The ethics of lying to the blood bank

Great Debates
1

In this thread, OpalCat thoughtfully invited us all to donate blood.

Ever since I was old enough (15, with a note from my parents) I have happily donated blood as often as was permitted. The nurses were friendly, the free juice and cookies lovely, and the fuzzy feel-good feeling from helping others just couldn’t be beat.

Then I went to England, for two years. I was vegetarian, ate no part of a cow, drank no milk, ate very little cheese.

Upon my return to Canada I found that I was no longer permitted to donate, because I had been to England and could thus potentially infect the blood supply with CJD.

Now, I know all the reasons for this.

  • The mechanisms by which CJD is transmitted are unknown
  • Canadian Blood Services (CBS), formerly the Canadian Red Cross, are still reeling from accidentally infecting people with Hep C and AIDS in the 80’s, because they weren’t cautious enough.

And so on, and so on.

BUT … there are constant shortages of healthy, willing people to give blood. I am such a person, but am unwelcome to give it. (As are, incidentally, openly gay or bisexual men, people who have had sex with someone whose past sexual history they don’t know - and how many of us can honestly say they haven’t? - and so on.)

But please see this editorial from a local lefty rag. It contends that CBS’s policies are
(a) stupid, since their screening questions have little to do with your likelihood of having come in contact with AIDS, and
(b) bigoted against gay people, since they rule you out if you have had sex with a gay or bisexual man, but never ask about safe sex practices.

So now I see their heartwrenching ads, with large-eyed little kids pleading for blood for their operation, asking from the bottom of their hearts for me to donate. And I have to say ‘No.’

What do y’all think? I’m interested in a discussion, but I posted in Great Debates in hopes you could answer the following question:

Given that

  • I am a healthy, willing, and otherwise eilgible person with a fairly rare blood type
  • More healthy, willing people are needed to donate blood
  • CBS are trying to be extra careful after the whole Hep C fiasco, which came about because they weren’t careful enough in screening donors, and didn’t fully understand the mechanisms of the disease
  • I have a miniscule, but potentially present, chance of carrying CJD, having lived in England but not eaten cows

should I lie to them about my time in England?

2

** Absolutely not. It’s not your call.

First, it’s the responsibility of the people in charge of the blood supply to balance need against risk, not yours. The same folks making those heart-rending commercials are making up the rules as to who may donate. It would be completely unethical for you to unilaterally substitute your judgement for theirs.

Second, to go back to Kant, what would happen if everyody did this? It’s all very well for you to say that you “know” that you aren’t infected. However, I’m sure that there are lots of people who “know” they’ve never been exposed to AIDS or CJD or whatever . . . except they’re wrong. Once again, the people making the rules have attempted to create objective criteria rather than relying on people’s subjective opinion as to whether they pose a risk to the blood supply or not. Let them do their jobs.

Third, it’s been said that the best way to change a bad policy is to strictly enforce it. I understand, for example, there is something of a crisis in New York City because virtually everyone in Manhattan fails one of the American Red Cross criteria for blood donation. If this creates a crisis, so be it. It will only force the American Red Cross to re-think the risk/benefit calculation they made when setting up the rules in the first place.

BTW, pretty ironic username you’ve got, given the OP.

3

Do the hell not ever lie to these people. The only reason they rule out some people is due to an overwhelming health risk.

You know, my father caught a disease from untested blood. He may well die from it. Fact is, these rules are in place because they are desperately trying to protect people. If the situation changes, and they feel the need for rare donor blood more than they need positively clean blood, they’ll call you.

4

I’m screened out for similar reasons, so I don’t even try, and politely refuse when approached by the bloodmobile folk. No, do not lie to them. Like the other guys said, ain’t our call to make.

5

I agree with the other two responses - the blood bank should make the call. Have you tried to discuss the details of your stay in England with the nurses or the other staff of the blood bank? The screening questions don’t necessarily mean you get booted immediately - I assume there is some discretion.

It is a shame more people don’t donate - but the list of questions has gotten a lot longer in the 30 years I’ve been doing it.

6

For the exact same reason as yours (2.5 years in England), I can no longer give blood. When I’m asked, I always say that I’d love to but the Red Cross won’t let me. I, too, have thought about omitting my overseas stay, but decided honesty is the best policy.

7

What’s your motivation here? Are you really so concerned about those poor, helpless, injured people who need your blood, or are you more concerned that CBS is rejecting you?

