1 Bioethics Beyond Altruism 7Altruism and Moral Economy
By the turn of the twenty-first century, public narratives of tissue
donation and provision remained largely wedded to the promotion
of a moral economy based on altruism as a social good.^1 As a term in
common usage, altruism refers to behaviour that is motivated by a
primary regard for the welfare of others rather than oneself. In sociol-
ogy and psychology, altruism is frequently identified as a key element
in morality (Jeffries et al. 2006 ; Post 2007 ), yet its nature and varieties
differ vastly depending on context (see Oakley et al. 2012 ). Since the
French sociologist Auguste Comte first coined the term in his Positive
Philosophy in the nineteenth century, altruism has been contrasted with
egoism. Its precise meaning varies between disciplines and across dis-
courses, but the belief that altruistic behaviours occur as a loss to the
self is deeply rooted in Western thinking that divides altruism into soft
and hard versions (Weiss and Perez 2014 ). In the hard version, altruis-
tic behaviour is egoless, self-sacrificial and unconditional, whereas ‘soft’
altruism takes reciprocation into account and includes practices such as
mutual care, volunteerism and cooperation. In the organ transplanta-
tion literature, for example, altruism denotes intentional acts motivated
by the absence of external reward, monetary exchange and commerciali-
sation (Delmonico et al. 2002 ; Epstein and Danovitch 2009 ; Ghods
2004 ). Soft versions of altruism may permit donor compensation
beyond direct expenses, as is the case for women in the UK ‘Newcastle
Egg Sharing for Research scheme’ (NESR), who ‘share’ their ovarian
eggs for research purposes in exchange for discounted fertility treatment
(Haimes 2016 ; Haimes et al. 2012 ).
In medical sociology and bioethics, the term altruism has been cou-
pled with the metaphor of the gift, to describe both unconditional
acts and processes of reciprocity and exchange involving the human
body (see Fox and Swazey 1978 ; Murray 1987 ; Novaes 1989 ; Titmuss
([1970] 1997 ). Alan D. Schrift ( 1997 ) traces the operationalisation of
gift terminology in the humanities and social sciences to several sources.
In addition to Marcel Mauss’s ([1950] 1990 ) anthropology of gift-
exchange in archaic societies, Schrift identifies Jacques Derrida’s ( 1992 )
thinking on the impossibility of the gift in philosophy‚^2 and gendered