Welfare, National Blood Policy Records 1969–1981.

References

  • Alchian, A., et al. (1973). The economics of charity. London: Institute of Economic Affairs.

    Google Scholar 

  • Anderson, E. (1990). The ethical limitations of the market. Economics and Philosophy, 6, 179–205.

    Article  Google Scholar 

  • Anderson, L., et al. (1999). “Selling blood”: Characteristics and motivations of student plasma donors, Sociological Spectrum, April–June (19, no. 2), pp. 137–162.

  • Archard, D. (2002). Selling yourself: Titmuss’s argument against a market in blood. The Journal of Ethics, 6(1), 87–103.

    Article  Google Scholar 

  • Drake, A. W. (1976). Getting people to give blood: Some ideologies, practices and issues. In D. B. Johnson (Ed.), Blood policy: Issues and alternatives. American Enterprise Institute: Washington, D.C.

    Google Scholar 

  • Drake, A. W. (1978). Public attitudes and decision processes with regard to blood donation. Cambridge, MA: Operations Research Center, Massachusetts Institute of Technology.

    Google Scholar 

  • Drake, A. W., et al. (1982). The American blood supply. Cambridge, MA: MIT Press.

    Google Scholar 

  • Eckert, R. D. (1986). AIDS and the blood bankers, Regulation 10, September–October, pp. 15–24 and 54.

  • Eckert, R. D. E., & Wallace, E. (1985). Securing a safer blood supply: Two views. Washington: American Enterprise Institute.

    Google Scholar 

  • Espeland, W. (1984). Blood and money: Exploiting the embodied self. In A. K. Joseph & F. Andrea (Eds.), The existential self in society (pp. 131–155). Chicago: University of Chicago Press.

    Google Scholar 

  • Fontaine, P. (2002). Blood, politics, and social science. Richard Titmuss and the Institute of Economic Affairs, 1957–1973. Isis, 93(3), 401–434.

    Article  Google Scholar 

  • Frantz, D., & Collins, C. (1999). Celebration. New York: Henry Holt.

    Google Scholar 

  • Goodrich, C. (1977). Comments about blood donation: nondonor exdonor and recent donor responses to some open-ended questions prepared by Christine Scott Goodrich and Alvin Drake. Cambridge: Operations Research Center, MIT.

    Google Scholar 

  • Havighurst, C. (1976). Legal responses to the problem of poor-quality blood. In D. B. Johnson (Ed.), Blood policy: Issues and alternatives (pp. 21–37). Washington, D.C.: American Enterprise Institute for Public Policy Research.

    Google Scholar 

  • Hayek, F. (1997). Socialism and war. Chicago: University of Chicago Press, Bruce Caldwell.

    Book  Google Scholar 

  • Healy, K. (2006). Last best gifts. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Hegel, G. (1942). Philosophy of right, tr. Knox, London: Oxford University Press; available at: https://www.marxists.org/reference/archive/hegel/works/pr/prcivils.htm.

  • Holmes, S. (1988). The community trap, New Republic, November 28, pp. 24–28.

  • Kessel, R. (1974). Transfused blood serum hepatitis, and the Coase theorem. Journal of Law and Economics, 17(2), 265–289.

    Article  Google Scholar 

  • Kretzmann, M. J. (1992). Bad blood: The stigma of paid plasma donors. Journal of Contemporary Ethnography, 20(January), 416–441.

    Article  Google Scholar 

  • LaBerge, G., & Curley, B. (1998). The Mother of Blood Banking, Oral History Transcript: Irwin Memorial Blood Bank and the American Association of Blood Banks, 1944–1994, Bernice M Hemphill; held at the Bancroft Library, U.C. Berkeley; available online at: https://archive.org/details/motherbloodbank00hemprich.

  • Leveton, L. B., et al. (Eds.). (1995). HIV and the blood supply. Washington D.C.: National Academy Press.

    Google Scholar 

  • Miller, D. (1995). On nationality. Oxford: Clarendon Press.

