Sunday, May 11, 2008

Selling Organs for Transplant

I have recently gotten an urge to take an important moral issue where I really do not know what the right answer is and look at it from a desire utilitarian perspective. I want to look at a set of steps that desire utilitarianism suggests and to use it as a kind of a road map for looking at other issues.

The issue that I want to write about is that of selling organs such as kidneys.

I discussed this issue two years ago in a post called "Buying and Selling Organs" . There, I looked at a number of arguments against selling organs and dismissed each one rather quickly. The only argument that I gave in favor of organ selling is that it would save lives. Though that, to me, sounds like a particularly good argument.

Like I said, this time I want to look at the issue in more detail and tie the specific arguments directly into desire utilitarian theory.

The first and strongest argument that we will likely encounter against selling organs is that it feels yucky. The opponent simply thinks of the idea of a person being paid a sum of money to give up a perfectly good kidney – an offer that he then takes. This just feels wrong. Going on feelings alone, these people side with any politician who would oppose such a system.

In response to this feeling of wrongness, the opponent might drum up all sorts of rationalizations to give this feeling legitimacy. They might argue that it is "playing God" – though, in fact, God gets his morality directly from us. We are the ones who decide what God likes and dislikes and then assign our preferences to Him. God is a human invention, and so is His ethics.

Other catch phrases that are used is that violates human dignity to reduce a human body to a product to be bought and sold on the market place. But what is this 'dignity' and how is it violated by the buying and selling of organs? After all, I sell my brain to the highest bidder for 40 hours each day, as well as the use of my muscles. People also sell blood, eggs, and sperm. These do not seem to have harmed human dignity in any way.

Ultimately, these claims about 'playing God' and 'human dignity' are ultimately just different ways of saying, 'It feels yucky'. Only, we don't want to say 'It feels yucky' because this hardly seems like a good enough reason to bring people to an early death that could have been prevented. We need a better, nobler, grander idea so we pretend that our feelings are associated in some way with a divine entity or some mysterious entity called 'human dignity'.

Within desire utilitarianism, the fact that something 'feels yucky' is a legitimate concern. At the point of action, we all act so as to fulfill the most and strongest of our desires, given our beliefs. If those desires include a particularly strong aversion to the buying and selling of organs, then that is going to impact our behavior. It is just like the aversion that people have to, say, the feeling generated by a third degree burn. If a state of affairs that involves buying and selling organs causes so much discomfort, that alone is a good reason not to do it.

Yet, for a desire utilitarian, we have to go one step further. In addition to noting that we have an aversion to the buying and selling of organs, we have to ask (1) is this aversion malleable, and (2) if it is malleable then how should we mold it to make it compatible with the fulfillment of the most and the strongest of other desires?

Consider, for example, the aversion that some people have towards interracial relationships. They have a primary aversion to these relationship such that the mere thought of a white person and a black person having children. They, like the person who is averse to the buying and selling of organs, are likely to take their sentiment as the final word on the issue. They neglect the desire utilitarian question, "Okay, we know that we have these sentiments. Is it a good idea that we have these sentiments, or should we train the next generation to be free of these prejudices so that they can have longer, healthier, and happier lives than we allowed ourselves?"

Do we have reason to promote this aversion to the buying and selling of organs, or do we have more and stronger reason to inhibit this aversion?

The prima facie argument on the other side argues for inhibiting the aversion to buying and selling organs.

First, there is the fact that voluntary exchange between two individuals tends to fulfill the desires of both individuals. At least, it tends to fulfill the more and stronger desires given the beliefs of the agent.

Now, no agent does a perfect job of knowing his own interests. Agents are fallible. Still, for the sake of efficiency, we have many and strong reasons to establish institutions where each person's decisions are made by the most knowledgeable and least corruptible agent imaginable. Except in cases of young children and severely mentally handicapped, the most knowledgeable and least corruptible individual for advancing an agent’s interests (fulfilling his desires) is the agent himself.

If person A is put in charge of decisions affecting A's life, then A is going to make choices based on what best fulfills the most and strongest of A's desires, given A’s beliefs, at any given time. On the other hand, if person B is put in charge of decisions affecting A's life, then B is still going to perform those actions that tend to fulfill the most and strongest of B's desires. Hopefully, B has a desire to advance A's interests and enough knowledge of A to know what those interests are. Yet, even in the best of circumstances, B's desire to advance A's interests will necessarily be a subset of B's interests. B will still have other desires, and will still act so as to fulfill the most and strongest of B's desires given B's beliefs.

