U.S. Food and Drug Administration (FDA) policy prohibits blood donation from men who have had sex with men (MSM) even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the MSM policy and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy.

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The health care reform signed by President Obama in March 2010 mirrors the Clinton reform proposal of 1993 in that both excluded undocumented immigrants from federal insurance coverage. In both cases substantive discussion of their possible inclusion was stifled by political timidity. This paper begins with a brief descriptive overview of undocumented immigrants in the U.S. and their health care and insurance coverage. It highlights the most common moral, economic, and public health arguments made for and against the inclusion of undocumented immigrants in the 2010 health care reform. The paper then asserts that undocumented immigrants are part of the U.S. health care community and urges health care workers to become more active participants in this policy arena.

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We often speak of health care as a social good. What kind of good it is--and what justice requires of us in making it available to the members of society--depends on how society understands it. Yet the value of health care may be understood in many different ways within society.