The Gift Relationship: From Human Blood to Social Policy

Whole Earth, Spring, 1998

The Gift Relationship

From Human Blood to Social Policy

Richard M. Titmuss. Expanded and updated edition: Ann Oakley and John Ashton, eds. 1997; 388 pp. $30. The New Press.

The Gift Relationship was published in 1970, with almost immediate policy results. It compared blood donating in Britain (voluntary) and the US (some donated, some bought and sold). Its conclusions--that the voluntary system was superior in efficiency, efficacy, quality, and safety--helped preserve the National Blood Service from Thatcherite privatization. The US government consulted with Titmuss, instituted efforts to stimulate voluntary donation, and mandated labeling of blood from paid donors. Titmuss's most profound conclusions concerned the quality of life and community when people are encouraged to give--often, literally, the gift of life--to strangers. When blood becomes a commodity, he argued, its quality is corrupted (American blood was four times more likely to infect recipients with hepatitis than was British blood).

Titmuss died in 1973, before the AIDS epidemic. This new edition discusses AIDS and the evolution of blood-donation technology, reexamines Titmuss's conclusions, and adds a chapter on donating breast milk. It just hints at more intriguing questions now emerging around organ donorship.

"The ways in which society organises and structures its social relationships--and particularly health and welfare systems--can encourage or discourage the altruistic in man; such systems can foster integration or alienation; to recall Mauss, they can allow the "theme of gift," of generosity towards strangers, to spread among and between social groups and generations. This, we further suggest, is an aspect of freedom in the twentieth century which, compared with the emphasis on consumer choice in material acquisitiveness, is insufficiently recognized. It is indeed little understood how modern society, technical, professional, large-organized society, allows few opportunities for ordinary people to articulate giving in morally practical terms outside their network of family and personal relationships.

"Men are not born to give; as newcomers, they face none of the dilemmas of altruism and self-love. How can they and how do they learn to give--and to give to unnamed strangers irrespective of race, religion, or color--not in circumstances of shared misery but in societies continually multiplying new desires and syndicalist private wants concerned with property, status, and power? ... If the opportunity to behave altruistically--to exercise a moral choice to give in non-monetary terms to strangers--is an essential human right, then this book is about the definition of freedom.