My series answering the New York Times’ Ethicist column with an active, leadership approach instead of an analytical, philosophical perspective continues with “Should I Forgo Gay Sex to Donate Blood?”.

Recently, I’ve become more curious about sex. I never had a relationship in high school and, out of nervousness, declined some opportunities in college. Later, I had two frightening nonconsensual, nonpenetrative encounters. When I sought help, I was advised that I take the time to explore my sexuality as part of my healing process. I think I might be ready to act, but as a man who anticipates that my partner will also be a man, I’m not sure how to square my sexual desires with my conviction that I should be donating blood.

I have forgone donating blood before. My parents wouldn’t let me until I was 18. I took Accutane. And I lived in a country that requires a one-year residency for blood donations. But each prohibition had a clear limit. Were I to have sex with men, I might nudge the limit indefinitely, a restriction that strikes me as discriminatory. And in the earlier three situations, I still felt comfortable encouraging my acquaintances to donate blood, but I have trouble imagining being open enough about my sexual experiences to encourage others to donate in my place.

I can’t claim that not having sex with others has made my life feel deficient. So is it wrong to pose this question to myself because of how it might implicate others who have chosen to have sex? I don’t want to add to the stigmatization that men who have sex with men already face.

Admittedly, I could limit my sex acts to those that allow me to donate. But that avoids the question. I recognize that donating blood is neither an obligation nor the only way to help others. Still, it has been a simple way for me to help, in addition to my volunteer activities and charitable donations. Giving it up would be a loss for me. But I’m not sure how to measure this loss against the loss of sex, especially because I haven’t had it.

My response: You wrote a lot and sound troubled, but your question is “So is it wrong to pose this question to myself because of how it might implicate others who have chosen to have sex?“

There is no book in the sky or other measure of absolute right, wrong, good, bad, or evil that 7.6 billion people will agree to. If there were, you would have consulted it, gotten your answer and wouldn’t have had to write here. There isn’t, so you did.

Besides the problem you describe, you say you feel guilty/anxious/angry/other emotion you don’t like. You can manage your emotional response—through, for example, choosing your environment, beliefs, and behavior—and I’ve never seen a benefit to suffering or being miserable. I recommend developing the emotional skills to manage your emotions. You’ll make yourself more effective in achieving your goals and feel emotions you prefer, which I call a better life.

As for rules that authorities apply to everyone, comedian Jim Jefferies does a bit on it in this video (strong language), starting at 3 minutes, that may show that it happens in a lot of cases.

The New York Times response:

Your letter touches on a number of issues. Let’s start with the blood ban. The American Red Cross disallows blood donations from a variety of candidates, including: anyone who in the previous 12 months got a tattoo from an unregulated tattoo parlor, had sex with someone with hepatitis, received a blood transfusion or visited a malarial region; anyone who has anemia or uncontrolled diabetes; anyone who spent six months in Britain, cumulatively, between 1980 and 1996; and anyone who was ever a nonprescription IV drug user. Consistent with F.D.A. guidelines, it also disallows blood donations from men who have had sex with men in the previous 12 months.

Is this policy discriminatory? According to the Centers for Disease Control and Prevention, the rate of new H.I.V. diagnoses among M.S.M. (men who have sex with men) is more than 44 times as high as it is among other men. Donated blood is tested, and the tests have a low false-negative rate, but they don’t work when the donor has been infected only recently. Activists ask why straight people who engage in risky sexual behavior aren’t subject to the categorical exclusion that applies to M.S.M. who don’t. Others ask whether donating blood, as opposed to receiving blood, is properly considered a right, and whether the prohibition is a significant source of stigma.

In ways that the legal scholar Frederick Schauer has explored at length, a good many laws, rules and protocols proceed from generalizations, and all can be faulted for being underinclusive and overinclusive. Everyone knows that people’s capacities decline at different rates, but the F.A.A. requires commercial pilots to retire at 65, citing age-related losses in vision, hearing and cognitive abilities and an increased rate of sudden incapacitation by a heart attack or a stroke. Age-of-consent laws mean that the difference between consensual and nonconsensual sex may be measured in minutes. Traffic safety is a major reason for speed limits, even though one motorist may be able to drive safely at higher speeds and another can’t drive safely at the speed posted. Plenty of 16-year-olds would cast votes more wisely than many 60-year-olds, but the United States won’t let them. For that matter, many 16-year-olds are better drivers than those 60-year-olds, but their car-insurance premiums lump the good ones in with the bad.

These rules are hard and fast; the reality they govern is anything but. In some cases, we might decide we can replace a demographic generalization with individual assessments or testing programs — as the AARP has urged in the case of the F.A.A.’s mandatory retirement age. (Of course, a test would also give you an arbitrary cut off.) In other cases, the fixed rules, however imperfect and arbitrary-seeming, may be our best way to manage risk and uncertainty. I can’t tell you what the optimal policy would be for M.S.M. blood donation. But making discriminations isn’t always discriminatory, and it isn’t a knockdown argument against a rule to say that it excludes good candidates and includes bad ones. Generalizations like these, paradoxically, have to be appraised one by one.

A second issue relates to your particular approach to moral accounting. You suggest that if you were not to give blood, you should do your part by urging others to do so in your place. I confess to being puzzled by this logic. There are many ways to do good in the world. Even if you think, as some do, that we have a duty of benevolence, it is a so-called imperfect duty — a duty to engage in some benevolent action or other, not in a particular one. So it’s a mistake to think that not giving blood means you must get someone to replace each pint you might have given. You have no duty, as you note, to make a donation at all, and you can expand your overall altruistic contribution in a wide variety of ways.

I’m puzzled, too, by your related worry that you won’t be able to explain to people why you’re asking them to donate without divulging your sexual experiences. Encouraging suitable people to give blood is perfectly doable without outing yourself. Indeed, I would doubt that anyone would feel more inclined to give blood if you told them that you wanted them to make up for your missing donations.

Finally, the way you discuss sex and sexuality suggests some real ambivalence about whether sex is for you. As a psychological matter, you might want to explore this with a qualified counselor, but there’s an ethical point here, too. Ethics, in its classical sense, is about what it means for a life to go well, and there’s no reason to think that a life without sex is in itself a misfortune; as you note, your celibacy hasn’t made your life feel deficient. People are different, and some aren’t disposed to enjoy or even to make much sense of sexual activity. If that’s true of you, accepting it may be a first step on the path to happiness. If it isn’t, you should find other ways to exercise your altruistic desires.

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