Bioethics Forum Essay
Time to Change FDA’s Discriminatory Blood Donation Policy
A recent flurry of articles in the mainstream media (The Atlantic,CNN, Huffington Post) reflects yet another wave of protest against the Food and Drug Administration’s blood donation policy, which prohibits men who have had sex with men (MSM), even once since 1977, from donating blood – ever. Citing current research, the articles urge policy change, which is likely to be from a lifetime deferral to a one- or five-year deferral period for some low risk MSM. Notably each article also blurs the important distinction between MSM and gay men, the former being a larger group defined by sexual activity not identity.
The FDA’s current donor policy is the result of a constellation of morally problematic factors, not simply a lack of empirical data or political will. A policy change to a shorter MSM deferral would have benefits. It would probably allow relatively low risk MSM to donate, thus adding blood to our collective supply. But it would also likely heighten FDA scrutiny of MSM, adding screening questions about sexual activity that others are not asked, and it would leave in place a host of institutional conditions that contribute to discrimination.
I became interested in this issue eight years ago when a student where I was teaching complained to the university that the use of student activities fees for campus blood drives was discriminatory because the fees supported an activity, blood donation, in which he was not allowed to participate. Given the precious nature of blood and the many social and cultural associations we attach to it, it is little surprise that blood donation policies elicit strong debate about justice, exclusion, safety, risk, and community. Commonly understood as an example of individual altruism, blood donation is also a powerful expression of social solidarity. Unjustified exclusion from donation can be a form of discrimination leading to social marginalization and stigmatization.
Public health interventions often legitimately target specific high-risk groups, but the FDA policy does not fall into this category. It is discriminatory, not simply because it excludes MSM, but also because:
- The scientific basis for the MSM exclusion is weak at best, especially in today’s context of advanced blood testing practices.
- The technical regulatory process preempts discussion of the policy’s social and ethical dimensions and effects.
- The policy embodies stereotypes and norms that marginalize gender and sexual minorities and privilege dominant groups.
- The policy presumes an “acceptable” level of risk in the blood supply absent a transparent and inclusive deliberation about what this standard should be.
- It embodies an inequitable risk tolerance: an acceptance of risk posed by most heterosexuals and a concurrent rejection of risk posed by MSM. A stark example of this inequity is that MSM are permanently deferred while women who have sex with MSM are deferred for 12 months.
Decisions about how much, and whose, risk is acceptable in the blood supply are not only scientific matters; they are moral matters. Many potential blood donors carry various risks – witness the many questions asked pre-donation in order to identify and defer risk. And each unit of blood is tested for multiple pathogens. The level of “acceptable” risk in the blood supply is informed by empirical data but at the end of the day, is a values question.
There is precedent for changing FDA’s blood donation policy regarding groups labeled “high risk.” In 1989, given claims of unfair discrimination, the FDA was pressured to reconsider its policy of excluding Haitian immigrant donors. Finding insufficient scientific and moral justifications for the policy, the FDA retracted it.
Now there is another chance for policy change involving an excluded group. But such fragmented and piecemeal efforts at change leave much moral ground wanting. For example, intravenous drug users and persons who receive payment for sex (not those who pay for sex) are also permanently deferred from blood donation, but unlike MSM and Haitians, they have few advocates questioning the scientific and moral justifications of their deferrals.
To make donation practices more just and the blood supply safer, an overhaul of the FDA’s donation policy requires at least two changes. First, we need comparable epidemiological data that documents the relative risks of potential blood donors based on specific rather than general behaviors. This data would better inform decisions about how much risk is, and which risks are, “acceptable.” We also need a revised regulatory procedure that not only allows for but also requires serious deliberation of the ethical, social, political, and economic implications of proposed blood policies. This would necessitate broadening current FDA decision-makers to include potential blood donor and recipient representatives. Elusive changes perhaps, but not impossible.
Charlene Galarneau is an assistant professor in the Department of Women’s and Gender Studies at Wellesley College.
Posted by Susan Gilbert at 10/17/2012 03:06:36 PM |