    Google Scholar 

  • Oakley, A. (1966). Man and wife. London: HarperCollins.

    Google Scholar 

  • Piliavin, J., & Callero, P. (1991). Giving blood: The development of an altruistic identity. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Popper, K. (1945). The open society and its enemies. London: Routledge.

    Google Scholar 

  • Putnam, R. (2000). Bowling alone. New York: Simon & Schuster.

    Book  Google Scholar 

  • Putnam, R. (2007). E Pluribus Unum: Diversity and community in the twenty-first century The 2006 Johan Skytte Prize Lecture, Scandinavian Political Studies, 30(2), pp. 137–174.

  • Radin, E. (1996). Contested commodities. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Reisman, D. (1977). Richard Titmuss: Welfare and society. London: Heinemann Educational.

    Google Scholar 

  • Reisman, D. (2001). Richard Titmuss; welfare and society (2nd ed.). London: Palgrave.

    Book  Google Scholar 

  • Rodrigues del Pozo, P. (1994). Paying donors and the ethics of blood supply. Journal of Medical Ethics, 20, pp. 31–5.

  • Ross, A. (1999). The celebration chronicles. New York: Ballantine Books.

    Google Scholar 

  • Sapolsky, H. M. (1989). AIDS, bloodbanking, and the bonds of community. Daedalus, 118(3), Living with AIDS: Part 2 (Summer), pp. 145–63.

  • Sapolsky, H. M., & Finkelstein, S. N. (1977). Blood policy revisited—A new look at The Gift Relationship. Public Interest, Winter, 46, 15–27.

    Google Scholar 

  • Schwartz, J. (1999). Blood and altruism. The Public Interest, 136, 35–51.

    Google Scholar 

  • Shearmur, J. (2001). Trust, Titmuss and blood. Economic Affairs, 21, 29–33.

    Article  Google Scholar 

  • Shearmur, J. (2002). Living with a marsupial mouse. Policy, Winter, 18(2), pp. 19–22. Available at: http://www.cis.org.au/Policy/winter02/polwin02-4.htm.

  • Shearmur, J. (2003). Beyond fear and greed? Social Philosophy and Policy Winter, 20(1), 247–277.

    Article  Google Scholar 

  • Shearmur, J. (2007a). The real body shop part 1, Policy, http://www.cis.org.au/images/stories/policy-magazine/2007-summer/2007-23-4-jeremy-shearmur.pdf.

  • Shearmur, J. (2007b). In defense of the commercial provision of blood: Reactions to voluntarism in the United States national blood policy in the early 1970s. Journal of Value Inquiry, 40(2–3), 279–295.

    Article  Google Scholar 

  • Shearmur, J. (2010). Preferences, cognitivism and the public sphere. In C. Favor, G. Gaus, & J. Lamont (Eds.), Essays on philosophy, politics and economics: Integration and common research projects (pp. 69–98). Stanford: Stanford University Press.

    Google Scholar 

  • Singer, P. (1973). Altruism and commerce: A defence of Titmuss against Arrow. Philosophy & Public Affairs, 2, 312–320.

    Google Scholar 

  • Singer, P. (1977). Freedoms and utilities in health care. In G. Dworkin, et al. (Eds.), Markets and morals. New York: Halstead Press.

    Google Scholar 

  • Starr, D. (1998). Blood. New York: Knopf.

    Google Scholar 

  • Titmuss, R. M. (1970) The gift relationship: From human blood to social policy. London: Allen and Unwin.

  • Tönnies, F. (1957). Community and society (1887). East Lansing: Michigan State University Press.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Philosophy, RSSS, CASS, Australian National University, Canberra, ACT, 0200, Australia

    Jeremy Frank Shearmur

Authors
  1. Jeremy Frank Shearmur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeremy Frank Shearmur.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shearmur, J.F. The Gift Relationship Revisited. HEC Forum 27, 301–317 (2015). https://doi.org/10.1007/s10730-014-9252-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10730-014-9252-6

Keywords

Search

Navigation