The Gift Relationship: Origins and Arguments

Richard Titmuss's The Gift Relationship: From Human Blood to Social Policy appeared in the United Kingdom in 1970 and in the United States in 1971 and was his last major work published in his lifetime. It dealt with the acquisition of blood for transfusion in, especially, Britain and the US. To summarise its argument, discussed further below, Titmuss, utilising a large volume of empirical data, argued that the British system involved donors giving voluntarily and for no material reward and, given that they could not know the recipients of their donations, effectively to ‘strangers’. This took place within the necessary framework of a system of socialized health care (the National Health Service – NHS). In America, by contrast, commercial considerations were often to the fore with, for example, those down on their luck selling blood to commercial blood banks. For Titmuss, the British system was more morally just, and more economically efficient, than its American counterpart. Altruism thus triumphed over the market.

The book had a long gestation, part of which involved an acrimonious dispute between Titmuss and the free-market think tank, the Institute of Economic Affairs (IEA). This started in 1963 with an article in which Titmuss criticised market-based health care provision, such as predominated in America. Around the same time, he told readers of an American magazine that, contrary to the disinformation they were being fed, the NHS was in good shape. This was shown by, for example, the threefold increase in voluntary donations to the National Blood Transfusion Service since the NHS's foundation in 1948. Titmuss was thus both defending the NHS and arguing that the flourishing system of voluntary blood donation was an indicator of its success. For the rest of the 1960s Titmuss continued his dispute with the IEA while collecting material on, and developing his ideas about, the acquisition of blood. In 1966, for instance, he told a Fabian Society meeting that in New York City blood was often both wasted and in short supply while coming from individuals not necessarily in robust health. In England and Wales, though, blood was ‘freely donated by the community for the community’. Hence it was a ‘free gift from the healthy to the sick irrespective of income, class, ethnic group, religion, private patient or public patient’.