The gift of blood
I lived the early part of my life in Britain, emigrating to the U.S. when I was about 40. While in Britain I regularly donated blood. When I came to the United States I continued giving blood, but after two or three donations decided to stop. The experience was no longer a source of satisfaction to me. I’d like to explain why.
In The Gift Relationship: From Human Blood to Social Policy (1970, reissued 1997), Richard Titmuss described the voluntary donation of blood as 'institutionalized altruism':
[It] represents the relationship of giving between human beings in its purest form, because people give without the expectation that they will necessarily be given to in return.
However, the concept of 'altruism' does not quite capture the appeal of giving blood – at least, not for me. The altruist, unlike the egoist, gains satisfaction from giving to others. But the altruist still perceives those 'others' as separate from his or her self, and consequently experiences giving as a loss. In these respects, the altruist and the egoist are alike. The only difference between them is that the altruist gains sufficient moral satisfaction from the giving to outweigh the loss, so that on balance the experience is a rewarding one.
For me, the essence of giving blood in the context of the British National Health Service was not altruism but the sense of participating in a community. Members of a community give not to 'others' -- perceived as separate from the self – but to the community, perceived as an overarching entity that encompasses both self and others. In that sense, they give to another, broader aspect of the self, and do not experience the giving as a loss. Nor, for that matter, do they experience it as a gain, but rather as a transfer from one aspect of the self to another. Giving to the community is experienced more as egoism (of a special kind) than as altruism.
Whenever I gave blood in Britain, I was brought to sit and rest afterward with other donors in a special area where nurses gave us all biscuits and tea, to replace the lost fluid, and made sure that each of us felt well before leaving. When I gave blood in the United States (at Brown University) there was none of this. True, we were free to continue lying down for a while after the blood was extracted, but no one asked how we felt or offered us anything to eat and drink. And this was why I stopped giving blood.
Of course, I could easily have solved the practical problem by taking a beverage with me and finding a spot nearby to drink it. However, it was not the practical problem that prompted my decision. Rather, the indifference shown to our welfare as donors brought home to me the fact that here in the U.S., where there is no health service for everyone, I was no longer participating in a community by giving blood. In Britain, I had given my blood without payment in the knowledge that a patient who needed it would likewise receive it without payment. Here, although I was giving my blood for free, the patient would still have to pay for it. That made of me a sucker, seduced into contributing to the profits of some medical business.
From a very informative article by Joel Schwartz [see reference], I learn that it is in fact common practice in America to offer blood donors fruit juice and cookies. I suppose I was just unlucky in that respect. The author also suggests that the fruit juice and cookies might be regarded as a sort of 'payment' given in exchange for the blood.
For blood given in the context of a community, this is an absurd interpretation. Giving blood to the community weakens you, so you then receive sustenance from the community until your strength is restored. In the first instance you give, in the second you receive, but there is no exchange involved whatsoever. You are helping to look after others, but at the same time you are being looked after – as a matter of course, because you are part of the community. After all, if you need sustenance for a reason that has nothing to do with an act of giving on your part, you will still receive it. Giving and receiving arise not in response to one another, but out of participation in the community.
Reference. “Blood and altruism – Richard M. Titmuss’ criticism on the commercialization of blood,” Public Interest, Summer 1999