In an somewhat extreme demonstration of their commitment to free markets, The Economist has come out in favour of allowing people to sell their kidneys (subscription required). The justification is twofold: an affirmation of the right of individuals to make choices regarding their own lives, and a pragmatic appraisal of the consequences of a ban on such sales:
With proper regulation, a kidney market would be a big improvement on the current, sorry state of affairs. Sellers could be checked for disease and drug use, and cared for after operations. They could, for instance, receive health insurance as part of their payment—which would be cheap because properly screened donors appear to live longer than the average Joe with two kidneys. Buyers would get better kidneys, faster. Both sellers and buyers would do better than in the illegal market, where much of the money goes to the middleman.
Regardless of such arguments, I think this position is wrong. Unlike illegal drugs – where the sheer impossibility of preventing production and sale forms the basis for a strong argument for legalization on harm-reduction grounds – it does seem as though the surgical profession can be regulated to the extent that illicit kidney transplants can be made very rare. Clearly, there is an international dimension to consider, but that doesn’t seem like an insuperable obstacle to the effective prevention of illicit transplants in most cases.
On the philosophical side, it is true that in a liberal society the onus is on governments to justify restrictions of individual liberty. In this case, it seems like a strong case can be made. The idea that you can legitimately give consent to sell a kidney ignores the fact that most of those who would do so would presumably have their hands forced by especially dire financial circumstances. The case is not absolutely clear-cut, largely because many such inequalities already exist, but it does not seem legitimate to add to that number.
Cecile Fabre argues for organ sales in her latest book, Whose Body Is It Anyway?
She makes it somewhat easier for herself by restricting the case to ‘ideal theory’ – where no one is so poor they cannot live a minimally flourishing life. Mind you, even in non-ideal circumstances, you might say it should be allowed. If people would rather have one kidney and money, rather than two kidneys, it’s still paternalist of government to stop them making the transaction…
Ben,
I can see the logic behind that argument, but it does seem to me that it is a legitimate role for government to help prevent people who are in a position to be severely exploited from having that done to them. Of course, a sensible addition to that theory would be some kind of positive requirement to materially assist those who are so desperate that they would consider something like kidney selling (potentially, a fairly large group of people).
it is true that in a liberal society the onus is on governments to justify restrictions of individual liberty
– That’s why I am unsure whether it’s a good thing to live in liberal societies…
How do you mean? Because you think such restrictions should not require justification, because you think such restrictions can never be legitimate, or for some other reason?
The question is: are the presuppositions liberal society makes about individuals true in the cases where people would decide to sell their own kidneys? Decisions, to be free, need not be made under coersion. Extreme poverty or neccesity, it seems to be, violates the principals which liberal society takes for granted when it requires governments to justify taking away freedoms from the individual.
Spoken more simply, for the Government to have to justify itself to take freedoms from the individual, it must be the case that the individual actually exists, and not in the tautological sense, but in its full capacity as free (which is not merely formal philosophical proposition but a substantive state of human beings)
Well argued, Tristan.
Have you heard of the case of Zell Kravinsky? He voluntarily donated a kidney to a stranger, and what’s more has suggested he’d consider paying a third party to do likewise…
Markets for organs have traditionally been a bit touchy because of the extreme-case scares about people having their organs involuntarily harvested, whether by organised crime or other concerns and a belief that this would become more widespread if there was a global practice of having commercially-sourced organs for transplant.
There is the health insurance and NHS issue of later medical support for people who have voluntarily impaired their bodies for financial gain.
There are various SF explorations of such themes and spin-off issues.