Keywords: blood donation, blood, gift relationship, gift exchange, body parts commoditisation .. Final thanks go to the sociologist Dr Anne Chappell, who supported me and made me perhaps develop Richard Titmuss' seminal work on blood donation in The Gift .. in the body it was taken from was a clinical judgement. Chapter Three: re-reading Titmuss 'The Gift Relationship' This thesis is based on a critical re-appraisal of Richard Titmuss' classic formulation of gift . were raised by this practice.8 My judgement that it would be important to look at this In summary, there is a picture of considerable change in the regulation of medical. final act of “doing good” is bridged by a balanced judgment between . The Gift Relationship: From Human Blood to Social Policy () because of various . Richard Titmuss summarized blood donor motivations of Urban Batu in Durban.
This omission is less surprising when one examines the two operative survey questions: Please tick on the list below the main reason why you give blood? Could you say why you first decided to become a blood donor? What was seen by these donors as a good for strangers in the here-and-now could be they said or implied a good for themselves—indeterminately one day. In not asking for or expecting any payment of money these donors signified the belief in the willingness of other men to act altruistically in the future.
If Titmuss had been less obviously self- serving in his classification of American donors, and more self-effacing in his classification of British donors, his comparative analysis of the motives of donors in these two countries might have been considerably more subtle and interesting than it actually is.
As we have observed, British donors had no choice in how they gave blood, since the opportunity to engage in any kind of material exchange, available to some blood donors in United States, was simply not an option. Under conditions of plenty, this arrangement was not generally problematic for the British.
But under conditions of scarcity, the limits of altruism as an organizational principle of blood procurement became plain. When the need became acute for plasma products that were more difficult to procure, such as concentrated Factor VIII,18 the flaws of the U.
But this system was only sustainable by aggressively, if quietly, patroniz- ing the for-profit procurement system in the United States so as to remedy shortfalls in the supply of blood products such as concentrated Factor VIII.
From a psychological standpoint, Titmuss believed that the altruistic impulses of prospective donors were oppressed by the very existence of a commercial market. Titmuss lacked any meaningful comparison between conditions before and after commercialization to undergird his robust cause-and-effect claims regarding the introduction of incentives and subsequent altruistic behavior.
Had Titmuss been less hostile in characterizing the motives of U. Finally, we should note that Titmuss also drew a connection between commercialization and the safety of purchased blood.
In The Gift Relation- ship, he documented unacceptably high rates of post-transfusion hepatitis in the United States from contaminated blood. He inferred that paying for blood eroded a sense of community, and that a commercial system attracted blood providers who were less concerned about their fellow men and the quality of the blood they gave than they were about the payment they would receive. But this turned out not to be a compelling reason to condemn a commercial procurement system, as scholars were able to show that poor- quality blood did not flow from the cash payment per se, but rather from the donor population to whom the payment was offered, in conjunction with inadequate screening techniques.
Socioeconomic characteristics of donors, such as income level and location of residence, were more strongly correlated with testing positive for hepati- tis antigens than whether or not the donor was paid. Once such tests for hepatitis and HIV became widely available, the rates of transfusion- related disease transmission plummeted.
The Gift Relationship: From Human Blood to Social Policy
Indeed, some hybrid donation- commercial blood banks actually reported discarding more infected blood products from their altruistic donor population than from people who had been paid for their blood. Indeed, most of the infected blood came from a most socially conscious group with a strong, reliable record of voluntary blood donation: Remarkably, French authorities knew the supply was tainted yet allowed the blood to be used.
Furthermore, the United States maintains a thriving domestic and export business in blood plasma, almost all of which is obtained from paid individuals. We explore a few of these examples below. Israeli Day Care Case. Historians David and Sheila Rothman amplified the concern that the introduction of incentives might result in fewer organs procured.
Their arguments drew on a study of ten Israeli day care centers, undertaken in by Uri Gneezy and Aldo Rustichini, both pioneering scholars in the field of motivational crowding theory. Within a week, the number of late pickups in the fine group increased signifi- cantly compared to the controls.
After the fines were rescinded, the rates of late pickups remained comparable to pre-fine levels. In this instance, the fine was a fixed price, and one apparently well worth paying in the judgment of many tardy parents.
Richard Titmuss - Wikipedia
The intriguing empirical point is that the introduction of a financial incentive in this instance or, in the case of the day care centers, a financial disincentive actually encour- aged rather than dissuaded undesirable behavior.
His conclusion was that the relationship between the amount of payment and improvement in performance is not always linear, and that at low levels of payment, performance may be inferior. As applied to organ markets, this is not an argument against payment in general, but against payments too small to improve performance, as suggested by the title of his paper.
One proposed explanation of this phenomenon is that payment deprives the actor of the chance to signal to others that he is a charitable or civic-minded person. Apparently, the greater the desire to be liked and well-regarded by others, the less effective rewards will be. Around this time, Titmuss was also active in the British Eugenics Society.
Inhe was recruited to write a volume in the civil series of the official war historyProblems of Social Policy, a work which established his reputation as well as securing him the new chair at the London School of Economics.
In this process, he was strongly supported by the sociologist T. At the LSE, where he was the first professor of Social Administration, he transformed the teaching of social work and social workers and established Social Policy as an academic discipline.
He also contributed to a number of government committees on the health service and social policy. His concerns focused especially on issues of social justice. His final and perhaps the most important book, The Gift Relationship expressed his own philosophy of altruism in social and health policy and, like much of his work, emphasized his preference for the values of public service over private or commercial forms of care.
The book was influential and resulted in a study of the blood bank systems, specifically with regard to regulation on the private blood market exchange.
The Gift Relationship | The New Press
President Nixon called for a complete study of the lack of coordination within the system only months following publication of Titmuss' findings. For example, he was much criticised for his role as a vice-chairman of the government's Supplementary Benefits Commission which some critics felt did not allow him enough distance. He, by contrast argued in favour of trying to make inadequate institutions work better for the benefit of the poor even if his involvement with them had the potential to sully the purity of his reputation.
He held his chair fromafter brief spells in the Cabinet Office and the Social Medicine Research Unituntil his death in Influence[ edit ] Some of his works are still read and some have been re-printed in newly edited forms exploring their contemporary relevance. Many of the writings for which he is known were actually delivered as lectures at the LSE or when he was a much sought-after public speaker. Although several of these were later assembled as 'readers' or 'essays', he never completed a summary of his work or philosophy nor wrote a single magnum opus on social policy.