Skip to main content

Challenging the Moral Status of Blood Donation

Health Care Analysis volume 22, pages 340–365 (2014)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Notes

  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.

  19. Available at http://www.blood.co.uk/video-audio-leaflets/tv-radio-ads/.

  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

  22. Available at http://www.youtube.com/watch?v=fhoPEUXFcT4.

  23. Thanks to Dr Sabita Menon for the translation.

  24. For example, see http://www.friends2support.org/.

  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].

  29. Available at http://www.uktransplant.org.uk/ukt/adverts_and_video/adverts_and_video.jsp.

  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.

  38. The full list is available at http://www.blood.co.uk/can-i-give-blood/who-cant-give-blood/.

  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.

References

  1. Akl, E. A., Oxman, A. D. Herrin, J., Vist, G. E. Terrenato, I., Sperati, F., Costiniuk, C., Blank, D. Schünemann, H. (2011) Framing of health information messages (Review) The Cochrane library, December 2011.

  2. American Red Cross. (undated). FAQs about donating blood. [on line] http://www.redcrossblood.org/hosting-blood-drive/ultimate-guide-hosting-blood-drive/recruitment-strategies-tips. Last accessed 14th March 2012.

  3. Arnold, E., & Lane, S. (2011). Qualitative research in transfusion medicine. Transfusion Medicine, 21(5), 291–300.

    PubMed  Article  CAS  Google Scholar 

  4. Baron, M. (1987). Kantian ethics and supererogation. The Journal of Philosophy, 84(5), 237–262.

    Article  Google Scholar 

  5. Bartlett, M. Y., & DeSteno, D. (2006). Gratitude and Prosocial behaviour: Helping when it costs you. Psychological Science, 17, 319–325.

    PubMed  Article  Google Scholar 

  6. Baumeister, R. F., & Ilko, S. A. (1995). Shallow gratitude: Public and private acknowledgements of external help in accounts of success. Basic and Applied Social Psychology, 16(12), 191–209.

    Article  Google Scholar 

  7. Beauchamp, T. L., & Childress, J. F. (2008) Principles of Biomedical Ethics (sixth edition) Oxford: Oxford University Press.

  8. Bednall, T. C., & Bove, L. L. (2011). Donating blood: A meta-analytic review of self-reported motivators and deterrents. Transfusion Medicine Reviews, 25(4), 317–334.

    PubMed  Article  Google Scholar 

  9. Belda Suarez, I. M., Fernandez-Montoya, A., Rodriguez Fernandez, A., Lopez-Berrio, A., & Cillero-Penuela, M. (2004). How regular blood donors explain their behaviour. Transfusion, 44, 1441–1446.

    PubMed  Article  Google Scholar 

  10. Bennett, R. (2007). Should we criminalise HIV transmission? In C. A. Erin & S. Ost (Eds.), The criminal justice system and health care, Chap. 13 (pp. 225–236). Oxford: Oxford University Press.

    Chapter  Google Scholar 

  11. Brassington, I. (2007). John Harris’ argument for a duty to research. Bioethics, 21(3), 160–168.

    PubMed  Article  Google Scholar 

  12. Brassington, I. (2011). Defending the duty to research? Bioethics, 25(1), 21–26.

    PubMed  Article  Google Scholar 

  13. Brennan, L., & Binney, W. (2010). Fear, guilt, and shame appeals in social marketing. Journal of Business Research, 63, 140–146.

    Article  Google Scholar 

  14. Buyx, A. (2009). Blood donation, payment and non-cash incentives: Classical questions drawing renewed interest. Transfusion Medicine and Hemotherapy, 36, 329–339.

    PubMed  Article  PubMed Central  Google Scholar 

  15. Cabinet Office. (2010). Applying behavioural insight to health. London: Cabinet Office Behavioural Insights Team.

    Google Scholar 

  16. Cabinet Office. (2011). Behavioural insights team annual update 2010–11. London: Cabinet Office Behavioural Insights Team.

