Markets in Everything
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A Dish reader objects that allowing people to sell their kidneys – as per Virginia Postrel’s thought-provoking Atlantic piece – might lead families facing foreclosure or struggling to feed their children to, well, sell their kidneys:
People are doing everything they can to stay in their homes, and/or to feed their children. I can only imagine what many families would do if it were legal to sell one’s body parts for money. And I’m not kidding: as I think about a loved one whom I lost last year, I would have gladly sold one of my own kidneys, if this would have helped pay for better medical treatment for him. If I had the option now, I would do this without much of a second thought.
Perhaps it’s just me, but I fail to see how this constitutes a serious objection, and notwithstanding the obviously weird and potentially problematic aspects of open markets in human organs I can’t shake the conviction that carefully experimenting – at the state level, please – with the legalization of such markets and the establishment of other financial incentives to encourage organ donation is absolutely the right thing to do. I suspect, though, that I’m solidly in the minority in that conviction, and I’m willing as ever to be reasoned with, so fire away.
Please, though, make your objections more forceful than “Allowing people to do X for money might lead people who need money to do X”.
Filed under: government/law, morality
Philosopher James Stacey Taylor has been beating this drum for years, and there’s probably no objection likely to be raised here he hasn’t heard.
As for the poor being forced through destitution to sell their kidneys, he addressed that by looking at how many poor people in India actually took advantage of the (currently and relatively) lucrative opportunity to sell their organs. Very few did.
Well, I might start with something along the lines of…
“It is helpful, above all in today’s context, to return to reflect on this scientific breakthrough, to prevent the multiple requests for transplants from subverting the ethical principles that are at its base. As I said in my first Encyclical, the body can never be considered a mere object (cf. Deus Caritas Est, n. 5); otherwise the logic of the market would gain the upper hand. The body of each person, together with the spirit that has been given to each one singly constitutes an inseparable unity in which the image of God himself is imprinted. Prescinding from this dimension leads to a perspective incapable of grasping the totality of the mystery present in each one. Therefore, it is necessary to put respect for the dignity of the person and the protection of his/her personal identity in the first place. As regards the practice of organ transplants, it means that someone can give only if he/she is not placing his/her own health and identity in serious danger, and only for a morally valid and proportional reason. The possibility of organ sales, as well as the adoption of discriminatory and utilitarian criteria, would greatly clash with the underlying meaning of the gift that would place it out of consideration, qualifying it as a morally illicit act. Transplant abuses and their trafficking, which often involve innocent people like babies, must find the scientific and medical community ready to unite in rejecting such unacceptable practices. Therefore they are to be decisively condemned as abominable. The same ethical principle is to be repeated when one wishes to touch upon creation and destroy the human embryo destined for a therapeutic purpose. The simple idea of considering the embryo as “therapeutic material” contradicts the cultural, civil and ethical foundations upon which the dignity of the person rests.”
http://www.vatican.va/holy_father/benedict_xvi/speeches/2008/november/documents/hf_ben-xvi_spe_20081107_acdlife_en.html
Petullius: Okay, nicely done. But of course not all vices have to be proscribed, right?
Also, a few other points:
- It’s obviously an empirical question, as Dain’s comment above suggests, whether “the logic of the market” really would “gain the upper hand” in the way Benedict assumes; clearly this sort of thing can’t be known a priori, and so it was with this sort of concern in mind that I talked only about “carefully experimenting” in the original post.
- There’s no doubt that abuse and trafficking would be unacceptable.
- The really crucial sentences in what you quote seem to me to be these:
Can Benedict really be saying that financial, or otherwise “utilitarian”, considerations can’t have any impact on the decision to donate an organ without making that decision morally illicit? And if so, is this claim plausible? I.e., couldn’t the prospect of compensation be something that motivated or “freed up” a person to do something that he independently recognized as morally worthy?
I can’t shake the conviction that carefully experimenting – at the state level, please – with the legalization of such markets and the establishment of other financial incentives to encourage organ donation is absolutely the right thing to do. I suspect, though, that I’m solidly in the minority in that conviction, and I’m willing as ever to be reasoned with, so fire away
There are a number of objections to experimenting with legalized compensation for organ donors. The most basic one I would posit is: who sets the price?
