THE BLOOD DEBATE
Bernick, Michael
In 1971, Richard Titmuss, professor at the London School of Economics, published The Gift Relationship, a study of blood-collection systems throughout the world.' The book contrasted American...
...Such families do receive a small allowance for foster children...
...People themselves must come forward, sick people can't get out of bed to ask you for a pint to save their life, so I came forward in hope to help somebody who needs blood (woman, age 25, machine operator...
...Arrow noted in passing that only 6 percent of the eligible population in Britain donated blood, and he remarked, The picture of a broadly altruistic society seems somewhat blurred when we realize what a small fraction of the population is in fact functioning altruistically...
...Donation also gave rise to a feeling of community with others...
...For example, in one oft-cited experiment conducted by J. Bryan and M. A. Test, the number of persons who stopped to help someone standing beside a car with a flat tire was significantly greater when there was an example of altruism down the road—a motorist helping another to fix his car— than when no example was present .6 Reflecting on his own altruistic acts, the political theorist Peter Singer remarked that he found it hardest to act with consideration for others when the norm of the people with whom he associated was to act egoistically, while when altruism was 3Titmuss, pp...
...Spring 1973...
...But the supply of blood in Britain, as mentioned above, has increased continually to meet demand, with nearly two and a half times as many donors in 1968 as in 1948...
...There has been no shortage of blood in Britain...
...The possibility of bonds of community, even across a large nation, is recognized by Solow...
...2Kenneth Arrow, "Gifts and Exchanges," Philosophy and Public Affairs, Summer 1972...
...226-36.] Titmuss concluded from his study that the market system stifled altruism, a desire to help others was widespread, and the role of altruism in social services could be increased...
...IN AMERICA, about one-third of the blood supply comes from paid donors...
...Blood donation gave rise to a feeling that one was not so selfish...
...IN THEIR REVIEWS, Arrow, Solow, an Glazer each disputed the idea that the market system should stifle altruism...
...Multiplying the "Gift Relationship" HOW CAN the capacity for altruism be utilized, the "gift relationship" multiplied...
...We do not wish to use up recklessly the scarce resources of altruistic motivation...
...As one student said, "I felt better about myself after giving...
...125-29...
...I think it best on the whole that the requirements of ethical behavior be confined to those circumstances where the price system breaks down...
...There might be further experimentation with removing other goods from the market—e.g., reliance might be placed on altruism for day care...
...Feeling of guilt at receiving so much and giving so little (woman, age 20, schoolteacher...
...Robert Solow, "Blood and Thunder," Yale Law Journal, July 1971...
...In some cases, members of the armed forces receive small rewards, like steak dinners...
...And there is good reason why a market in blood should stifle altruism...
...358-62...
...Nathan Glazer, "Blood," Public Interest, Summer 1971...
...Some saw donation as an opportunity to repay the National Health Service for blood or other health aids (e.g., surgical shoes, eyeglasses), which they had received without cost...
...Some replies to Titmuss's questioning: I thought it just a small way to help people—as a blind person other opportunities are limited (man, age 49, piano tuner...
...The arguments that in modern society altruism is of a fixed, limited supply are not convincing...
...It should not be so...
...Knowing I might be saving somebody's life (woman, age 40, power press operator...
...At present, private firms and churches donate space for day-care centers, and private individuals do volunteer labor...
...additional services might be supplied by altruism— an arrangement that should bring satisfaction to donors and recipients and would strengthen the bonds of social solidarity...
...To Our Contributors • When sending manuscripts, please make sure that you do not send your only copy...
...for they will often soften and reduce the competitions and divisions that will arise in modern society...
...In Britain, blood is completely removed from the market: all blood is procured from volunteers and neither patients nor hospitals pay for it...
...For one, cities and towns in America might experiment with removing blood from the market, and relying entirely on volunteers...
...Yet none of these reviewers presented evidence or arguments to support this view of altruism...
...Not only does it pressure the indigent to sell their blood...
...Each argued that in a large, industrial society, the supply of altruism is strictly limited...
...And please also be sure to enclose a stamped, selfaddressed envelope...
...And the donors have been broadly representative of the population by age, sex, income, and profession.' Further, a recent survey by researchers at Swansea University suggests that more persons would donate if additional blood was needed.' The British experience in blood suggests not that the supply of altruism is of a fixed, limited amount but that it will vary according to the degree to which it is called forth by society...
...The book attracted wide attention among social scientists and was discussed in print by Kenneth Arrow, Robert Solow, and Nathan Galzer.z Each praised highly Titmuss's expose of the inefficiency of the American system: the wastage caused by lack of planning and centralized administration, the hoarding of blood by hospitals, the high incidence of disease caused by commercially acquired blood...
...No man is an island (man, age 36, foreman maintenance fitter...
...Indeed, it is these bonds that democratic socialists such as R. H. Tawney and Richard Titmuss meant when they spoke of socialism as fellowship...
...The AABB concern was caused not only by the cost of commercial blood but by its high risk of disease...
...84-87...
...They all maintained that persons still had the option to donate voluntarily in such a system...
...And, at least on a microlevel, there have been a number of experiments indicating that altruism breeds altruism...
...Arrow stated: I should add that like many economists I do not want to rely too heavily on substituting ethics for selfinterest...
...The Satisfaction of Benevolence VISUALIZING improvement in the health of others is one motivation for giving blood...
