The Associated Press is reporting that Singapore is considering legalizing kidney trading to help meet demand for kidney transplants, the city-state’s health minister said Monday.
I hope the Health Ministry will reject this foolish idea.
The Health Ministry is quoted as saying, “There are desperate patients out there wishing to live and desperately poor people willing to exchange a kidney for a hopefully improved life.”
And, that’s the rub.
I think there are two significant arguments that the Ministry should consider.
The first concerns the fact that allowing people to sell their organs will invariably lead to the commodification of human bodies.
The second concern I have is that a policy like this will exploit the poor for the benefit of the rich.
These are difficult arguments to explain and are not convincing to everyone, but they cut to the heart of the issue for me.
Austin Cline has an excellent article on these two arguments that I recommend for those wrestling with the ethics of this issue.
Here’s his argument:
Commodification & Ownership:
It is not clear that just because the only possible “owner” of an organ is the person in whose body it exists that, therefore, this same person should also be able to sell it to the highest bidder.
You own your body as a whole as well, but does that mean you can sell yourself into slavery? Of course not — human beings cannot be made into commodities like that. There are even restrictions on how a person can sell their labor, such as laws concerning minimum wages.
A commodity is something that “can be turned to commercial or other advantage.” A person certainly uses their body for themselves and their benefit, but they cannot turn that body over to others for their own permanent use and benefit. Restrictions on the ability to transfer ownership and control are not only common, but in fact inherent in how ownership is defined.
In modern society, the “ownership” a person exercises over their body is treated as unique in that it cannot be legally transferred to any other party. Merely observing that you “own” something does not also confer the right to transfer ownership and control to anyone else and in any manner you wish.
An important social reason why the ability to transfer “ownership” of one’s own body is so restricted is because of how it is exploitable against the poor by the rich. Rich people have not sold themselves into slavery, the poor have.
Rich people are not protected by minimum wage laws, the poor are.
Rich people are not protected by laws against selling organs, the poor are.
In each case, it is the rich who would most benefit by moving laws into the opposite direction, not the poor.
If one’s organs become simply another commodity that can be bought and sold, like cars or furniture, and are part of an estate, like houses or stock, doesn’t that mean they should be consistently treated as such?
If a person goes into bankruptcy, would the value of their organs be considered in the final value of their estate? If a person dies and property has to be sold in order to pay off debts, might the person’s relatives be forced into selling the organs?
Even those who favor some system of selling and buying organs will normally balk at such prospects and would favor regulations that would prevent just such things from happening.
Once that happens, however, it is an admission that organs are not “just like any other property” and should not be treated as such. If such an admission is made, though, the case for allowing the purchase and sale of organs in the first place is weakened.
In addition to case that the selling of organs would create an inappropriate commodification of the human body, there are also very strong arguments for the idea that buying and selling organs would lead to the exploitation of the poorest segments of society.
Selling an organ is dangerous, so why should people be pressured into doing it?
There are two possible forms which selling organs could take: selling organs of the living and selling organs of the dead.
Because it is difficult to live without your internal organs, the former would be limited just to selling kidneys because people can generally live with only one kidney if necessary.
Having a kidney removed is a difficult, painful, and dangerous process. It hurts a lot and the pain continues long after the surgery.
Like any surgery, the process itself is dangerous and it is possible that the patient will not wake up. If they do, there remains the problem of post-operative infection — which can kill — and the muscles of their abdomen may never regain their former strength and elasticity.
Finally, there is no guarantee that the person really will be able to live with just one kidney — disease or injury later on could be fatal for a kidney donor. This is even more likely with the poor because of their health, behavior, where they live, etc.
Given the above circumstances, why would anyone sell a kidney?
The rich don’t do it, and neither does the middle class — only the poor are likely to do it, and it is without question an act of desperation.
When such desperation is the motive for selling a kidney, to what degree can we argue that the decision is genuinely voluntary?
In a just society, no person should have to sell off pieces of their body in order to survive.
Do we really want to start flying poor people from Africa or Asia to Europe and North America so that they can sell a kidney to the wealthy?
This, then, is why these issues cut to the heart of what we want our society to be like: will it be just enough that selling organs is something people can, but never feel they need, to do?
Paying for Organs Means Increasing Costs:
Organ transplantation is already an expensive process — so expensive that many poor people are unable to have it done and simply end up dying.
Paying people for the organs of deceased relatives may make more organs available, but it would also increase the cost of the process, shutting out more poor people and increasing the cost for those who do have enough insurance to pay.
Neither of those results is desirable and both can occur not simply when paying living people for organs (like kidneys) but also paying for organs taken from the deceased.
If one of the reasons for allowing the sale of organs is to make more organs available and save more lives, it can’t be done in a way that effectively prevents many people from ever obtaining an organ at all.
Pressuring the Sick:
There are already serious ethical concerns when it comes to doctors recommending that a person on life support be taken off the machines and their organs donated.
These questions will increase if money changes hands.
Will families be tempted to have their relatives denied medical care in order to sell the organs? Will hospitals be tempted to withhold treatments for the sake of money?
A general policy against selling organs does not necessarily mean that such sales should not be allowed in very narrow circumstances or in the context of special exceptions.
For example, it might be legitimate for two families to “trade,” perhaps a kidney for a bone marrow transplant. This sort of trade is also prohibited as a type of sale, but it is not an unreasonable exception.
Narrow allowances for selling would have to ensure that the poor have other, genuine options in order to prevent exploitation.
There would have to be safeguards to prevent things like bidding wars and “organ markets” which would cause problems with the general costs of transplantation.
Finally, there would have to be sound measures to ensure that no one is pressured or tempted to allow others to die for the sake of cash.
All of this would be difficult, but without it, the ethical problems with unregulated and unmanaged trafficking in human organs would be enormous and unacceptable.