Organs and obligations

Simon Rippon has recently argued here that markets in organs lead to harms, harms which may be outweighed by benefits, but which must nevertheless be taken into account in deciding whether such markets should be legal. He has argued that there are harms to specific third parties and harms to society at large. I’m not persuaded by his arguments that these harms arise. 

There are two ways that Simon suggests that harms to specific third parties arise. The first is that a market in organs would undermine voluntary exchanges and thereby reduce overall supply of organs. Simon claims that strong reason to believe this is given by Richard Titmuss in his book The Gift Relationship, who claims to have shown that buying blood reduces the overall supply. This is an empirical claim and it is contrary to the entire body of empirical evidence on which economists base the law of supply and demand. I think we have overwhelming evidence that paying more for something increases its supply. So I doubt it is true.

The second way is that even if a market increased the overall supply, a market would reduce the number going to the most needy because the organs would go to those who can pay. Again, this is an empirical question and it is not obviously true that the most needy would get less organs than they get now. Furthermore, this is not a problem that is specific to organs. It applies to any goods whatsoever. It seems pretty obvious that market economies provide more goods for more people at cheaper prices than any other way of supplying goods. There is no reason to think this doesn’t apply equally in the case of organs. Furthermore, the current lack of market prices for organs is a disincentive to biomedical companies developing artificial organs, since they have no idea how profitable they might be, and they must also fear that the anti-market bias in this area would make it easy for governments to steal their products.

The way in which Simon suggests harm to society at large would arise is through changing the norms of ‘the relationship of all of us to our body parts, and to each other’. In general you can be held accountable for ‘not making the choices that are necessary in order to fulfil your obligations’. If you have the option to sell a kidney to raise funds you could be obliged to sell your kidney, for example, to feed your children. To be obliged in this way, when if kidney sales were illegal you would not be so obliged, is harmful.

This argument is, I think, question begging in two ways. First it simply assumes that losing an organ is a harm. But is it? For example, we know one kidney is enough so losing one may be no harm at all. And for all the others, you sell a future on the organ so you don’t lose it till you’re dead.


he second way in which it is question begging is that it assumes that organs ought not to be sold. Do we think that the obligation to feed your children is a harm? No. It may be a cost but it is not a harm. If there ought to be a market in organs then an obligation to sell a kidney will arise because it is a means to satisfy some other obligation, say to feed your children. If the obligation to feed your children is no harm then the obligation to sell the kidney in order to do so is similarly no harm, even if it is a cost. This can be blocked by assuming that organs ought not to be sold, but not otherwise. I think this generalises, and hence for an obligation to sell an organ to be a harm depends on assuming that organs ought not to be sold.

P.S. I do not know of a better concise exposition of what is wrong with the arguments against a market in kidneys than the talk given by Janet Radcliffe-Richards

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27 Responses to Organs and obligations

  • I’ll restrict myself to commenting on one point.

    You say:
    “Simon claims that strong reason to believe this is given by Richard Titmuss in his book The Gift Relationship, who claims to have shown that buying blood reduces the overall supply. This is an empirical claim and it is contrary to the entire body of empirical evidence on which economists base the law of supply and demand. I think we have overwhelming evidence that paying more for something increases its supply. So I doubt it is true.”

    But just saying that you don’t believe something isn’t a response! I’ve never read the Titmuss book, but he is making a clear claim, which Rippon is referencing. Surely it deserves to be looked at? If you’re just going to dismiss it out of hand, why bother writing a response? As motivation, here is a different example of a market where supply and demand don’t work in a straightforward way: prostitution. Given the omnipresent supply of people equipped to sell the goods of prostitution on the market, it’s unclear why prostitution pays so much better than any other jobs that so many people are equipped to perform. Maybe there’s a convincing, principled explanation for this, but it needs to be given. Just like you need to give a convincing and principled explanation of why Rippon and Titmuss’s claim is false.

  • Marinus: The reason I gave for rejecting Titmuss’s claim is that it is contrary to a large body of well known empirical evidence. I don’t understand why you think the law of supply and demand doesn’t explain the price of prostitution. The supply curve for prostitution slopes up, the demand curve slopes down. The price is high because that is where they cross. The curves represent the preferences of the suppliers and demanders. So the price is high because the service is valued highly enough by customers that they are willing to pay the high price at which prostitutes are willing to sell the service.

  • Anthony Drinkwater says:

    I think you are absolutely right in stating that the second argument is circular. So let’s come back to the first:
    The facts may be (I accept them as such for the sake of argument, though I notice that you state that losing a kidney “may” be no harm at all) that losing one kidney does no harm, and that you won’t lose the others until you’re dead.
    There remain nevertheless other reasons for not wanting to open the market to organ donation, arguments which apply, of course to a large number of other transactions which are not currently legally marketable. For example, I do not think that any legal or moral system condones the selling of oneself, other than for restricted periods of time or activity. “Wage slavery ” is legal, as is prostitution, but both have limitations : the purchaser hires but does not own, and the hirer cannot do exactly as he pleases with the person hired.
    The selling of one’s body parts comes perhaps into the same realm : there exists an understandable fear of the debasement of the notion of personhood which underlies the reasoning of those who oppose the marketing of organs.
    A short comment is not the place to go into an examination of this reasoning, but I think that you should accept that it exists, and might even be justifiable.