...Being in the construction side of building you see 94 many people hurt and it makes you feel as though you have done a little bit to help (man, age 25, scaffolder...
...See Virginia Peterson, "Payments for Foster Parents: Cost-Benefit Approach," Social Work, July 1974...
...Although the bonds created by altruistic acts will not be as strong as those formed during a war effort, nor, of course, as strong as the deep bonds formed in families and among friends, they will not be insignificant...
...My own talks with students at Oxford University and at the University of California, Berkeley, who had donated blood, indicated a number of satisfactions...
...Less isolated," "Linked to others in a common enterprise": these explanations may seem too vague to be accorded any significance...
...Replies in Titmuss's survey indicate, however, not only that persons desire the well-being of others but that they desire to contribute to their well-being...
...He compared the capacity for altruism to sexual potency: if much used it constantly renews itself, but if rarely called upon it begins to atrophy...
...Titmuss, pp...
...4 David Oborne, "Why Give Blood," New Society, October 23, 1975...
...Yet, it was precisely the mutual sacrifice during the war—the knowledge persons had that they were sacrificing for others and others for them—that created these bonds...
...8) 7 Peter Singer, "Altruism and Commerce," Philosophy and Public Affairs...
...it offered an opportunity to express the virtue of benevolence...
...However, except for children with mental or physical handicaps, this allowance is no more than a token contribution toward the expenses of food, clothing, and personal incidentals, and can by no means be construed as payment for care...
...In 1971, Richard Titmuss, professor at the London School of Economics, published The Gift Relationship, a study of blood-collection systems throughout the world.' The book contrasted American dependence on market sources for blood with Britain's fully voluntary system...
...For other experiments indicating how altruism breeds altruism, see Derek Wright, Psychology of Moral Behavior (London: Penguin, 1973), pp...
...Though demand rose greatly between 1948 (when the National Health Service was established), and 1968, it was indeed more than met by an increase in the number of blood donations of 277 percent, and an increase in the number of blood donors of 243 percent...
...10 percent from volunteers...
...95 expected, he found it "much easier to be genuinely altruistic...
...Perhaps such care will not be provided without remuneration-especially as day-care personnel will need to be screened and instructed...
...He suggests that the war effort in Britain created bonds between citizens, and he points to these bonds as a reason for the success of the voluntary system in blood...
...Yet, although they are imprecise, they are nevertheless likely to be understood by many readers who have experienced similar feelings of social unity through forms of social sacrifice...
...5 Marcel Mauss, The Gilt (London: Cohen & West, 1954...
...In the intervening years, Titmuss's work has been useful in the efforts toward better planning and administration of blood supply in America...
...Krebs, "Altruism," Psychological Bulletin, April 1970...
...But, eventually, recognizing that children need attention, and are dependent upon altruism for such attention, enough suitable persons might volunteer such care...
...it reduces the importance of donation to others...
...The Association suggested a number of ways in which commercial blood banks that use both commercially and voluntarily acquired blood could increase the number of volunteers— including lengthening their hours, opening on weekends, and providing transportation to potential donors...
...133-34...
...This is pointed up by the above-cited replies to Titmuss's survey, and especially by the following reply: You can't get blood from supermarkets and chain stores...
...Titmuss, p. 227.] The variability of altruism has been emphasized by Marcel Mauss, the student of gift-giving in primitive societies, and by John Stuart Mill .5 They each linked the amount of altruism displayed in a society not only to opportunities for altruism but also to the altruism displayed by others...
...THE EDITORS 96...
...one-half from people exchanging their blood for free blood transfusions later on for themselves or their friends or family...
...sThese reviewers, however, were less enthusiastic about Titmuss's conclusion that British cooperation in blood collection is a model that might be extended to other services...
...Many more explained that they donated because they wanted to help others...
...Even though the recipient was anonymous, the act of giving caused donors to feel "less isolated," to feel that they were "linked to others in a common enterprise...
...But his ideas on voluntary cooperation have been, and continue to be, ignored by social reformers...
...John Stuart Mill, "Utilitarianism," in The Philosophy of J. S. Mill (New York: Modern Library, 1961), pp...
...They all asserted that what accounted for the reliance on the market for blood and other services was the limited supply of altruism...
...prisoners may increase their chances for parole [Titmuss, pp...
...And consideration of subsequent work on blood donations and other "gift relationships," such as free provision of foster parents and day care for the elderly, suggests that 'Richard Titmuss, The Gift Relationship (New York: Vintage Books, 1972...
...Bryan and M. A. Test, "Models and Help: Naturalistic Studies in Aiding Behavior," Journal of Personality and Social Psychology, August 1967...
...As Solow commented, I know that on none of the many occasions on which I have failed to appear at the local Bloodmobile has my realization of the existence of a market in blood played the slightest part...
...They no longer feel that fellow-citizens are dependent upon their donation...
...see also D.C...
...Is Altruism Of a Fixed, Limited Supply...
...In the course of his survey, Titmuss interviewed 3,800 British donors, querying them on their reasons for giving blood...
...and 5 percent from "captive" volunteers—i.e., members of the armed forces or prisoners...
...And already, many thousands of families voluntarily take children into their homes, often for many years, on foster care programs--in 1971, 331,000 children in America were in foster homes...
...Such reliance was urged a few years ago in a report by the American Association of Blood Banks (AABB...
Vol. 25 • January 1978 • No. 1