I cannot see a rationally functioning market in organ donation – and that’s not to say that all markets function rationally. What are the downside risks for the potential donors? Are these risks priced into the compensation the donors receive? Will donors be allowed to “market” their services to the highest bidder, or will this be deemed unethical when someones life is on the line?
Imagine a scenario where you line yourself up to be a donor for a specific individual, and the preparation for surgery is nearing completion. Suddenly you have a change of heart, no longer want to give up your second kidney (maybe you want more money for it), and you ask that the procedure be stopped. Let’s assume that compensation for donation is contingent upon completion of the surgery, so you have received no payments yet. What happens here?
What if it took 3 months to line you up as the donor, and the individual receiving your kidney was on his/her last stand? (not sure how common this is, but humor me) Could you be held liable if that person were to die as a result of you backing out of the deal? How do you set up the agreement such that the donor’s rights are protected at all times?
Markets work because of the laws that protect the contractual agreements that we are free to make with each other. What does the contract for donating a kidney for money look like?
I could go on…but I think you get my point. In the abstract, getting paid for organ donation makes a whole lot of sense. In reality, it would be a nightmare.
Why would the price have to be “set” by anyone, Matt C? Wouldn’t it work the way that markets usually do?
And more importantly, don’t all the rest of your concerns apply equally even when organ donors are required to go uncompensated?
P.S. I promise to write a longer and more thoughtful post on the subject, so keep firing away with your objections, folks!
Obviously there are varying schools of thought in the Tradition about the proscription of vices. Prostitution seems to be the nearest analog, insofar as it involves the commodification of the body in a similar fashion, and of course Thomas rather (in)famously advocated its legalization.
It seems that this kind of commodification of the human body is precisely what is so objectionable, in that it violates the dignity& integrity of the human person, even if it’s done with that person’s consent. And (on a more social-utility level) it’s at least arguable that this kind of degradation serves to undercut the anthropology that is the necessary foundation of liberal government. Though that’s not an argument that I particularly care about – you may want to check with the First Things crowd on that one.
This idea – that the sale of the body is wrong, and beneath the dignity of a man – runs at least back to the ancients, and occasionally comes out looking odd to us (e.g., the Greek disdain for banausic labor; the revocation of citizenship of any Roman who performed on stage). But there’s something there, which I can’t quite put my finger on, about the worth of a man and a citizen that we risk losing if we just let people start pimping themselves out like this.
And I am not sure that the “logic of the market” phrase is necessarily meant to imply that poor people will necessarily start selling their organs. I think it is meant more as a reference to the devaluation of the human person when he becomes a commodity with a price tag, mentioned above. Also, there is necessarily going to be some form of rationing here – organs are a scarce resource, indeed. And while the current regime of determining suitability and wait-listing is hardly ideal, letting the market sort it out is going to start looking creepily eugenic.
(Though I admit that the “eugenic” argument could also be used against private healthcare. But the imminent life-or-death situation of organ transplantation presents us with a pretty vast difference in degree, if not in kind.)
I know that I didn’t address all your points, but I think I’ve gone on long enough. Sorry to ramble; I’m really just thinking out loud on this one.
“Why would the price have to be “set” by anyone, Matt C? Wouldn’t it work the way that markets usually do?”
Well, rationally functioning markets of course set prices. But our current healthcare system doesn’t function by these methods, and there is no reason to believe that organ donation will circumvent these issues.
On a similar note, we have a
terriblepricing mechanism that courts use in personal injury cases to assess how much the loss of a particular body part is worth in monetary terms. The judgements received most undoubtedly supercede what the anatomy’s “real market value” is.And if organ donation/selling did operate like a typical market, which would allow the donors to set the price, I don’t think we would have many transactions. I can only imagine what people think their body parts are worth.
And more importantly, don’t all the rest of your concerns apply equally even when organ donors are required to go uncompensated?
Of course not – first and foremost, the incentive of money will most likely introduce new donors into the equation who otherwise would never go under the knife. One can imagine that a family member would go to unending lenghts of personal sacrifice for the sake of his/her kin; however, I doubt the same could be said for Joe Smith and the random person waiting for his tissue.
