Altruism, markets and the importance of the social contract in healthcare: Richard Titmuss’s The Gift Relationship

This book chapter examines Richard Titmuss’s The Gift Relationship: From Human Blood to Social Policy, which was first published in 1970. In the book, Titmuss set out a forceful set of arguments about the importance of recognising the altruistic impulse inherent in donating blood on a voluntary, unpaid basis. Following its publication, his arguments in this regard proved highly influential, with the gift relationship becoming a core ethical principle underpinning human tissue policy and regulation at national and international levels. More broadly, he positioned himself as an academic leader in political debates which continue to resonate today about the extent to which market values should encroach upon the provision of healthcare. He argued for a recognition of a social contract between state and citizen in relation to such provision, which he viewed as involving a moral choice which recognises our social connectedness, rather than being determined by the values of the marketplace. Titmuss’s arguments interweave with, or otherwise provide, important contextual background to many of the key topics examined in the field of health law and ethics. It is for these reasons that The Gift Relationship should be considered a leading work in the field.