    Google Scholar 

  17. Carter, M. C., Wilson, J., Redpath, G. S., Hayes, P., & Mitchell, C. (2011). Donor recruitment in the 21st Century: Challenges and lessons learnt in the first decade. Transfusion and Apheresis Science, 45, 31–43.

    PubMed  Article  Google Scholar 

  18. Chan, S., & Harris, J. (2009). Free riders and pious sons—Why scientific research remains obligatory. Bioethics, 23(3), 161–171.

    PubMed  Article  PubMed Central  Google Scholar 

  19. Clouser, K. D., & Gert, B. (1990). A critique of principlism. The Journal of medicine and philosophy, 15(2), 219–236.

    PubMed  Article  CAS  Google Scholar 

  20. Coggon, J. (2009). Public health, responsibility and English law: Are there such things as no smoke without ire or needless clean needles? Medical Law Review, 17, 127–139.

    PubMed  Article  Google Scholar 

  21. Coggon, J. (2012). What makes health public? A critical evaluation of moral, legal and political claims in public health. Cambridge: Cambridge University Press.

    Google Scholar 

  22. Condie, S. J., Warner, W. K., & Gillman, D. C. (1976). Getting blood from collective turnips: Volunteer donation in mass blood drives. Journal of Applied Psychology, 61(3), 290–294.

    PubMed  Article  CAS  Google Scholar 

  23. Cullity, G. (1995). Moral free riding. Philosophy & Public Affairs, 14(1), 3–34.

    Article  Google Scholar 

  24. De Kort, W. (Ed). (2010). Donor management manual. Nijmegen; Domain Project. [on line] http://www.domaine-europe.eu/ManualPDF/tabid/115/Default.aspx. Last accessed 14th March 2012.

  25. Department of Health. (2009). Reference guide to consent for examination or treatment (2nd ed.). London: Department of Health.

    Google Scholar 

  26. Department of Health. (2010). The NHS constitution. London: Department of Health.

    Google Scholar 

  27. Devine, D., Goldman, M., Engelfriet, C. P., Reesink, H. W., Hetherington, C., Hall, S., et al. (2007). Donor recruitment research. Vox Sanguinis, 93, 250–259.

    PubMed  Article  CAS  Google Scholar 

  28. Driver, J. (1992). The Suberogatory. Australasian Journal of Philosophy, 70(3), 286–295.

    Article  Google Scholar 

  29. Eaton, S. (1998). The subtle politics of organ donation; a proposal. Journal of Medical Ethics, 26, 166–170.

    Article  Google Scholar 

  30. Edwards, S. D. (2008). Discussion document; Introduction of an opt out (presumed consent) system in the context of Organ Transplantation. Cardiff: Welsh Assembly Government. [on line] http://wales.gov.uk/dhss/publications/health/guidance/discussion/discussionconsente.pdf;jsessionid=xTPHTTZL2C1XgCJC1GNxKQvsKyBRrb3J2lQqQJXhWw6pLxQrcfhV!1374374152?lang=en (last accessed 14th March 2012).

  31. Fabre, C. (2006). Whose body is it anyway?. Oxford: Oxford University Press.

    Book  Google Scholar 

  32. Farrell, A.-M. (2006). Is the gift still good? Examining the politics and regulation of blood safety in the European Union. Medical Law Review, 14, 155–179.

    PubMed  Article  Google Scholar 

  33. Farrugia, A., Penrod, J., & Bult, J. M. (2010). Payment, compensation and replacement—The ethics and motivation of dlood and plasma donation. Vox Sanguinis, 99, 202–211.

    PubMed  Article  CAS  Google Scholar 

  34. Ferguson, P. R. (2011). ‘Smoke gets in your eyes…’: The criminalisation of smoking in enclosed public places, the harm principle and the limits of the criminal sanction. Legal Studies, 31(2), 259–278.

    Article  Google Scholar 

  35. Ferguson, E., Farrell, K., & Lawrence, C. (2008). Blood donation is an act of benevolence rather than altruism. Health Psychology, 27(3), 327–336.

