I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs
Is it true that “everyone’s a winner”, as Julian Savulescu suggested recently on this blog , if we price life and body parts? Let’s accept that if there is a valid objection to buying and selling body parts, it must be grounded in the recognition of a harm that would come to some person or group of people. Consider, then, Savulescu’s suggestion that we should price body parts, and engage in buying and selling of them. We could categorize the potential harms that it might generate under the following headings:
(1) Harm to the participants in the transactions: donors, recipients, or facilitators
(2) Harm to specific third parties
(3) Harm to society at large
If we discover that any harms of types (1) – (3) would arise from selling body parts, then we must engage in an ethical analysis to see whether those harms would be all-things-considered justified or not. Savulescu focuses his blog post on harms of type (1), and in particular, on harm to donors: “the objection to selling eggs [and organs] … has to be about doing it in exchange for cash. But the exchange is only wrong if it exploits someone – and that is easily prevented by setting a minimum fair price [to compensate for the small risk involved].” While I think that Savulescu is right that setting a minimum fair price would prevent the economic exploitation of donors by buyers, I retain some doubts about the practice of selling body parts. In this post I want to highlight some potential further harms, not of type (1), to donors, but of types (2) and (3), to specific third parties and to society at large.
If a widespread market for body parts were to develop, donors (or, more accurately, sellers) would presumably be able to earn significant amounts of cash for them, and somebody would need to pay the prices that they would command. Although the state could be the sole buyer of body parts and distribute them according to need, most of those who argue for a free market in organs envisage that those buyers willing and able to pay the highest prices would have the best access. And contra Savulescu’s optimistic claim that each free market transaction would “remove a potential egg [or organ] recipient from the altruistic pool … and there will be more eggs [or organs] to go around to those who can’t afford to buy them”, there is strong reason to believe that the development of a market would tend to undermine the voluntary exchange system that presently exists. Richard Titmuss showed in his seminal book The Gift Relationship that paying blood donors can significantly decrease supply overall. As giving blood becomes commodified, he argued, the existing system of voluntary donations becomes crowded-out, and altruistic motivations cease to have their very important positive influence. Even if it were not the case that the introduction of a market for body parts would similarly reduce the overall supply, it seems highly likely that it would reduce the supply of voluntarily donated body parts. The net effect of the change would then be the accompaniment of any expansion in the overall supply of body parts with a significant reallocation of them from those most in need to those in relatively little need but with a high ability to pay. A useful analogy here is to our existing system of funding for pharmaceutical research: private drug companies spend a great deal of money on research, and arguably it is more money than any alternative system of funding could provide – but the research that is privately funded is heavily tilted toward providing lifestyle drugs for rich westerners rather than cheap drugs with potentially much greater public health benefits for the third world. With the introduction of a free market system in body parts, some of the worst off members of society – those in the highest medical need and also lacking in financial resources – would surely be harmed. Thus we have identified a harm of type (2), to a third party, that must be considered in considering the case for pricing body parts. (Note that this argument may apply to human eggs equally as it does to vital organs if we think that society ought to provide treatment for infertility – the development of a market in eggs could produce a shortage among those who need them most, for example if the available eggs were bought by women who are not intrinsically infertile, but rather have decided to postpone reproduction beyond the natural age of fertility for reasons of convenience.)
There is also at least one important way, I think, in which the development of a market in body parts might harm society at large; a harm of type (3). This is because the development of a market in body parts would change the norms of the relationship of all of us to our body parts, and to each other. And I believe it is plausible to think that we would lose something of significant value about our current relationships with that change. To see why, consider that as things stand, organs do not have a monetary value for their owners. Faced with, for example, a rent demand and inadequate cash to pay for it, a couple of the choices you can make are to sell some of your possessions, or to find (additional) employment and sell some of your labour. One choice that you do not currently have, and therefore do not have to consider, is whether to sell a kidney or a piece of one of your lungs to raise the funds (nor, indeed, the organs of a dying relative, if you happen to have one around). It might first be thought that it can never be a good thing for you to have fewer rather than more options. But I believe that this attitude is mistaken on a number of grounds. For one, consider that others hold you accountable for not making the choices that are necessary in order to fulfil your obligations. As things stand, even if you had no possessions to sell and could not find a job, nobody could criticize you for failing to sell an organ to meet your rent. If a free market in body parts were permitted and became widespread, they would become economic resources like any other, in the context of the market. Selling your organs would become something that is simply expected of you when the financial need arises. A new “option” can thus easily be transformed into an obligation, and it can drastically change the attitudes that it is appropriate for others to adopt towards you in a particular context.
I haven’t attempted to show that we should not price body parts; perhaps the harms of the kinds I point to would in the end be outweighed by the enormous benefits that a free market would bring along with it. But I have pointed toward just two examples of the potential harms of types (2) and (3) that may result, and that give me some personal reservations about the idea of introducing a market system for body parts.
Richard M. Titmuss, The Gift Relationship: From Human Blood to Social Policy (London: Allen & Unwin, 1970).