This fact remains: money is an incentive that makes people do things they otherwise would not do. We have to draw the line somewhere in our society as to what we allow people to do for money. In modern times, putting your body or body parts on the market (for a variety of services) tends to be illegal. You open the door for one type of these transactions (organ donoration) and you risk opening the door to them all.
There are a few interesting objections in the comments on Megan McArdle’s post, e.g. this one on potential legal ramifications.
Still, overall I’d support at least some amount of payment, if not perhaps a totally free market. Right now it works out to be an actual loss for many donors due to the restrictions on reimbursement.
I think the problem is that if it becomes legal to sell your kidney, then poor people who are completely broke and are currently viewed as being worthy of assistance because they have lost everything, might no longer be viewed as deserving of charity because they still have a kidney to sell and thus are no longer viewed as “completely broke”.
I agree that that is a very real concern.
But is that really how markets typically work? Aren’t prices a function of the interests and resources of both sellers and buyers?
So I don’t think the slippery slope argument that comes at the end here is especially compelling. (Though for the record I’m willing to entertain arguments for e.g. the legalization of prostitution, too, so long as they’re based on the social harms of prohibition rather than abstract appeals to self-determination.) But to the claim that there should be limits to what people can do for money, doesn’t it matter whether the activities in question are immoral ones or not? I mean, when there’s no money involved we think of organ donation as a noble and altruistic act – so why exactly does the addition of some financial incentive (and I agree with kenB that there could be legal limits on what was acceptable) necessarily change that? Surely we don’t want to insist on a Kantian-style view according to which moral actions must be entirely detached from considerations of self-interest, and while I agree with the concerns Petellius cited about the possibility for self-commodification it seems to me that it’s an open – i.e., empirical – question whether legalizing financial incentives for organ donation would lead to a significant rise in such problematic attitudes.
Anyway, this was all very hand-wavy. A longer post soon, I promise – though keep going with the objections!
Perhaps another parallel worth thinking about: should I be permitted to sell myself into slavery? (I realize that such a system has all kinds of potential for abuse, but set that aside for the moment; I am talking about the basic legality/morality of the act itself.)
I think what Matt C is getting at about the pricing is that vital organs would have an incredibly steep demand curve – when you need an organ to stave off imminent death, you need it now, there are few, if any, acceptable substitutes, and you basically are willing to spend all your resources for it (because it’s not like you’re going to spend them on anything else, if you *don’t* get the organ). Hence, the supplier basically gets to set whatever price he wants – that is how the market works when demand is extremely inelastic. I think it is only a mild overstatement to say that you’re likely to end up seeing people mortgaging their houses to buy hearts.
One other thought, re: “But to the claim that there should be limits to what people can do for money, doesn’t it matter whether the activities in question are immoral ones or not?”
I don’t know that I agree. There are plenty of activities (e.g., sex) which can be moral when done in certain contexts (i.e, marriage), but are immoral in others, particularly when done for money.
[...] John Schwenkler: Perhaps it’s just me, but I fail to see how this constitutes a serious objection, and [...]
The merits of the issue aside, I’m not sure what the qualification “at the state level, please” is supposed to mean. If we are talking about buying and selling organs, we are by definition talking about people who are willing to travel out of state for extended periods of time and who have the means to do so. If North Carolina legalizes organ selling and South Carolina does not, what practical effect do you imagine that South Carolina’s continued ban on the practice will have?
Presumably that medical providers in South Carolina won’t be able to be involved in organ transplants for which financial compensation was involved. Treating this as meaningless is a bit like saying that speed limits on residential streets are irrelevant so long as there are also highways in the vicinity, or that prostitution bans in California don’t matter so long as people can get what they’re looking for in Nevada (or Singapore).
Treating this as meaningless is a bit like saying that speed limits on residential streets are irrelevant so long as there are also highways in the vicinity, or that prostitution bans in California don’t matter so long as people can get what they’re looking for in Nevada (or Singapore).