    PubMed  Article  Google Scholar 

  36. Ferguson, E., Atsma, F., de Kort, W., & Veldhuizen, I. (2012). Exploring the pattern of blood donor beliefs in first time, novice, and experienced donors: Differentiating reluctant altruism, pure altruism, impure altruism and warm glow. Transfusion, 52(2), 343–355.

    PubMed  Article  Google Scholar 

  37. Gill, P., & Lowes, L. (2008). Gift exchange and organ donation: Donor and recipient experiences of live related kidney transplantation. International Journal of Nursing Studies, 45, 1607–1617.

    PubMed  Article  Google Scholar 

  38. Gillespie, T. W., & Hillyer, C. D. (2002). Blood donors and factors impacting the blood donation decision. Transfusion Medicine Reviews, 16(2), 115–130.

    PubMed  Article  Google Scholar 

  39. Gillum, R. F., & Masters, K. S. (2010). Religiousness and blood donation; findings from a national survey. Journal of Health Psychology, 15(2), 163–172.

    PubMed  Article  Google Scholar 

  40. Goette, L., Stutzer, A., Yavuzcan, G., & Frey, B. M. (2009). Free cholesterol testing as a motivation device in blood donations: Evidence from field experiments. Transfusion, 49, 524–531.

    PubMed  Article  Google Scholar 

  41. Goette, L., Stutzer, A., & Frey, B. M. (2010). Prosocial motivation and blood donations: A survey of the empirical literature. Transfusion Medicine and Hemotherapy, 37, 149–154.

    PubMed  Article  PubMed Central  Google Scholar 

  42. Hardin, R. (2007). David Hume: Moral and political theorist. Oxford: Oxford University Press.

    Book  Google Scholar 

  43. Harris, J. (2005). Scientific research is a moral duty. Journal of Medical Ethics, 31, 242–248.

    PubMed  Article  PubMed Central  Google Scholar 

  44. Hart, H. L. A. (1955). Are there any natural rights? The Philosophical Review, 64(2), 175–191.

    Article  Google Scholar 

  45. Heyd, D. (1982). Supererogation. Cambridge: Cambridge University Press.

    Google Scholar 

  46. House of Commons Health Committee. (2005). Smoking in Public Places; First report of session 2005–2006. London; The Stationary Office limited. [on line]. http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/485/485.pdf. Last accessed 14th March 2012.

  47. Hume, D. (1748 [2007]). An enquiry concerning human understanding. Oxford; Oxford University Press.

  48. Hupfer, M. E. (2006). Helping me, helping you: Self-referencing and gender roles in donor advertising. Transfusion, 46, 996–1005.

    PubMed  Article  CAS  Google Scholar 

  49. Institute of Innovation and Improvement. (2010). Consent/authorisation for donation after brain-stem death. [on line] http://www.organdonation.nhs.uk/ukt/about_us/professional_development_programme/pdf/Consent_and_Authorisation.pdf. Last accessed 14th March 2012.

  50. International Society of Blood Transfusion. (2000). A code of ethics for blood donation and transfusion. Amsterdam: International Society of Blood Transfusion.

    Google Scholar 

  51. International Society of Blood Transfusion. (undated). Aims and objectives. [on line] http://www.isbtweb.org/about-isbt/isbt-partners/ifbdo/ last accessed 14th March 2012.

  52. Jarvis, R. (1995). Join the club: A modest proposal to increase the availability of donor organs. Journal of Medical Ethics, 21, 199–204.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  53. John, S. (2011). Expert testimony and epistemological free-riding: The MMR controversy. The Philosophical Quarterly, 61(244), 496–517.

    Article  Google Scholar 

  54. Lavee, J., Ashkenazi, T., Gurnham, G., & Steinberg, D. (2010). A new law for allocation of donor organs in Israel. The Lancet, 375, 1131–1133.

    Article  Google Scholar 

  55. Lemmens, K. P. H., Abraham, C., Ruiter, R. A. C., Veldhuizen, I. J. T., Bos, A. E. R., & Schaalma, H. P. (2008). Identifying blood donors willing to help with recruitment Vox Sanguinis, 95, 211–217.

