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UBC Theses and Dissertations

Negotiating trust in the Canadian blood system : governance and the politics of public accountability in the wake of the tainted blood scandal Fiddler, Jay


Blood and its derivatives are critical public health resources. Therefore, the ability to ensure a sufficient and safe supply of blood is a central role for governments and blood organizations. The challenges involved in ensuring this complex resource became evident following the contamination of blood supplies in the 1980s and 1990s with the Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV). In Canada, this became known as the “tainted blood scandal”, with approximately 2000 people infected with HIV and more than 160,000 people infected with HCV through contaminated blood products. This crisis resulted in the loss of public trust in the Canadian blood system and in those responsible for its management. The public outcry led blood experts and governments to adopt more efficient ways of anticipating and managing emergent threats to blood safety by implementing the precautionary principle. These efforts also aimed to retain their legitimacy and rebuild public trust by integrating formal mechanisms of stakeholder engagement in risk governance. By using stakeholder engagement as a case study, this study focuses on the institutional processes of rebuilding trust in the Canadian blood system following the tainted blood scandal. The analysis describes competing ideas about trust, risk and responsibility in the blood system and traces the influence of stakeholders groups such as the hemophilia community and other blood consumer organizations. The findings suggest that stakeholder engagement primarily serves the interests of the blood operator by enhancing its reputation as a responsible manager of the blood system. It also diverts attention away from the role of the state in managing blood risk through expert systems and a policy of strict adherence to the precautionary principle. The analysis also demonstrates that stakeholder engagement can also serve as an alternative form of power and influence for hemophilia consumers. As victims of tainted blood, these consumers are able to play a unique role in endorsing blood safety and thus helping to rebuild reputation and public trust. However, because of this role they may also become an organizational risk if their interests are not reflected in blood policy.

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