You said yourself that the transmission mechanism for CJD is unknown. Maybe you’re a carrier (probably not, but you can’t be sure). If so, could you live with yourself, knowing you’ve infected others through your own selfish behavior?

So let’s look at risk/benefits:
Benefits:
You get the satisfaction of giving blood to help others.
You put one over on those idiots at CBS.

Risks:
You potentially infect dozens of people with a horrible disease.
You are caught in your lie (there must be some record of your trip to England), and potentially criminally prosecuted.
You have to live with the guilt and worry that your selfish actions have harmed someone else, which result you may never know.

I’m a big believer in letting people make their own decisions, provided those decisions are well-informed. So it’s your choice - good luck.

8

Maybe the "cute and fuzzy kittens argument has no place here, but I’;m going for it anyway. Maybe you don’t fret overmuch about the risk of giving some obscure disease to some 80-year old woman undergoing a hip replacement, but remember that often platelets go tiny babies in the NICU.

While you might not infect the dozens of people Danalan cited, your blood components may go into up to five people.

The real problem is not that the Red Cross are supercareful about who donates. The problem is that not enough people even try. It’s something like 5% of the eligible population who donates. Instead of trying to get around their rules because they are too strict, why not recruit some blood donors? If you really want to help, tell friends “I can’t give because of my England stay, but would you consider it?”

9

Can the CBS not test for CJD? I remember hearing in the weeks following 9-11 that people who had given blood were called back by the Red Cross because their sample had tested positive for AIDS (their infection unbeknownst until said call-back). I’d imagine that if there was a chance of the propagation of a disease through the blood supply that it would be something a blood bank would test for before using.

10

You don’t have a right to donate blood, and the CBS is perfectly entitled to reject you for any reason that suits it. If you lie to them yu’re perpatrating a fraud. It’s illegal and unethical. So why the hell would you do it?

As for the editorial…

“So let’s get this straight: CBS bans homosexuals from donating for life, but heterosexuals, who account for nearly one-third of all new HIV cases, are its donors of choice…”

Let ME get this straight; straights, who comprise 90% of the population, constitute 1/3 of new AIDS cases; presuming homosexuals/bisexuals constitute the remaining two thirds, that means that the rate of new AIDS infection among homosexuals or bisexuals in Canada is at least eighteen times higher. In truth the total rate of HIV infection, cases old and new, among gay men is probably higher still; I’ve seen numbers ranging around 75-80% of all cases. It’s a simple truth that gay men are vastly more likely to be HIV positive than straight women or men, and the rate of new HIV infections in Canada is so much higher for gay men than it is for straight women than men that it’s just appalling. (Of course, then you have your IV drug users, a completely different kettle of fish.) Canadian Blood Services - it’s not the Red Cross - would be criminally negligent in not accounting for that.

Now, maybe they should ask questions about condoms - but according to this editorial, they DO ask donors if you’ve had casual sex with someone in the last 12 months whose history you don’t know. So they’re screening for that, too.

There’s nothing WRONG with being gay, and the odds are that any given gay man isn’t HIV-positive. Gay people should not have fewer rights under the law than straight people. Gay men should be allowed to serve in Canada’s armed forces. But donating blood simply isn’t a legal right, and there’s a bona fide concern here. CBS would be criminally negligent in not admitting that 18-to-1 truth in screening applicants, and given that the Red Cross was hit with CRIMINAL charges over the tainted blood catastrophe, they have a reason to be afraid.

And they’d be criminally negligent in not admitting the fact that people who’ve been in certain countries for a long period of time are much likelier to be carriers of blood-borne pathogens - people like, say, YOU.

If it makes you feel better I’ll donate twice as much to make up for your blood. I’m O-negative, a very useful blood type.

11

Personally, I think the writer of the OP’s cited editorial should be prevented from giving blood, lest they infect others with their sanctiminous dick-headedness. The “have you had sex with someone whose sexual background you don’t know?” is clearly meant as a polite way to ask if you’ve had a one-night stand recently.

I find the editorial lacking because nowhere does it mention the people who became infected through blood donations and no fault of their own. Ask any hemophliac and they’d likely say the questionnaire is not stringent enough. Somehow the hurt feelings of the editorial staff of eye weekly and other would-be donors seem pretty trivial compared to the potential harm of a tainted donation.

