Markkula Center of Applied Ethics

Giving Blood:
The Development of Generosity

By Claire Andre and Manuel Velasquez

Out nation's blood supply is sustained entirely by voluntary donations, yet fewer than 5% of Americans eligible to give blood do so each year. Why so few? Among other reasons, donating blood involves obvious costs time, some pain, and occasionally unpleasant or physically harmful consequences ranging from nausea to blood clots.

Perhaps the more interesting question is "why so many?" In other words, why would anyone donate blood? This was the question that intrigued Richard Titmuss, author of the widely-acclaimed book, The Gift Relationship. In this book, Titmuss examines the role of altruism in society as it's manifest in voluntary blood supply systems, and highlights the characteristics of voluntary blood donation that distinguish it as a unique form of altruistic behavior, distinct from other forms of exchange in a market-oriented society:

In the gift of blood . . . there is the absence of tangible immediate rewards in monetary or non-monetary forms; the absence of penalties, financial or otherwise, and the knowledge among donors that their donations are for unnamed strangers without distinctions of age, sex, medical condition, income, class, religion, or ethnic group.... How can they and do they learn to give to unnamed strangers?

How, indeed, do people learn to give? According to the philosopher Aristotle, the generosity displayed by blood donors, like other "virtues," is learned over time. That is, one becomes generous or otherwise virtuous by repeatedly performing generous or virtuous acts.

We acquire virtues first by acting, just as we do in the case of acquiring crafts.... for example, by building we become builders, by playing the Iyre, Iyre players. And so too, webecome just by doing just actions, and temperate by doing temperate actions and brave by doing brave actions.

Moreover, Aristotle argued, the motivation behind virtuous acts changes over time. A young person, for example, acts virtuously initially only because he or she is subjected to external pressures or rewards, such as the praise of others. But as the person acquires a virtue, the person develops a sense of ease and delight in acting virtuously. The virtuous person is moved by an internal motivation, engaging in virtue for its own sake.

Since Titmuss' book, several studies have explored the motives behind commitment to regular blood donation, and these studies have tended to confirm the traditional theories of Aristotle. In one study, Ernie Lightman, a professor at the University of Toronto, sent detailed questionnaires to nearly 2000 voluntary blood donors. Lightman found that, initially, the decision to donate blood was likely to be motivated by external factors, such as the convenience of a clinic or an appeal from a blood drive, as well as by internal factors, such as a general desire to help others. But, he writes:

With the passage of time . . . the key motivators became increasingly phrased in moral language. Ideas such as a sense of duty and support for the work of the Red Cross, along with a general desire to help„motives which may be described as strongly internal to the respondent„assumed an increasingly important role as motivators. Though the general location of clinics remained important, other 'external' motivators„in particular peer pressure„became relatively insignificant. With repeated performance of a voluntary act over time, the sense of personal, moral obligation assumed increasing importance. . .

Similar findings were reported by researchers at the University of Wisconsin, who observed that the motivations of blood donors developed and changed over time. The results of their studies revealed that the greater the number of donations reported by donors, the less likely donors were to say that they gave so as not to disappoint others, and the more likely donors were to report that they were motivated by a sense of moral obligation and responsibility to the community. Whereas external motivations, such as social pressure, were likely to prompt the initial decision to donate, it was internal motivations, such as a sense of moral obligation, that maintained the behavior over time.

While the motives of blood donors are admittedly complex, these studies may suggest one answer to Titmuss' question, "how do they learn to give?" Donors learn to give by giving. Moreover, learning to give in one context may carry over into other contexts. Several studies, for example, have found that active blood donors are more likely to engage in volunteer work or to make charitable contributions than non-donors. Perhaps Aristotle was right: virtue is a learned habit.

Further reading

Aristotle. The Nicomachean Ethics. (F. H. Peters, trans.) London: Kegan Paul, Trench, Treubner & Co., Ltd., 1891.

Lightman, E. "Continuity in social policy behaviors: The case of voluntary blood donorship." Journal of Social Policy, 1981,10 (1), pp. 53-79.

Piliavin, J. A., Evans, D. E., & Callero, P. "Learning to 'give to unnamed strangers': The process of commitment to regular blood donation." In E. Staub, et al., (Eds.), Development and maintenance of prosocial behavior: International perspectives on positive morality. New York: Plenum Press, 1984.

Piliavin, J. "Why do they give the gift of life? A review of research on blood donors since 1977." Transfusion, 1990, 30 (5), pp. 444-459.

Titmuss, R. M. The gift relationship: From human blood to social policy. New York: Vintage Books, 1971.

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