Bad blood

I have always admired blood donors, although I'm not one (health reasons).

I love them because of all the things they're prepared to give.  Their blood, of course.  Their time.  Their resources, to drive to a place they can donate - and maybe to take an hour or two off work to do it.  Their comfort; because even when you're a veteran donor, needles still aren't all that fun.

Donors don't know who their blood will go to.  It could be anyone from a baby needing surgery, to a drunk driver who injured themselves in the course of killing someone else.  But that's the nature of this kind of gift: without judgement, and given in return for only the greater good and a pretty average biscuit. It’s hard to imagine a universal health system without it.

The parents of the baby who needs life-saving heart surgery - who will not allow their child a blood transfusion from someone vaxxed - have their reasons.  It's easy to judge them, and I'd be lying if I said I wasn't.  Maybe it's not even the parents we should be mad with: probably, it's the cynical network of stirrers who are egging them on, making headlines of their tragedy. These parents are suffering, and whether we agree with their choices, they deserve our compassion.

The history of blood donation is fraught, with demand sometimes driven less by science and more by emotion. For example, in 2021, the American Red Cross apologised for “the regrettable decision to segregate blood based on race, accommodating cultural norms of the time rather than relying on scientifically based facts”. They phased out this segregation in 1948, moving to practices with a scientific basis.

Of course, this is a dramatic example. The parents of this baby almost certainly have no ill intent, and especially not of the sort the Red Cross gave in to. But when you open up blood donation to preferences not based on science, you open a door - and that door could lead us to places that are ethically uncomfortable.  

The idea of choosing, without any scientific basis, what people we get blood from is at odds with the reasons - humane, universalist, non-judgemental - that people give blood in the first place.  Ultimately, it seems odd to demand what people give only voluntarily: to judge what has been offered without judgement. But it’s more than that.

If we would feel troubled by donors specifying who can receive their blood - because recipients are vaxxed, unvaxxed, or belong to some other group the donor doesn’t care for - we should think twice about a system that supports recipients to choose whose blood they get.

We should consider the implications of people choosing the blood they prefer for blood collection: whether donors should be asked to tick a checklist of all the reasons a recipient might object to their blood; whether we want the New Zealand Blood Service to create categories, gear its operations, to meeting these preferences.

We should ask whether we’d be OK with the other side of the coin, and the stigma it would carry: a potential recipient demanding to know whether a donor is unvaccinated, and rejecting their perfectly healthy blood on that basis.

In short, we should ask what values should primarily guide this critical health service: those of science or personal choice.

I've got my opinions who's right or wrong in this specific situation, but opinions are the luxury of people who live beyond infancy.  Ultimately, I hope that whatever can be done to help this child happens now, and the philosophical and legal arguments - important as they are - take place over this little one's recovering body, not their coffin.  This is the time to just get on with it. But whatever getting on with it looks like, it needs to take into account not just this child, but the next complex ethical situation: the next person who finds their life in the hands of the blood donation system, and the next one after that.

Finding your life in someone else’s hands is the great leveler. I learned this when I had my first child: a birth I would not have survived, and nor would he, in a lesser health system. I don’t know who were the medical professionals who rallied around me, with anaesthetic and scalpel and masks and gloves. They didn’t know me.

In the urgency and panic of that moment, my greatest feeling was fear. The next was a kind of inarticulate relief that - without knowing my vaccination status, my health status, who I was or what I believed - these people did their jobs in accordance with the science, absent any judgement, and without fear or favour. I am grateful for them, for the universalist principles of the system they represent, because without them I would never have held my baby - as I hope the parents in this story will hold their baby, when all is said and done.

Blood donors get on with it. They don't specify who their gift will help; who is more or less deserving of life.  They look away from the needle as it goes in, towards the reason the needle matters. They remind me, as they give, of the values I cherish, I celebrate.

The spirit in which a gift is given is surely the same with which it should be received. 

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