12

Also, why would you want to lie? It’s not as if you’re being denied something precious or wonderful if they don’t let you donate. Sure, you get to help people, but there are other ways of helping others. Maybe I’m really insensitive, but I just don’t see why getting your arm pricked and losing a pint of blood is worth lying for. It’s just not up there with voting and life, liberty, pursuit of happiness and all that. Speaking as someone who can’t give blood (too underweight), I don’t see how the pros of giving blood would outweigh the negative consequences of health risk. Just as Danalan was saying, the cons outweigh the pros.

13

Cowgirl,

I know how you feel. I’ve been banned for a year due to an afternoon visit to Chichen Itza on my Mexican vacation. I find myself yelling at the CBS ads (“I tried and you won’t let me! Shut up!”).

Cranky speaks of “eligible donors” I have heard the 5% statistic before, and I am curious what they consider an "eligible donor’. Is it the percentage of the population that fits in between the age and weight restrictions? The reason I ask is that I know very few people who fit into the age catagory, and are allowed to donate. Childhood diseases, certain medications, tattoos, piercings, trips to other places…any of these categories takes a person off the eligibility list for a year, or forever.
I’m not saying I disagree with their caution in screening donors this way, just that they will find it more and more difficult to find donors that are deemed acceptable.

It was my impression that a large part of the tainted blood scandal hinged on the issue that there were some doctors who were aware that there was a problem with tainted blood, and little or no action was taken until it was far too late. (I won’t even mention the government’s shameful handling of compensation - thank you Allan Rock.) Although the Red Cross no longer handles the blood supply in Canada, I wonder if the association change will fully address the issue of who has the responsibility to ensure it remains as clean as possible. Screening donors can only go so far.

14

http://www.cdc.gov/hiv/stats.htm#exposure

Cases by Exposure Category

Following is the distribution of reported AIDS cases among adults and adolescents by exposure category. A breakdown by sex is provided where appropriate. The categories and totals are:

Exposure Category Total
Men who have sex with men 368,971
Injecting Drug Use 201,326
Men who have sex with men and inject drugs 51,293
Hemophilia/coagulation disorder 5,292
Heterosexual contact 90,131
Recipient of blood transfusion, blood components, or tissue 8,971
Risk not reported or identified 81,091

I thought I’d throw out the AIDS statistics for the US. Rickjay’s concerns are founded (esp. considering:
Donated Blood and the Risk of AIDS Scientists Say Chance of Contamination is Less Than 1 in 82,000 ) but, in my opinion, there ought to be a verbal screening caveat for those of us that are safe, monogamous, tested and HIV negative. I also would hold those standards to a straight person as well.

As for the OP, NO NO NO. As much as I’d like to help out by donating blood, I can’t per their rules and won’t lie to do so.

15

Regular blood donors are very important to the blood supply and are treasured by blood banks. The decision to exclude people on various criteria are not undertaken lightly. If the regulations are seen as unfair or unwise, the thing to do is lobby for change, not lie to the blood banks (for reasons already discussed).

Can cowgirl absolutely swear that she didn’t eat a thing in England that could possibly have contained beef in some form?
Incidentally, there are no specific tests to diagnose CJD, at least none that anyone in their right mind would even think of undergoing in order to give blood. You can do a spinal tap to look for a certain kind of cerebrospinal fluid protein, but that is not a sure thing. You could undergo a brain biopsy, but with the small amount of tissue obtained you might very well miss early changes in a non-symptomatic person. To be really sure, a comprehensive brain examination at autopsy is the gold standard for diagnosis. And I haven’t heard of any blood donors, even really dedicated ones, who are literally dying to give blood.

People who volunteer to donate blood in order to get tested for infectious agents like HIV and hepatitis C (and there’ve been cases on record) are taking a horrible chance with other people’s lives. There are no diagnostic tests that are 100% accurate.

16

To make things clear: I have NOT lied to the blood bank. I have no plans to lie to the blood bank. I have not donated since I’ve been back.

I just want to donate to try to make up for the people who are otherwise eligible but too squeamish, or whatever.

Rickjay, thanks for donating on my behalf ! :slight_smile: Now I’ll think of you whenever I see those wide-eyed children.

And yes, Voyager, having been in England automatically rules you out, forever.

Jackmannii: unless I was lied to, yes, I can honestly say I never ate anything that came in contact with beef. I did most of my own cooking (have you ever tried to eat out in England? ughhh …)

I guess I’m just bummed that they are giving up on me: they are forgoing (30 years x 4 times a year) 120 pints of my precious A-, for being overcautious.

And yes, I still think it’s overcautious. People in Canada who have never been to England have had CJD. Also, as the linked editorial illustrates, you could answer all the screening questions honestly, and still be at high risk for HIV, and they would still take your blood.

