Societal Support for Paying Plasma Donors in Canada

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TThe legal status and regulation of economic transactions do not depend only on considerations regarding their economic efficiency, but also on whether a society supports the occurrence of trades through a price mechanism (if at all). Concerns that individuals engaging in certain transactions may be exploited or unduly influenced, that the terms of trade may not be fair, or that some transactions violate human dignity, the sanctity of life, or traditional institutions may lead a society to prohibit certain trades. These principles may take priority over material considerations and may contribute to defining common identities or a collective conscience that allows complex societies to be tied together. Alvin Roth defines as “repugnant” those transactions that third parties wish to prohibit even if the underlying exchanges may be beneficial for the parties directly involved.

Examples of transactions that raise or have raised moral concerns often leading to their prohibition include prostitution, same-sex marriage, indentured servitude, and markets for human organs for transplantation. The legal treatment of several of these transactions has changed over time in many countries. For instance, same-sex marriage, which until recently was nearly universally prohibited because it was regarded by many as being in conflict with religious and traditional values, is now legal in several countries. Additionally, countries that otherwise share many similarities in social structure, level of economic development, and historical and cultural roots treat certain transactions differently. For example, prostitution is legal in Germany but illegal in France, and commercial surrogacy is legal in several jurisdictions in the United States but illegal in Canada.

These legislative choices raise questions as to whether the different legal treatments of certain transactions actually reflect different levels of societal support for those activities across countries, and if so, why. Moreover, seeming inconsistencies introduce additional challenges to our understanding of what explains support for, or opposition to, morally contentious transactions. Our research focused on one such apparent inconsistency: the case of plasma donations in Canada and the United States. The United States allows payments for plasma donors and the establishment of for-profit plasma centers. In contrast, payments to plasma donors are illegal in several provinces of Canada, and more provinces are considering bans. Canadian policymakers justify the prohibition on compensation with moral considerations and with concerns about the safety of plasma collected from paid donors. However, Canada relies on imported plasma from American paid donors to meet its need for plasma-derived therapies. For example, approximately 83 percent of immunoglobulin, which is used to treat several immune, blood, and neurological disorders, is made from plasma imported from American for-profit plasma centers.

Evidence about the degree of social support (or disapproval) for morally controversial activities is scant. Even less evidence is available regarding whether the social support is general or country specific—for example, whether the moral opposition that a society may have toward a certain trade refers only to allowing that trade in that same country, or everywhere. In particular, individuals may display some form of “moral NIMBY-ism” (referring to the concept of “not in my backyard”), wishing to reap the benefits from a contested transaction (e.g., compensated plasma donation) while outsourcing its moral costs. Thus, with specific reference to plasma donations in Canada, in our research we asked the following questions:

  • How prevalent is opposition to compensating plasma donors in Canada?
  • What are the main reasons for and against payments? What is the relative importance of moral concerns, safety concerns, and considerations about guaranteeing a sufficient supply?
  • Are Canadians opposed to paying all plasma donors, or just Canadian plasma donors?
  • Do the majority of Canadians exhibit consequentialist preferences (meaning that the practical effects of payments are important to their attitudes toward payments) or deontological preferences (meaning that their opposition to compensation reflects a sacred value that cannot be sacrificed)?

We conducted a randomized survey experiment with a representative sample of 826 Canadian residents. In the survey, respondents were randomly assigned to express their opinion in favor of or against compensating plasma donors in one of three countries: Canada, the United States, or Australia. Similar to Canada’s position, compensation to plasma donors is not allowed in Australia, and Australia relies on imported plasma to satisfy its domestic needs. Next, according to whether they were in favor of or against paying plasma donors, we asked how much the respondents agreed with a set of possible motivations for their position. The sentences that expressed those motivations stressed the morality of allowing or not allowing payments, the risk of attracting donors with transmittable diseases if payments were legal, and the importance (or lack thereof) of guaranteeing a sufficient domestic supply. By asking a representative sample of people from one country about support for payments in their own country or elsewhere, we could determine whether attitudes are general or specific to a person’s country of residence. The additional questions about the individuals’ motives behind their stance further helped to identify not only the differential relevance of these motives, but also the weight assigned to them when referring to one’s own country as opposed to other countries.

First, we found that most respondents are in favor of legalizing payments to plasma donors: 72.6 percent were in favor of compensating plasma donors in Canada, 78.7 in Australia, and 76.4 in the United States. Thus, we found no evidence of widespread societal opposition to payments to plasma donors. Although the support of our Canadian respondents was higher for paying plasma donors in Australia and the United States than in Canada, the differences were small, suggesting a weak role for moral NIMBY-ism or moral relativism in explaining the findings.

Second, respondents gave moral concerns the highest rates among the reasons to oppose payments. Respondents also gave high importance to concerns for the safety of plasma supplied by compensated donors, although most of the plasma in Canada does come from paid American donors. Furthermore, the organizations in charge of the procurement and allocation of plasma have repeatedly assured (and proven to) Canadians that plasma from American paid donors is as safe as plasma from Canadian unpaid donors. Because safety concerns are unjustified by the evidence, appropriate informational campaigns could help dispel this misconception. More opportunistic considerations, such as the fact that the supply surplus from the United States allows Canada to rely on imports without the need to pay donors domestically, had a less important role as motivation for opposing compensation.

In contrast, among those in favor of legalizing compensation for donors, the highest-rated motive was to guarantee a higher domestic supply. The majority of the respondents who were in favor of legalizing compensation also agreed that compensation would not run against mainstream Canadian moral and societal values.

Because roughly half of those who declared they were against payments reported that they would reconsider their position if the domestic supply and imports were insufficient to meet domestic demand, we conclude that up to about 85 percent of our Canadian respondents share a consequentialist view regarding the regulation of the demand and supply of plasma. Conversely, the remaining approximately 15 percent of respondents who continued to oppose payment even when faced with a hypothetical supply shortage can be characterized by deontological preferences: prohibiting payments is a value of a higher order than guaranteeing an adequate supply of plasma. The finding that the attitudes of Canadians toward compensating plasma donors are very similar regardless of whether donors are in Canada or elsewhere is consistent with the attitudes reported in the survey and the stated motivations, representing general moral values of the respondents.

NOTE
This research brief is based on and includes excerpts from Nicola Lacetera and Mario Macis, “Moral NIMBY-ism? Understanding Societal Support for Monetary Compensation to Plasma Donors in Canada,” Law and Contemporary Problems 81 (2018): 83–105, https://scholarship.law.duke.edu/lcp/vol81/iss3/5.

Nicola Lacetera and Mario Macis

Nicola Lacetera, University of Toronto, and Mario Macis, Johns Hopkins University