Ethical Case Study

Sexual Orientation & Blood Donation

Case Study

            A man named James was living in Australia and wanted to donate blood. James had type O-negative blood, considered the “universal donor,” as any individual can safely receive O-negative if their specific blood type is unavailable. Only seven percent of the population has O-negative blood, and those with O-negative can only receive that particular blood type. As such, there is a high demand for O-negative donors (Blood Types, 2022). James wanted to help those undergoing cancer treatments, individuals with blood diseases, and those with burns by participating in blood donation. However, is a gay man, and in Australia, men are prohibited from donating blood if they have had sexual relations with another man three months before donating (HIV Overview, 2023). James was denied the right to donate blood based on his sexual orientation. This rule stems from the prejudicial notion that if a man is gay, he is likely to be infected with HIV, regardless of his sexual habits. Rather than mandating individual risk assessments from every donor, regardless of their sexuality, the Australian government chose to ban men who have sexual relations with other men from donating. Women and straight men can be infected with HIV, yet they are not denied the opportunity to donate blood due to their sexual orientation (History of HIV Infection in Australia, 2019). A more inclusive approach would not only combat homophobia but would ensure the safety of recipients of donative blood.

Why is this Discriminatory Policy in Place?

               HIV is an infection which results from the human immunodeficiency virus. The most severe stage of HIV is advanced immunodeficiency syndrome (AIDS), which can be fatal if left untreated. From the 1980s to the 1990s, cases of AIDS rose rapidly, leading to an AIDS epidemic. HIV cannot be cured, however, those infected can live a long life if they receive HIV treatment: antiretroviral therapy (HIV Overview, 2023). This treatment was not available until 1987, at which point there were already 2,773 individuals infected with HIV in Australia. From 1985 to 1986 in Australia, fourteen percent of HIV patients were infected due to receiving blood from a donor infected with HIV. During the AIDS epidemic, most cases of HIV -- roughly eighty percent -- resulted from sexual contact between men (History of HIV Infection in Australia, 2019). Thus, in the 1980s and 1990s, many countries banned men who have sexual contact with other men from donating blood for life. In recent years, many HIV prevention methods have been implemented, such as safe sex practices, which have led to a drastic decline in cases of HIV (History of HIV Infection in Australia, 2019). The Canadian government regonized that its policy on blood donation was discriminatory in the 2010s, and protocols shifted to screen sexual behaviour for all donors, regardless of sexual orientation (Sexual Behaviour-Based Screening, 2022). The United States also changed its discriminatory blood donation policies in 2023 (Weintraub, 2023).

To me, being a Catholic involves believing that every person is created equally in the image of God. Therefore, we must not discriminate against others based on any social constructs, including sexuality. The Catholic Church is often associated with homophobia, as many invoke religion to defend homophobic attitudes. However, the correlation between Catholicism and anti-gay beliefs relates to a mistranslation of the Bible in 1946. 1 Corinthians 6:9 denounces sexual perversion, though, in 1946, it was incorrectly translated to condemn homosexuality (Ho, 2023). In 2023, Pope Francis announced his support for priests to bless homosexual marriages, solidifying that Catholicism is no excuse for discrimination based on sexual orientation (Blessings for Same-Sex Unions, 2023). Human equality, prioritizing the common good, and participating in all aspects of life are central to Catholic ethics. Banning gay men from donating blood goes against all of these Catholic ethical principles. This ban perpetuates inequality, prevents individuals from participating in their community, and hinders the common good.

What is the Ethical Response?

Approach 1

            Australian laws could change to mandate risk assessment for all donors, regardless of sexual orientation. This way, James and all other gay men in Australia have an equal opportunity to donate blood. The safety of patients remains at the forefront of policy-making according to this approach. The “parity thesis” states that an individual’s sexual orientation does not impact their moral status. Thus, it is immoral to discriminate against someone because they are gay. This approach assumes the parity thesis is correct (Jordan, 1995). Discriminatory attitudes towards homosexual individuals are due, in part, to gender-based stereotypes. Sexual relations between two men contradict the stereotype that men must be dominant, as one party must take on a subordinating position. There is a perceived correlation between masculinity and taking control over women; homosexual relations also counter this heteropatriarchal ideal. Though there is a lower tolerance for blatant discrimination in modern society, discriminatory notions still manifest in laws such as the ban on blood donation from gay men (Dunne, 1998). We must dismantle this system of heterocentric ideals to create a more equal society.

Approach 2

            Another approach is to uphold the policies currently in place. Mandating risk screening for all donors would be very costly to the Australian healthcare system. Men who have sexual relations with men are the population with the highest rate of infection for HIV. Thus, it is more economical to ensure safety by preventing gay individuals from donating (History of HIV Infection in Australia, 2019). The "difference thesis" states that there is a difference in the moral status between homosexual and heterosexual individuals. Thus, it is acceptable under certain circumstances to discriminate based on sexual orientation. The difference thesis would align with the notion that jeopardizing another individual’s health necessitates discrimination, as in the case of blood donation (Jordan, 1995). The principle of non-maleficence obliges healthcare providers to avoid harming their patients; this principle is vital to maintaining an ethical healthcare system. Preventing the population with the highest infection rate for HIV from donating blood would protect recipients of blood from potential harm (Terry, 2007). 

