「男性間性行為者」捐血禁令之公共衛生倫理分析

Public health ethical analysis of blood donor deferral policy on men who have sex with men

捐血者延緩捐血政策（blood donor deferral policy）藉著設定捐血者條件，達到控制風險、確保血液品質、以及維持穩定捐血量的目的。本文簡要回顧此政策在台灣的變遷歷程，分析當前法律對於曾進行男性間性行為者（men who have sex with men, MSM）永久不得捐血的規定。結果發現，運用重疊共識之方法學，效益主義、康德主義及社群主義之公共衛生倫理檢驗皆可支持廢除此禁令。因為：第一，根據效益主義的必要性與降低傷害的原則，此禁令並非限制最小的措施，無助於擴大愛滋病感染風險的防禦範圍；第二，根據效益主義的效益最大化觀點，此禁令無法提升捐贈血液之品質，反而可能降低捐血量，無法達到最大化良好品質捐贈血液數量的效果；第三、根據康德主義及平等權觀點，此禁令是國家對特定群體之制度性歧視，既不尊重自主，又不公平，甚至可能產生傷害的效果；第四、根據自由社群主義觀點，人們應能共同為了良好品質捐血的社會共同良善而努力，如此可超越威權社群主義維持禁令的主張。本文建議若政府無法提出合理的公共證成，應廢止此規定。

Blood donor deferral policy aims at maintaining blood quality and a stable blood supply. In this ethical analysis, we review the transitions of the policy in Taiwan and focus on the lifetime ban on men who have sex with men (MSM). We subject the ban to a public health ethical examination based on three ethical theories. Using overlapping consensus as the methodology of justification, we have found that utilitarianism, Kantianism and communitarianism all support the repeal of the ban. First, we apply the doctrine of necessity and minimal harm and note that the ban cannot widen risk protection from HIV/AIDS. Second, we turn to the principle of maximizing utility and contend that the ban does not improve the quality of the blood, nor does it maximize the quantity of donated blood. Third, we apply Kantian and egalitarian perspectives to contend that the ban is actually a state-sanctioned act of institutional discrimination against MSM. Lastly, we apply liberal communitarianism and point out that virtuous society members would have the capacity to pursue the common good, which is maintaining the quality blood for the needy, if there were no such regulation unjustly targeting MSM. We suggest that if governmental authorities for the blood donor deferral policy cannot provide public justification for this regulation, it should be abolished.