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A Brief Commentary on Decline in Blood Donation Rate among Black communities in England - An analysis on Law and Ethics

November 11, 2017

Currently, The England Blood Donation service is in need of blood donations from black, Asian and minority ethnic communities with focus on the black due to the Sickle Cell Disease. For a long time, black population is the target of racial discrimination and they are usually of lower socio-economic status. They may regard themselves as an under-privileged group that is in need of help from others instead of providing help to others. In order to encourage the black population to donate, we should consider their needs from the ethical and social aspects. From the point of deontological ethics, the government owes the black community a duty of care when they join the citizenship. The government should do whatever intrinsically right to provide the black community with job and social care or we should say the government has obligations to the black community. The government should improve their social status so as to save their human dignity. The best example here is the first elected black President Barack Obama in the US history in 2008 and 2012. This breaks the record of the US presidents must be Caucasians. From the point of social justice, the black population is protected by equal opportunities, equal distribution of resources, and equal access to health care. Of course, with limited health care resources, we should set priority of access and this issue of priority will be the top concern here. Black community was considered as a top priority because the Sickle Cell Disease happens almost only in the black community. Since it is of top priority so the provided resources must be sufficient. How much is sufficient? Sufficiency is a relative term that means it should be an adequate amount to deal with the need or demand. We should discuss it later in this commentary. With the improved situation on these ethical and social aspects, the black community should be more willing to reach out and make blood donation.

With reference to the change in legal framework in the UK, there are Sex Discrimination Act 1975, Race Relations Act 1976, Disability Discrimination Act 1995, and finally Equality Act 2010. The Equality Act 2010 (1) protects discrimination against race including colour, nationality, ethnic or national origin. In fact, the act of encouraging black-to-black blood donation is an act of racial discrimination in itself. From a medical point of view, blood donation is about the compatibility between blood groups. Although the black population does have more Sickle Cell Disease and rarer blood groups, the majority of them still belong to the more common ABO blood groups. So, we should encourage or set up regulations to promote blood donation in general but not to focus only on the black population. Under the principle of natural selection, Sickle Cell Disease is still popular in Africa due to the endemic of Malaria. Black populations with the Sickle Cell Disease are somehow protected from the infection of Malaria parasites. With the migration of the black populations to other continents globally, the Sickle Cell Disease is much rarer, nowadays, in the black populations reside in the other parts of the world such as UK and US. Eventually, Malaria is not endemic in the developed countries. This also explains the point that there is no need to put too much focus on the Sickle Cell Disease of the black community.

The autonomy of the donor is another consideration in persuading the black community to make blood donation. Autonomy means the rights of self-rule, rights of self-determination and, for the black community, the rights to choose whether to make blood donation or not. In some less developed countries, such as China, it previously encouraged blood donation with incentives. Nowadays, even in China, they encouraged blood donation without material inducement. So, what the government should do is to advertise, promote, or market the blood donation. We should promote the concept of individual obligations to the community after we talked so much about the obligations of the government to the citizens. We should promote the concept that ‘being able to give’ is a kind of virtue. Of course, this comes with the improved social status of the black population or we should say the general population as a whole. The most relevant virtue in this social context will be being compassionate to others who are in need of help.

The Human Rights Act 1998 (2) protects the legal rights of self-determination with respect to medical intervention in which blood donation is a kind of medical intervention. As explained above, with the ever-rising protection of human rights worldwide, we should only encourage but not force the black population or the general population to donate blood. The use of material inducement will only deprive the under-privileged group such as the black community or ethnic minority. They will tend to make recurrent blood donations in order to receive material rewards especially those with rarer blood groups that are in demand. These groups of population will be more susceptible to abuse by the system. On the one hand, recurrent blood donations are detrimental to health. On the other hand, it has detrimental effects on the legitimacy and validity of the act of blood donations. We should set up laws to prohibit any material inducement and uphold the principles of autonomy. The relevant promotion or advertisement of blood donations is protected by the Freedom of Expression which is enshrined in the Human Rights Act 1998.

The health care resources are always limited. Besides the fact that we should set priority for allocation, the amount of resources allocated should be judged upon the prevalence or incidence of a particular disease. The blood donation campaign of England takes the decrease in black donors as an example and claims that there should be more black donors because of the Sickle Cell Disease. I agree that Sickle Cell Disease is a top priority in the black community but the actual fact is that the incidence of Sickle Cell Disease is only 3.2% in UK (1). This figure explains that it is a quite rare disease and the incidence of other rarer blood group disease is even lower. Judging from this point, we should set the treatment of Sickle Cell Disease as a top priority for the black community but the amount of resources should be allocated in accordance with actual incidence. We can explain this point based on two principles that are need based analysis and supply and demand principle. There is a need for blood donation in black community for treatment of Sickle Cell Disease according to the need based analysis. The amount of resources allocated won’t be too much but sufficient in accordance with the supply and demand principle. The actual rationale behind the low donation rate in the black community is because of the wrong strategy used by the Blood Donation service. The black community is actually aware of the fact that Sickle Cell Disease is nowadays very rare in UK so that they are not motivated by such a slogan of treating the rare Sickle Cell Disease and rarer blood group disease. Instead the England Blood Donation service should put more resources on promoting blood donation as a whole which will be much more effective in rising the donation rate in the general population. The black community will only feel that the problem of Sickle Cell Disease is over-exaggerated. This brings the fear of stigmatization.

Currently, the funding of healthcare accounts for 8% of the Gross Domestic Product (GDP) (1) of UK and they decided the allocation of resources according to the National Institute for Clinical Excellence (NICE) guidelines. But blood donation is not a disease (only a medical intervention) so the NICE guidelines do not apply. We should only allocate the resources for promotion or advertisement of blood donation according to the need based analysis and supply and demand principle. These will be a fairer way of resources allocation and the emphasis should be on blood donation from the general population as a whole rather than focusing on the black community alone.





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