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Gifts ondExchonges* Kenneth j. Arrow Richard Titmuss is justly distinguished for his devotion to the welfare of society at large and particularly to those who have received the least of society's benefits. He has not rested content with the moral satisfaction of advocating the good but has immersed himself in the detailed factual analysis and speculative thinking needed if good intentions are to become good deeds. The gift he has made of his talents has now found an appropriate embodiment in his latest and much-noticed study, The Gift Relationship: From Human Blood to Social Policy. 1 The study focuses specifically on the workings of a particular supply system, that by which blood is made available for transfusions in the United States and in the United Kingdom, with some reference to other nations. But this close study is intended as something of a searchlight to illuminate a much broader landscape: the limits of economic analysis, the rival uses of exchange and gift as modes of allocation, the collective or communitarian possibilities in society as against the tendencies toward individualism. Most of the discussion takes place in the precise and objective language of empirical sociology: surveys and tables are presented, the limits of the data are stated with the utmost care, but every now and then the strength of Titmuss's convictions shines forth.·Presented at the Conference on Altruism and Economic Theory held by the Russell Sage Foundation, and prepared with the partial support of NSF Grant GS-28626X, Harvard University. This paper was first published in Philosophy and Public Affairs, Vol. I, no. 4 (Summer 1974), 343-362. Reprinted by permission of Princeton University Press. 1 (London: George Allyn & Unwin, 1971.) All page references in the text are to The Gift Relationship. 13 14 • ALTRUISM, MORALITY, AND ECONOMIC THEORY Perhaps the flavor of the lessons he wants us to learn can best be suggested by a somewhat lengthy quotation of his final two paragraphs: From our study of the private market in blood in the United States, we have concluded that the commercialization of blood and donor relationships represses the expression of altruism, erodes the sense of community, lowers scientific standards, limits both personal and professional freedoms, sanctions the making of profits in hospitals and clinical laboratories, legalizes hostility between doctor and patient, subjects critical areas of medicine to laws of the marketplace, places immense social costs on those least able to bear them-the poor, the sick, and the inept-increases the danger of unethical behavior in various sectors of medical science and practice, and results in situations in which proportionately more and more blood is supplied by the poor, the unskilled, the unemployed, Negroes and other low-income groups, and categories of exploited human populations of high blood yielders. Redistribution in terms of blood and blood products from the poor to the rich appears to be one of the dominant effects of the American blood-banking systems. Moreover, on four testable non-ethical criteria the commercialized blood market is bad. In terms of economic efficiency it is highly wasteful of blood; shortages, chronic and acute, characterize the demand-and:-supply position and make illusory the concept of equilibrium . It is administratively inefficient and results in more bureaucratization and much greater administrative, accounting, and computer overheads. In terms of price per unit of blood to the patient (or consumer), it is a system which is five to fifteen times more costly than voluntary systems in Britain. And, finally, in terms of quality, commercial markets are much more likely to distribute the contaminated blood; the risks for the patient of disease and death are substantially greater. Freedom from disability is inseparable from altruism. The present essay is a series of reflections on the descriptive and prescriptive issues raised by Titmuss's evidence and assertions. It is obvious on the most superficial observation that the allocation of goods and services is not accomplished entirely by exchange, as standard economic models would hold. Clearly this is true for such impalpable goods as respect, love, or status, but even when we confine ourselves to goods whose allocation the economist believes himself capable of analyzing with his tools, the donation of blood for transfusions is only one example of a large class of unilateral transactions in which there is no element of payment in any direct or ordinary sense of the term. Formal philanthropy has always been a prominent element of all economic Gifts and Exchanges • 15 systems and has shown no signs...


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