    CAS  Google Scholar 

  56. Maghsudlu, M., & Nasizadeh, S. (2011). Iranian blood donors’ motivations and their influencing factors. Transfusion Medicine, 21, 247–252.

    PubMed  Article  CAS  Google Scholar 

  57. Martin, S. J., Bassi, S., & Rees, R. D. (2012). Commitments, norms and custard creams—A social influence approach to reducing did not attends (DNAs). Journal of the Royal Society of Medicine, 105(3), 101–104.

    PubMed  Article  Google Scholar 

  58. Masser, B. M., White, K. M., Hyde, M. K., & Terry, D. J. (2008). The psychology of blood donation: Current research and future directions. Transfusion Medicine Reviews, 22(93), 215–233.

    PubMed  Article  Google Scholar 

  59. McCulloch, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect? Psychological Bulletin, 127(2), 249–266.

    Article  Google Scholar 

  60. McKie, J., & Richardson, J. (2003). The rule of rescue. Social Science and Medicine, 56, 2407–2419.

    PubMed  Article  Google Scholar 

  61. Mellema, G. (1991). Beyond the call of duty. Albany: State University of New York Press.

    Google Scholar 

  62. Mulgan, T. (2001). The demands of consequentialism. Oxford: Oxford University Press.

    Google Scholar 

  63. Mullin, A. (2011). Gratitude and caring labour. Ethics and Social Welfare, 5(2), 110–122.

    Article  Google Scholar 

  64. Nagel, T. (1970). The possibility of altruism. Princeton: Princeton University Press.

    Google Scholar 

  65. National Aids Control Programme. (2007). Voluntary Blood Donation Programme. New Delhi: Ministry of Health and family Welfare, Government of India.

  66. New, C. (1974). Saints, heroes and utilitarians. Philosophy, 49, 179–189.

    Article  Google Scholar 

  67. Nozick, R. (1974). Anarchy, state and utopia. New York: Basic Books.

    Google Scholar 

  68. Nuffield Council on Bioethics. (2011). Human bodies: Donation for medicine and research. London: Nuffield Council of Bioethics.

    Google Scholar 

  69. O’Neill, O. (1996). Towards justice and virtue: A constructive account of practical reasoning. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  70. Pal, R., Kar, S., Akhtar, F., & Pal, S. (2011). The quest for an Indian blood law as of blood transfusion services regulatory framework. Asian Journal of Transfusion Science, 5(2), 171–174.

    PubMed  Article  PubMed Central  Google Scholar 

  71. Portmore, D. W. (2008). Are moral reasons morally overriding? Ethical Theory and Moral Practice, 11, 369–388.

    Article  Google Scholar 

  72. Prainswick, B., & Buyx, A. (2011). Solidarity: Reflections on an emerging concept in bioethics. London: Nuffield Council on Bioethics.

    Google Scholar 

  73. Ramani, K. V., Mavalankar, D. V., & Govil, D. (2009). Study of blood-transfusion services in Maharashtra and Gujarat States, India. Journal of Health Population and Nutrition, 27(2), 259–270.

    Article  CAS  Google Scholar 

  74. Rapport, F. L., & Maggs, C. J. (2002). Titmuss and the gift relationship: Altruism revisited. Journal of Advanced Nursing, 40(5), 495–503.

    PubMed  Article  CAS  Google Scholar 

  75. Rawls, J. (1971). A theory of justice. Oxford: Oxford University Press.

    Google Scholar 

  76. Reichlin, M. (2011). The role of solidarity in social responsibility for health. Medicine, Health Care and Philosophy, 14, 365–370.

    Article  Google Scholar 

  77. Ross, W. D. (1930 [2002]) The Right and the Good. Oxford: Clarenden Press.

  78. Shaw, D. (2012). We should not let families stop organ donation from their dead relatives. British Medical Journal, 345, e5275.