The point of speed limits is to prevent excessive speed on particular streets, not to slow people down in general because we don’t want them to get to their destination quickly. Speed limits are in that way perfectly effective local controls: If I’m going to Bob’s house on Main Street, then the speed limit on Main Street definitely matters — I can’t reasonably choose to go down State Street and hope that Bob will move there.
The prostitution example is an intermediate case — presumably, that ban is intended to reduce both the purely local deleterious effects of prostitution (e.g., streetwalking) and the incidence of the practice generally. As to that latter purpose, of the people in California who are prepared to engage the services of a prostitute, some have the motivation, means and time to travel to a jurisdiction where prostitution is legal, but many do not. So there is some reason to believe that the local ban would not only reduce local prostitution, but would also have some effect on the incidence of prostitution generally.
As to people who need kidneys and can afford to buy them, presumably all of them can afford to cross state lines. So what is the practical effect of a local ban?
Not to belabor the point, but sometimes state-by-state variation is practical and sometimes it is not. I don’t see how it is practical here.
That certainly doesn’t seem obvious to me. But in any case the point of a statewide ban would be perfectly parallel to the one you ascribe to speed limits: not primarily to keep organ donors from being compensated “in general”, but rather to prevent such compensation from taking place among a certain range of businesses. It makes perfect sense for a state (or town, or country) to prohibit a practice from taking place within its boundaries even if it knows that it will still take place (and perhaps will take place more frequently) elsewhere; I don’t see anything impractical about that at all.
As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.
In the mean time, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.
Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.
I think what Matt C is getting at about the pricing is that vital organs would have an incredibly steep demand curve -
Thanks for the clarification Petellius.
But to the claim that there should be limits to what people can do for money, doesn’t it matter whether the activities in question are immoral ones or not?
And I think our society has been clear on this issue – selling your body or your body parts, whatever the intention or the outcome, is almost always viewed as immoral.
Well, perhaps our society has been clear on that – though society can, of course, be wrong. And my point was just that organ transfer, unlike illicit sex between unmarried adults, doesn’t have anything intrinsically wrong with it, and so it seems to me that we need a good reason to think that the introduction of money changes its moral character in the way that our society seems to assume it does.
As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.
I disagree. Perhaps I’m too pessimistic, but it seems far more likely that as the death toll from organ shortage follows, public opinion will shift to a “presumed consent”-type regime, and then ultimately end up supporting the mandatory donation of organs from all non-disease-bearing corpses.
And my point was just that organ transfer, unlike illicit sex between unmarried adults, doesn’t have anything intrinsically wrong with it, and so it seems to me that we need a good reason to think that the introduction of money changes its moral character in the way that our society seems to assume it does.
Okay, so the sex parallel is probably not the best (not least because my post above leads to the rather preposterous question of whether it is immoral to pay your own spouse to have sex with you). How about something like spanking your child? I presume that the majority of people in this country still consider it permissible and morally licit for a parent to spank his child. But to do it for money? It seems to me that the introduction of money in that scenario pretty clearly makes it wrong (and also something that should be prohibited by law).
Please read “mounts” for “follows” in my second sentence above.
Well, perhaps our society has been clear on that – though society can, of course, be wrong. And my point was just that organ transfer, unlike illicit sex between unmarried adults, doesn’t have anything intrinsically wrong with it
Whoa, wait, you lost me there. What’s “intrinsically wrong” with two adults who haven’t made any exclusive commitments to anyone else exchanging money for sex? If you’re willing to question social norms for the one behavior, why not the other?
[...] mine, spins off a topic brought up at The Atlantic (which is by far my favorite magazine): namely, the idea of kidney donors being paid for their, uh, donations. He thinks (and is probably right) that his view is in the [...]
In general, I think the societal aversion to marketing one’s body or body parts is appropriate. Our bodies are singular in quantity; there are no other bodies on the planet exactly like them. Maybe this equation changes when we drill down to the organ/tissue level, but I still think the overriding issue is the value of one’s whole body.
Way I see it, it’s your body, you should be able to do whatever the hell you want with it. If you have a problem with it because you think poor people will be selling organs like mad, then isn’t the real issue not the sale, but the poverty.