I also want to get back to the ‘sex with someone whose history you don’t know’ question. I understand that it’s meant to weed out one-night stands but that’s not how it’s phrased. A ‘yes’ would make you ineligible.

Who among you can honestly say that you have never done this? Can you list (a) ALL your previous partners, (b) all THEIR previous partners, (c) all THEIR previous partners, etc etc. Unless all of these people are trustworthy virgins, this is nigh-on impossible.
oh, and Truth Seeker, cows are for more than just eatin’, you know :wink:

17

Um, me, and also many people I know. I have not been able to donate blood, however, since I have spent the past few years either pregnant, nursing, or with low blood iron–but I will as soon as I can!

I think it’s a bit nuts to sleep with someone whose history you don’t know, and it seems to me a perfectly valid question. There are a lot of diseases floating around out there, and they would prefer not to spread them. If you want to be able to give blood that badly, then avoid sex with unknown people. You might dodge a bullet for yourself as well.

If you can really be so sure that you did not come in contact with beef during your England stay, then by all means talk go down to the blood center, explain your situation, and let the qualified, educated person in charge make the call. But keep in mind that you said yourself that the transmission method of CJD is unknown, and they are perfectly within their rights to try to minimize risk. Hoof-and-mouth is transferred through the parasites that live on the grass, right? How do you know CJD is not also some weird form of transmission you’ve been exposed to?

18

Please understand that I am not seeking permission to lie. I have reluctantly accepted my status of ineligibility. The world is safe from my potentially infected blood.

But my other question: ‘sex with unknown people’ is NOT what the question is asking about. If even one person I have ever had sex with, has ever had sex with even one person I don’t know about, even if condoms were worn in each and every sexual encounter and all concerned tested negative for HIV, then the question must still, honestly, be answered ‘yes’. This is why I think it’s a dumb question.

Yes, the transmission method of CJD is unknown. But from what they do know, someone in my specific situation (ie vegetarian in England) is LESS of a risk than someone that they would define as risk-free (ie one of those Canadians who got CJD, pre-diagnosis).

And genie, have you read the thread?

Even if I hadn’t been to England, but was in a monogamous relationship with someone who has tested negative for HIV (which I am), I would be ineligible if I couldn’t confirm the HIV status of every partner that every partner of mine has ever had. I cannot make myself eligible by, as of now, not sleeping with any ‘more’ unknown people.

But thank you for illustrating the point. I resent the veiled accusation that my honest ‘yes’ means that I (a) am promiscuous and (b) do not practice safe sex, and I think CBS is doing itself a disservice by making this veiled accusation towards honest people who only want to help.

19

I did not mean to imply that you are promiscuous, and I apologize if it sounded like that; as soon as I pressed the ‘submit’ button i said to myself, 'whoops, I should have clarified that I meant a collective ‘you,’ not a cowgirl ‘you.’ So I’m sorry about that; I meant it generally, not specifically.

I have no idea whether you practice safe sex or not, or if you are promiscuous. I’m glad when you say you are safe. But I agree that if you don’t know the history of everybody you’ve had sexual contact with, directly or indirectly, then you will have to say ‘yes’ to the question. And I think it is a fair question, because ‘safe sex’ is a pretty relative term; it’s possible to pick up STDs even when taking precautions. As I understand it, a negative HIV test and no casual/unknown sex for the past year will get you accepted, right? So I think it’s fair. Your partner, as long as he is HIV- as well, will be considered safe.

20

I just donated this morning (California has a critical O+ shortage if there are any Northern CA dopers who would like to help). They just added, in the last 10 weeks, a question about going to Europe. I’ve been donating for > 30 years, and the list has doubled in size.
(I’ve practically memorized it, so I can tell when they add a new question.)

In the US, they do have a question about hemophilia, and one on getting transfused. They do not have the “one night stand” question - rather they have a questions about having sex with men (I’m male,) taking drugs through a needle, getting paid for having sex, (I wish! :slight_smile: ) or having sex with anyone in these categories. There is also a question about being in the armed forces, but I don’t know where that leads.

What happens when you answer yes is that they delve further. Here, at least, they don’t give you the bums rush for a single yes. Several of the questions have flow charts associated to dig further. So, were you actually rejected or are you assuming you would be rejected?

One thing they are very worried about here is people who donate to get a free AIDS test. Do you have the station where you can say that your blood should not be used? I assume they do that for those too embarrassed to say yes to the questions.