"I Can't Eat if I Don't Plass": Impoverished Plasma Donors, Alternatives, and Autonomy

One of the central considerations to be taken into account in evaluating the ethics of compensation for donated plasma is respect for donor autonomy. And one of the main arguments against compensated donation systems is that many donors do or would come from circumstances of poverty that restrict their alternatives in a way that compromises those donors' autonomy. In this paper, I develop and defend a novel version of this "compromised autonomy argument" which improves upon extant versions by employing a more nuanced account of the relationship between alternatives and autonomy. According to the version of that argument I offer, donors lack autonomy with respect to the sale of their plasma if their economic circumstances leave them with no choice but to sell their plasma (i.e., "plass") on the basis of a desire they have had no choice but to hold. After explicating the key terms of this argument, I examine its policy implications. I argue that, given several reasonable empirical assumptions, my argument implies that a majority of individuals whose income falls below a specified threshold would indeed lack autonomy with respect to the sale of their plasma. Most individuals whose income falls above that threshold, on the other hand, would be able to autonomously sell their plasma. I argue that respect for donor autonomy therefore speaks in favor of an income-restricted system of compensated donation which permits collection centers to purchase plasma from those whose income falls above the relevant threshold, but not those below it.