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Should I Forgo Gay Sex to Donate Blood?

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Your letter touches on a number of issues. Let’s start with the Blood ban. The American Red Cross disallows blood donations from a variety of candidates, including: anyone who in the previous 12 months got a tattoo from an unregulated tattoo parlor, had sex with someone with hepatitis, received a blood transfusion or visited a malarial region; anyone who has anemia or uncontrolled diabetes; anyone who spent six months in Britain, cumulatively, between 1980 and 1996; and anyone who was ever a nonprescription IV drug user. Consistent with F.D.A. guidelines, it also disallows blood donations from men who have had sex with men in the previous 12 months.

Is this policy discriminatory? According to the Centers for Disease Control and Prevention, the rate of new H.I.V. diagnoses among M.S.M. (men who have sex with men) is more than 44 times as high as it is among other men. Donated blood is tested, and the tests have a low false-negative rate, but they don’t work when the donor has been infected only recently. Activists ask why straight people who engage in risky sexual behavior aren’t subject to the categorical exclusion that applies to M.S.M. who don’t. Others ask whether donating blood, as opposed to receiving blood, is properly considered a right, and whether the prohibition is a significant source of stigma.

In ways that the legal scholar Frederick Schauer has explored at length, a good many laws, rules and protocols proceed from generalizations, and all can be faulted for being underinclusive and overinclusive. Everyone knows that people’s capacities decline at different rates, but the F.A.A. requires commercial pilots to retire at 65, citing age-related losses in vision, hearing and cognitive abilities and an increased rate of sudden incapacitation by a heart attack or a stroke. Age-of-consent laws mean that the difference between consensual and nonconsensual sex may be measured in minutes. Traffic safety is a major reason for speed limits, even though one motorist may be able to drive safely at higher speeds and another can’t drive safely at the speed posted. Plenty of 16-year-olds would cast votes more wisely than many 60-year-olds, but the United States won’t let them. For that matter, many 16-year-olds are better drivers than those 60-year-olds, but their car-insurance premiums lump the good ones in with the bad.

These rules are hard and fast; the reality they govern is anything but. In some cases, we might decide we can replace a demographic generalization with individual assessments or testing programs — as the AARP has urged in the case of the F.A.A.’s mandatory retirement age. (Of course, a test would also give you an arbitrary cut off.) In other cases, the fixed rules, however imperfect and arbitrary-seeming, may be our best way to manage risk and uncertainty. I can’t tell you what the optimal policy would be for M.S.M. blood donation. But making discriminations isn’t always discriminatory, and it isn’t a knockdown argument against a rule to say that it excludes good candidates and includes bad ones. Generalizations like these, paradoxically, have to be appraised one by one.

A second issue relates to your particular approach to moral accounting. You suggest that if you were not to give blood, you should do your part by urging others to do so in your place. I confess to being puzzled by this logic. There are many ways to do good in the world. Even if you think, as some do, that we have a duty of benevolence, it is a so-called imperfect duty — a duty to engage in some benevolent action or other, not in a particular one. So it’s a mistake to think that not giving blood means you must get someone to replace each pint you might have given. You have no duty, as you note, to make a donation at all, and you can expand your overall altruistic contribution in a wide variety of ways.

The post Should I Forgo Gay Sex to Donate Blood? appeared first on JoelsBlog.



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