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Is This Ethical? – Coerced Blood Donation

March 20, 2008

An acquaintance is taking some classes right now, and her school has blood drives periodically; in one of her classes, the instructor told them that if everyone donated blood (or at least attempted to), then they would get a day off from class. Personally, I found this appalling, but maybe I’m overreacting. Her fellow students might say, “Shut up! we want a day off from class!” The teacher might say, “Hey, I’m just encouraging my students to do a good deed.” And, hey, the Red Cross offers little gifts all the time to donors, right?

The problem, as I see it, is that normal blood drive incentives are individually based – you give blood, you get the little trinket. Nobody else who gives blood will be denied their “reward” if you don’t also donate. Basing a reward on the actions of others, however, creates peer pressure that is an undue influence on potential donors. The Red Cross itself notes that it “accepts donations only from voluntary blood donors.” Was the choice in this instance truly voluntary?

Aside from which, if some members of her class already knew that they are unable to donate because of one of the restrictions, they would have to choose between two somewhat unsavory options. The first is to go through the screening process (finger stick and questionnaire) anyway, wasting time and potentially going through the process of donating through the “confidential exclusion process” with no benefit to the individual and no ability for the blood to be used.

The second option for a class member who cannot or does not wish to donate would be to refuse to participate from the outset, leaving classmates to speculate on the reason and possibly generating resentment due to the lost free day. A student who refused might also wonder if any consequences would be directly or indirectly administered by the instructor, who offered the reward and is in a position of authority over the students.

Although blood donation isn’t clinical research, I don’t believe this incentive squares with the spirit of the Belmont Report principles of beneficence, or maximizing benefit and minimizing harm, and respect for persons, or treating each individual as an autonomous agent. When research is conducted on humans, informed consent must also be given voluntarily, in “conditions free of coercion and undue influence;” the report explains that “Unjustifiable pressures usually occur when persons in positions of authority or commanding influence — especially where possible sanctions are involved — urge a course of action for a subject.”

In my opinion, this seemingly minor reward created a completely unethical situation. Thoughts?

12 Comments leave one →
  1. pinkladybugs permalink
    March 20, 2008 8:18 am

    Instructors are always doing unfair crap like this to their classes; at least this time it’s for a good cause. I think they could probably have found a better way to reward the kids though, such as giving each blood donor a pass to miss one class.

  2. March 20, 2008 8:37 am

    Pinkladybugs, I think individual passes to miss a class would have been much more appropriate.

  3. March 20, 2008 9:17 am

    As a parallel to the way clinical studies are designed, one of the things you may think about with this kind of incentive is whether the incentive would cause an individual to do something that would otherwise be outside their better judgment, which is where it starts to cross the line into coercion. As you note, blood donation is a fairly benign procedure for some but can cause problems in some people – psychological issues about the needle and blood donation process (undue stress and anxiety), physiologic changes in some after donation (e.g. dizziness, nausea), persistent bleeding from the stick site, small risk of infection to the stick site, nerve damage and muscle spasms in rare instances…(ref. American Red Cross)

    You could see how a student might be really afraid of needles (not an uncommon phobia in our culture or others) but might feel pressured to donate either directly by the other students or indirectly by the feeling that refusing to participate may not be socially acceptable (from what I remember of college, this might be a big issue). Then what if this student proceeds with the donation, the phlebotomist goes to insert the needle (which isn’t exactly small and is much different in size from the ones we more commonly experience, for vaccinations and routine blood draws), the student gets overwhelmed and faints or otherwise freaks out – to me, this would seem to be an unfair risk to ask that particular student to take.

    This article by Grant and Sugarman has a pretty interesting discussion of the ethics of incentive in research, which does seem to have a lot of connections to this kind of situation.

  4. March 20, 2008 9:44 am

    Becky, thanks – I knew you’d have something smart to say about this. 🙂

  5. March 20, 2008 11:51 am

    We are given “blood points” in a few classes at medical school if more than 50% of the class donates. I don’t know if I think it’s unethical or not. I definitely thought it was strange when I first heard about it.

    Maybe I am more OK with it because it is a medical school and it’s a very low risk procedure? I am still one for freedom and informed consent, which I guess this still has.

  6. March 20, 2008 1:03 pm

    Hilary, while your scenario still sort of bothers me, the aspect of giving a day off only if every class member donated or attempted to do so really bothered me about my friend’s situation. Who wants to stand up and be the one person who messes it up for everybody?

  7. March 20, 2008 1:12 pm

    Maybe I’m biased because I’m incredibly phobic of needles–but that seems terribly unethical to me! For exactly the same reasons you’ve already outlined. Anyone who refuses is (based on my recent experience as a student) DEFINITELY going to suffer wrath from the students, at the very least.

  8. March 20, 2008 3:18 pm

    Yeah, making 100% abide is not appropriate.

  9. March 20, 2008 6:53 pm

    I should say, too, that I don’t expect every random teacher to have a good grasp on medical ethics, but thought it presented an interesting dilemma for students – and a brief “is this responsible?” is a good question for anybody to ask. 🙂

  10. ebebee permalink
    March 21, 2008 12:44 am

    Wow. Yeah. That would totally be a problem for me if I was a student in that class. I have a history of passing out when attempting to donate blood, which leads me to avoid trying to donate, even though I have type O blood and know it’s needed. I already have enough guilt around the issue because I know blood donation is so important, and this would only add to the guilt. It seems that the teacher has good intentions here, but didn’t think the whole idea through, which is also sort of disturbing, because I would hope that critical thinking skills would be a high priority for anyone in the teaching profession.

  11. March 21, 2008 6:27 pm

    I had an instructor in graduate school that said something like there wasn’t any excuse for us all not to give blood. How does he know that? I would like to – but I am very small and don’t weigh 110 pounds. People shouldn’t be pressured into doing it in any situation anyway.

  12. March 23, 2008 4:42 am

    I’m in the happy situation of being banned for silly reasons that bear no stigma. In the US I can’t give blood because of my time in the UK (fear of BSE). In the UK, they passed some retaliatory measure which scooped me up as well because of my time in the US, but I can’t remember what it was.

    The truth is I faint. The one time I gave I had a bad reaction and was told that if I had that reaction again I shouldn’t ever give blood. Turns out my grandfather had similar reactions – so I never tested it again.

    And frankly, I’d rather not admit that I’m a fainter. So yeah, I’d be pretty pissed if weren’t already excluded for Mad Cow-ness. The 50% rule seems kinda ok to me. It encourages people who can, but might not otherwise do so. Though there would still be a factor for embarrassment for those who can’t give blood ’cause their ex-boyfriend was a needle user.

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