    PubMed  Article  Google Scholar 

  79. Singer, P. (2009). The life you can save. London: Picador.

    Google Scholar 

  80. Smith, P. (1993). Family responsibility and the nature of obligation. In D. T. Meyers, K. Kipnis, & C. F. Murphy (Eds.), Kindred matters. Ithaca: Cornell University Press.

    Google Scholar 

  81. Snelling, P. C. (2012). Saying something interesting about responsibility for health. Nursing Philosophy, 13, 161–178.

    PubMed  Article  Google Scholar 

  82. Sojka, B. N., & Sojka, P. (2008). The blood donation experience: Self-reported motives and obstacles for donating blood. Vox Sanguinis, 94, 56–63.

    PubMed  Google Scholar 

  83. Spital, A. (2004). Should people who commit themselves to organ donation be granted preferred status to receive organ transplants? Clinical Transplantation, 19, 269–272.

    Article  Google Scholar 

  84. Steele, W. R., Schreiber, G. B., Guiltinan, A., Nass, C., Glynn, S. A., Wright, D. J., et al. (2008). The role of altruistic behaviour, empathetic concern, and social responsibility motivation in blood donation behaviour. Transfusion, 48, 43–54.

    PubMed  Google Scholar 

  85. Steinbock, R. (1980). Unrelated volunteers as bone marrow donors. Hastings Centre Report, 10(1), 11–20.

    Article  Google Scholar 

  86. Stewart, C., & Lynch, A. (2003). Undue influence, consent and medical treatment. Journal of the Royal Society of Medicine, 96, 598–601.

    PubMed  Article  PubMed Central  Google Scholar 

  87. Stutzer, A., & Goette, L. (2010). Blood donor motivation. What is ethical? What works? ISBT Science Series, 5, 244–248.

    Article  Google Scholar 

  88. Sykora, P. (2009). Altruism in medical donations reconsidered: The reciprocity approach. In Steimann, M., Sykora, P., Wiesling, U. (Eds.), Altruism reconsidered: Exploring new approaches to property in human tissue (Chap. 2, pp. 13–50). Farnham: Ashgate Publishing.

  89. Thaler, R. H., & Sunstein, C. R. (2009). Nudge: Improving decisions about health wealth and happiness. London: Penguin.

    Google Scholar 

  90. Titmuss, R. (1970). The gift relationship; from human blood to social policy. London: George Allen and Unwin.

    Google Scholar 

  91. Trotter, G. (2008). Preferred allocation for registered organ donors. Transplantation Reviews, 22, 158–162.

    PubMed  Article  Google Scholar 

  92. United Kingdom Blood Transfusion Service. (2010). Guidelines for Blood Transfusion in the UK. [on line] http://www.transfusionguidelines.org. Last accessed 14th March 2012.

  93. Urmson, J. O. (1958) Saints and Heroes. In Feinburg, J. (Ed.) (1969) Moral concepts (Chap. 5, pp. 60–73). London: Oxford University Press.

  94. World Health Organisation. (2010). Towards 100 % voluntary blood donation: a global framework for action. Geneva: World Health Organisation.

    Google Scholar 

  95. Zimmerman, M. J. (1996). The concept of moral obligation. Cambridge: Cambridge University Press.

    Book  Google Scholar 

Download references

Acknowledgments

I gratefully acknowledge funding for doctoral study from the University of the West of England and Dr John Coggon and Professor Margot Brazier for supervision at the University of Manchester.

Author information

Affiliations

  1. Adult Nursing, University of the West of England, Alexandra Warehouse, West Quay, Gloucester Docks, Gloucester, GL1 2LG, UK

    Paul C. Snelling

Authors
  1. Paul C. Snelling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul C. Snelling.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Snelling, P.C. Challenging the Moral Status of Blood Donation. Health Care Anal 22, 340–365 (2014). https://doi.org/10.1007/s10728-012-0221-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10728-012-0221-4

Keywords

  • Blood donation
  • Organ donation
  • Altruism
  • Obligation
  • Television advertisements