PoPulationand Public HealtH etHics

Looking at the proportionality principle from another perspective, however,
might lend support to the continuation of the MsM blood deferral policy in
light of the past history of the tainted blood scandal, the damage to public
trust and public perceptions of a safe blood supply. While tainted blood could
come from any number of sources, permanent deferrals
of high-risk groups may preserve public trust.
Thus, keeping the policy as is might maintain public
trust in a safe blood supply, while changing the policy
has the potential to result in a breach of public trust,
particularly if the public is not aware or informed of
new scientific tests for HIV detection and the minimal
risk posed by changing the policy. This is where
procedural values (see below) become important.
Beneficence, or acting in the best interests of the population, is a vital ethical
consideration. CBs now gets most of its donations from a mere three per cent
of the population and that number is continually decreasing. 6 Some cities are
making regular appeals to their residents to donate blood, and blood products
have even been rationed at hospitals during shortages. 7, 8 Lifting the lifetime
deferral has the potential to increase the donor pool by 1.3%. 5 It stands to
reason that increasing the number of donors would benefit the population,
and provide important justification for overturning the lifetime ban.
Equity is another significant ethical principle that applies to this case study.
The marginalization and stigmatization of the MsM community can be traced
back for many years, and continues to this day. Stereotypes and prejudices
9, 10
have been consistently portrayed in religious, lifestyle, and moral terms.
Statistics do show that the majority of aIDs cases are found among gay men, 3
but if this group had received the same attention as those who were facing
lung cancer or another more ‘acceptable’ disease, or if the high-risk group
were heterosexual, history may have played out differently. 9, 11 It is important
to note that MsM are treated differently than other groups of potential donors,
such as women who have had sex with a man who has had sex with another
man, who are only deferred for one year. 3, 11 They are also, however, treated
similarly to other groups that are indefinitely deferred, including individuals
who have received payment for sex since 1977, intravenous drug users and
individuals who have tested positive for HIV. Blood donation deferrals also
include other groups such as anyone who has had malaria, anyone who has
Deferring Blood Donation from Men Who Have Sex with Men
77
A one-year deferral on
monogamous gay men
only increases the risk
of one HIV-positive
unit being potentially
undetected in every
11 million collected.