School of Historical and Philosophical Studies - Theses
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ItemDamaged goods : hepatitis C and the politics of the Victorian Blood exchange( 2000)In February 1990, the Victorian Blood Transfusion Service (VIC BTS) became one of the first transfusion services in the world, to implement testing for the newly isolated hepatitis C virus. In this thesis, I trace the development of hepatitis C policy by the Victorian Transfusion Service. Policy development was complicated by the known indeterminacy of some hepatitis C test results, as well as the Service's desire to avoid a further AIDS-like crisis. In particular, the Service had to decide how to minimise the risk of hepatitis C infection to recipients, and what to do with the donors and recipients infected with the hepatitis C virus. In making these decisions, the VIC BTS was reshaping its relationship with donors and recipients, and this re-configuring of the relationships of Victorian blood exchange through the development of hepatitis C policy, is an underlying theme of this thesis. From its inception in 1929, the Victorian Service maintained a donor-oriented culture in which the health of donors and recipients was always a key priority. For Service staff, the voluntary gifts of donors made blood-banking a special enterprise, informing a 'moral economy' whereby the Service felt obligated to meet the needs of both donors and recipients. However, with the advent of the AIDS crisis in 1980s, the confidence of donors (and the public) in the safety of the Victorian blood supply fell, and some recipients, allegedly infected with HIV, initiated litigation against the Service's parent body, the Australian Red Cross Society. In response, the Victorian Service came to distrust the gift of blood, controlling and managing its risks by way of practices designed to assess other ordinary commodities. Blood came to be treated by the Service, and the Federal Government, not so much as a gift, but as an ambiguous commodity. The development of hepatitis C policy produced a growing tension between the Transfusion Service's longstanding 'moral economy', and its new, pharmaceutically informed, risk-assessment practices. On the one hand, the Service was very risk-averse in its policy development, implementing testing with great swiftness, and deferring all donors with indeterminate test results. Even when the Service later became aware that some of these donors had probably never been infected with hepatitis C, its desire to maintain as safe a blood supply as possible, necessitated the continuing deferral of all donors with indeterminate results. On the other hand, the Service felt obligated to provide the best care and treatment feasible for potentially infected donors. With few government resources available for the management of hepatitis C, the Victorian Service devoted great time and energy to ensure deferred donors could be confident in the interpretation of their test results, and would receive expert care and treatment if necessary. The tension between the special ethical nature of Victorian blood exchange, and the management of blood as a dubious commodity, came to a head in the development of lookback policy. The Victorian Service felt a clinically-informed, 'moral obligation' to 'look back' and locate individual recipients who may have been infected by blood transfusions contaminated with hepatitis C. However, others viewed hepatitis C lookback from a more distanced, population perspective, arguing that it was a technical issue to be resolved through a cost-assessment analysis. Such an analysis showed hepatitis C lookback would be inefficient and expensive as a public health intervention. Although major hepatitis C lookback programs were eventually supported at a national level, the `correct' way of developing Victorian transfusion policy remains open to debate. What is clear, however, is that future policy development by the Victorian Service will continue to reflect, and to reshape, its relationships with donors and recipients.