Altruism, blood donation and public policy: a reply to Keown

This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, ill Britain, an unpaid system of bl ood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that the y should, be aimed at the promotion and expression of altruism rather than of self-interest, especially that of a mercenary sort. Reflections upon Pre sident Kennedy's proposition, introduced into the debate by Keown, that we should ask not what our country carl do for Its but what we can do for our country is pivotal to this casting of doubt. A case is made for suggesting that advocacy along the lilies which Keown presents of an exclusive relianc e oil a voluntary, unpaid system of blood donation encourages inappropriate attitudes towards the provision of health care. Perhaps, it is suggested, and the suggestion represents, oil my part, a change of mind as a consequen ce of the debate, a dual system of blood provision might be preferable.