In a voluntary exchange – kidney for money – we may assume that both agents are fulfilling the most and strongest of their own desires by agreeing to the exchange. Interfering with the exchange thwarts the desires of both participants – leaving them in a situation that the most knowledgeable and least corruptible agent tells us will thwart many and strong desires of both agents. We also have a love of liberty telling us that this aversion to the buying and selling of organs is something that we ought to be inhibiting. This love of liberty that desire utilitarianism recommends shows itself in terms of an aversion to interfering with voluntary exchange. We should find the idea of people interfering with voluntary exchange (without special justification) to be objectionable in itself, regardless of its consequences.

However, at this point I would like to bring in a particular form of market failure that I have written about several times. Markets, when combined with wide differences in income, allow people with a lot of money to bid resources away from people with little money, even though the people with little money would use those resources to fulfill more and stronger desire.

My standard example of this is that of a rich person bidding up the price of bottled water after a disaster such as Katrina so she can give her dog a shampoo, or rich people bidding up the price of gasoline in order to fulfill their SUVs while poor people cannot afford to heat their house in the winter.

The application in this case is that rich people in this case would bid up the price of kidneys to where they can get a kidney whenever they want one, while poor people could not afford them.

It is not unreasonable to assume that, on average, the poor person values the rest of his life as much as the rich person. However, the poor person cannot pay as much to protect and preserve the rest of his life as the rich person. So, when the rich person bids a kidney away from a poor person, this is almost certainly an example in which the rich person's ability to pay more is in no way tied to the fact that his life has greater value.

As for those who keep their kidneys (who do not give them up for transplant) the same principle applies. The rich people get to keep both kidneys and turn down any money that might be offered for them (in a sense, very much like bidding up the price of a kidney), whereas the poor person cannot afford to give up that same amount of money as easily as the rich person. Even when he values his kidney as much (or more) than the rich person, the rich person still has the ability to 'bid' kidneys away from their higher valued uses.

It simply seems unfair that rich people (in virtue of their wealth) should be given the power to bid kidneys away from poor people for whom the kidney likely has an equal and may have a higher valued use. At least, not from a desire-utilitarian perspective. The system of buying and selling kidneys would not necessarily be one in which the most and strongest desires are fulfilled. It could very easily be one in which the fewer and weaker desires of those with money get fulfilled by bidding resources away from those who have more and stronger desires but less ability to pay.

This analysis is not done, and I am not yet ready to conclude that the buying and selling of organs is wrong. I have so far only looked at three arguments. The first is a 'gut feeling' response to the thought of selling organs which, like interracial marriage (for some) may well be a gut feeling that we are better off changing. Arguments for liberty and the benefits of voluntary trade for both participants argues for allowing organ sales. However, the capacity of the rich to bid resources away from the more highly valued uses to which the poor might put those same resources.

I want to continue to look at some of the other considerations that surround this issue tomorrow.


Anonymous said...

You've forgotten the title ;)

G-man said...

About "human dignity:"

I think the argument has to do with perception. In other words, there may be no intrinsic human dignity, but the way people perceive others influences the way they treat them. So, it seems normal to "sell" your brain and muscles, and nobody perceives that as violating human dignity...

But selling organs seems like it violates human dignity. And since it seems to do so, it actually does. Consider the feminists who request that men don't open doors for them. When I open a door for a woman, does it *actually* say anything about her dignity, status and role in society? Well, probably not. Yet I think people perceive, on some level, that there is a power difference between me as a man and her as a woman, and the perception counts.

So if the argument is about perception, maybe it is wise for us to avoid things that appear to violate human dignity. Sometimes feelings matter a lot and the "brain and muscles" parallel doesn't really work in this case.

On the other hand, you're right - if there is a malleable desire involved, we should discuss whether it's a good desire.

I would venture to guess that people who trade their organs don't find the process to be a violation of human dignity. That suggests that the desire is indeed malleable.

Anonymous said...

Perhaps I'm very odd, but I've never heard anything about "human dignity" as the reason we shouldn't allow the buying and selling of human organs.

Primarily what I've heard is that in the class system currently in place, it will create even more situations in which the haves are catered to by the havenots. Additionally, there's the fact that organs are non-renewable resources, unlike blood and semen and eggs (to a certain extent). So having given up ones kidney takes away the option of using it later (if something goes awry). In that situation, the person who may be forced through economics to use up their body's resources, has no options (primarily when we agree that if they needed to sell it in the first place, they probably don't have the money for a second one in the second place) other than (presumably) death.

As such, the argument has gone that those with little power are more likely to be targeted for invasive medical procedures, while those with more power reap the benefits. So I guess, it's more of saying "yucky" to using the poor as portable organ farms.

Granted, I don't often think about organ donation, but this was definitely one of the points brought up in a debate in a course I took 3 years back.