Commerce and medical ethics.

Several of the papers in this issue of the journal address issues of commerce in relation to medical ethics. Dr John Keown' argues in favour of the long-established British, and more recently also European Union, policy that blood for transfusion purposes should be donated, rather than sold. Even if-coun-terfactually-it were more expensive to use unpaid donors, he suggests, the promotion of altruism and social solidarity that the voluntary system promotes would justify the extra expense. Dr Donna Dickenson,2 responding to Dr Don Evans's earlier paper in the journal,3 argues (a) (like Dr Evans) that if men are to be paid for "donating" their sperm for infertility treatment then women, for whom such donation is a taxing and painful process, should also be paid; but (b) (unlike Dr Evans) that neither men nor women should be paid, but rather that people in general should altruistically donate their gametes for the benefit of others. Professor Tom Sorell4 argues that the current UK government emphasis on quasi commercial internal markets,-buying and selling services, and regarding patients in the National Health Service as customers and or "consumers", is mistaken, and that instead a model based on solidarity is preferable. Some of the arguments presented by these authors are persuasive. For example, in relation to blood donation Dr Keown argues that payment is unnecessary; that unpaid donation encourages altruism and social solidarity, whereas payment tends to undermine these virtues; and that blood that has not been paid for tends to be safer for the recipients than blood that has been bought from the donors. He goes on to argue that payment for blood "involves a significant risk of exploiting the poor and socially disadvantaged". Even if this can be guarded against by, for example, existing reputable companies working under careful regulation in the first world, extension of such activity within Europe might encourage less developed countries to embark (or continue) on the path of paid donation. This would risk widespread and serious exploitation, including exploitation by rich nations of the citizens of poor nations, and the inhibition of voluntary donation programmes in developing countries by commercial companies from rich nations attracting away potential volunteers by paying for their blood and taking it away, thus depriving those needing blood in the poor nations. He then suggests, by a series of questions under the subheading "Commercialisation of the human body", that payment for blood may lead, by …