Evaluation of Approaches

            I believe the first approach is the most ethical; giving each person who wishes to donate blood a fair chance is more just and guarantees the safety of recipients. Theories about what is considered ethical change frequently in response to changing social norms, and we must change policies to reflect our currently held ethical beliefs (Terry, 2007). Australian law prohibits discrimination based on sexual orientation in many areas of life -- such as education and employment -- and it is vital that blood donation policies also reflect this equality (Australia’s Ant-Discrimination Law, 2023). A legal right to not be subject to discrimination is difficult to circumvent. Thus, the Australian government must grant this right to all groups in blood donation. Utilitarian theories -- arguing we must promote the greatest good for the greatest number of people -- are the basis for most public policy. The blood donation ban for gay men is contradictory to utilitarian values, as it is both discriminatory and prevents access to a greater quantity of vital healthcare resources (Terry, 2023). 

           

           I believe in the parity thesis; it is immoral in every circumstance to discriminate against an individual due to their sexual orientation. My ethical beliefs as a Catholic demand James have a fair chance to donate blood. Allowing James and all gay men in Australia to donate blood would promote equality, benefit the greater good, and combat the limitation of resources in the healthcare system. The benefit of James donating O-negative blood far outweighs the risk so long as he and all other potential donors undergo risk assessment. To prevent James from donating solely based on his sexual orientation would be contrary to morality. One in thirty Australians donate blood, but one in three Australians will require blood at some point in their lifetime (Blood Donations, 2024). The demand for blood is far more crucial than upholding discriminatory values. James and many other men like him in Australia could help combat the shortage of blood supply if the government would abolish discriminatory rules. Though it is not as common, HIV can infect women and straight men. Mandating a risk assessment for all donors would not only be more inclusive but would make blood donation practices more safe.

Works Cited

“Australia’s Anti-Discrimination Law.” Attorney-General’s Department, 26 Apr. 2023, www.ag.gov.au/rights-and-protections/human-rights-and-anti-discrimination/australias-anti-discrimination-law#:~:text=In%20Australia%2C%20it%20is%20unlawful,life%2C%20including%20education%20and%20employment.

“Blessings for Same-Sex Unions Possible in Catholicism, Pope Francis Wrote to Conservative Cardinals.” CBC News, 2 Oct. 2023, www.cbc.ca/news/world/pope-same-sex-blessings-1.6984540.

“Blood Donations.” My Dr, 11 Jan. 2024, mydr.com.au/heart-stroke/blood-donations/#:~:text=Only%20one%20in%2030%20Australians,stomach%20and%20kidney%20disease.

“Blood Types.” Red Cross Blood Services, 8 Nov. 2022, www.redcrossblood.org/donate-blood/blood-types.html#:~:text=Types%20O%20negative%20and%20O,37%25%20of%20the%20population).

Dunne, Bruce. “Power and sexuality in the Middle East.” Middle East Report, no. 206, 1998, pp. 8–11, https://doi.org/10.2307/3012472.

“History of HIV Infection in Australia.” HIV Management Guidelines, 24 Nov. 2019, hivmanagement.ashm.org.au/the-epidemiology-of-hiv-in-australia/history-of-hiv-infection-in-australia/.

“HIV Overview.” National Institutes of Health, U.S. Department of Health and Human Services, 25 July 2023, hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-aids-basics#:~:text=HIV%20attacks%20and%20destroys%20the,and%20the%20onset%20of%20AIDS.

Ho, Vivian. “Did Christian Homophobia Come from a Mistranslation of the Bible?” The Guardian, Guardian News and Media, 1 Dec. 2023, www.theguardian.com/film/2023/dec/01/christian-homophobia-bible-mistranslation-1946-documentary.

Jordan, Jeff. “Is it wrong to discriminate on the basis of homosexuality?” Journal of Social Philosophy, vol. 26, no. 1, Mar. 1995, pp. 39–52, https://doi.org/10.1111/j.1467-9833.1995.tb00056.x.

“Sexual Behaviour-Based Screening.” Canadian Blood Services, 2022, www.blood.ca/en/blood/am-i-eligible-donate-blood/sexual-behaviour-based-screening.

Terry, Louise. “Ethics and contemporary challenges in health and Social Care.” Ethics, 10 Jan. 2007, pp. 19–34, https://doi.org/10.46692/9781847422286.002.

Weintraub, Karen. “Blood Donation Policy Is Updated, Allowing Gay and Bisexual Men to Give.” USA Today, Gannett Satellite Information Network, 17 Sept. 2023, www.usatoday.com/story/news/health/2023/09/17/fda-red-cross-end-ban-bisexual-gay-men-blood-donations/70772461007/.