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)

One of the central considerations to be taken into account in evaluating the ethics of compensation for donated plasma is respect for donor autonomy. And one of the main arguments against compensated donation systems is that many donors do or would come from circumstances of poverty that restrict their alternatives in a way that compromises those donors’ autonomy. In this paper, I develop and defend a novel version of this “compromised autonomy argument” which improves upon extant versions by employing a (...) more nuanced account of the relationship between alternatives and autonomy. According to the version of that argument I offer, donors lack autonomy with respect to the sale of their plasma if their economic circumstances leave them with no choice but to sell their plasma on the basis of a desire they have had no choice but to hold. After explicating the key terms of this argument, I examine its policy implications. I argue that, given several reasonable empirical assumptions, my argument implies that a majority of individuals whose income falls below a specified threshold would indeed lack autonomy with respect to the sale of their plasma. Most individuals whose income falls above that threshold, on the other hand, would be able to autonomously sell their plasma. I argue that respect for donor autonomy therefore speaks in favor of an income-restricted system of compensated donation which permits collection centers to purchase plasma from those whose income falls above the relevant threshold, but not those below it. (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)