  • Anthony: For what seems to me a comprehensive refutation of those other reasons, I refer you to the talk by Janet Radcliffe-Richards that I mentioned. One quick point: suppose selling yourself into slavery would bring about the end of all war and poverty. Would it still be wrong to do so? If not then the issue is simply the price, not the principle.

  • Nicholas: You’re still simply refusing to believe Rippon and Titmuss’s claim. The issue at question is whether the laws of supply and demand extend to medical donations. Blood and organs are treated differently from apples and oranges in many respects, and maybe that includes how they are treated in market conditions. This is exactly what Titmuss claims to have shown. Maybe his case is hopeless, but we deserve to hear why.

    At the risk of wandering off topic: about the prostitution case, you are now talking about preference curves, whereas we were talking about supply and demand. Those are different things. It is genuinely strange, from the view of classical economics, that given the enormous supply of people able to perform sex work (and the low or non-existent barriers to entry into that market) more people don’t do so, given the high demand.

  • Anthony Drinkwater says:

    Thanks for your reply, Nicholas : I’ll listen to the talk.

    Meanwhile, suppose that killing your mother would bring about the end of all war and poverty. Would it still be wrong to do so? If not then the issue is simply the price, not the principle. Welcome to matricide … (but beware of using Churchill aphorisms as a model of logical thinking)

  • Simon Rippon says:

    Hi Nick, I’m sure it won’t surprise you to hear that I don’t think your objections are successful!

    First, you reject the empirical eveidence about the supply curve for blood because, you say, it contravenes “the entire body of empirical evidence on which economists base the law of supply and demand”, I agree with Marinus Ferreira’s comments that you’re not offering an argument here, just refusing to accept the point. Moreover, there are well-known and widely accepted exceptions both to downward-sloping demand curves (e.g. goods that are valued mainly for conspicuous consumption purposes, or those for which price is taken to be an indicator of quality, such as luxury Swiss watches), and to upward-sloping supply curves (e.g. labour – paying workers more can give them a greater incentive and ability to take time off to enjoy their wealth) The laws of supply and demand are theoretical idealizations, not inductively established exceptionless truths!

    Second, you write: “It seems pretty obvious that market economies provide more goods for more people at cheaper prices than any other way of supplying goods.” Do you have any evidence of this when the good in question is necessary basic healthcare? I think it’s pretty obviously a false proposition in that case. You will need an arugment if you want to claim that a free market in organs would not be like a market in necessary basic healthcare in this respect.

    Third, I think your final point – in which you accuse me of begging the question – is the most interesting, but also fatally mistaken. I had argued that being obligated to sell an organ is a harm, and you respond that I begged the question in two ways, by: (i) assuming that losing an organ is a harm, and (ii) assuming that organs ought not to be sold. But in fact, my argument made neither of these assumptions. I said that one’s being (socially) *obligated* to sell an organ would be a harm. This could be true even if neither of the claims you mention were true. By analogy: I don’t think that having sex with a celebrity (ordinarily) harms a person. And I don’t think that people ought not to have sex with celebrities. But I do think it would be a harm to a person to (socially) *obligate* them to have sex with a celebrity. So it is quite possible to hold that being (socially) obligated to p is a harm even though p-ing is not wrong, and even though it p-ing does not (ordinarily) harm the person who p’s.

  • Hi Simon. Yes, I wasn’t expecting you to agree. First, to move the less interesting issues out of the way: On the two empirical questions, I have offered a very straightforward argument: your claims are contrary to well established empirical generalisations. In such a case the burden of proof is on you, and your burden is to show that your claims are true exceptions to those generalisations. On the first one you offer a book with empirical research that is 40 years out of date. You now mention examples of upward sloping demand curves and downward sloping supply curves, examples which are not (contrary to your claim) widely accepted but highly controversial. More importantly for our disagreement, the examples are not examples of markets in body parts and so they do not show such a market to be an exception to the general rule. On the second you don’t address the burden but try to shift it onto me.

    So you bear the burden of proof, not me. However, we do have evidence about organ markets from Iran’s market in kidneys. If you and Titmuss were right they ought to have worse waiting lists than we do, but they don’t. Nevertheless, I started by conceding that they are empirical questions because this is a philosophy blog not an economics blog and I will leave them to the economists to settle. For our interests, if as a matter of fact a market in organs means there are fewer organs available for transplant, or it means those most in need of organs get fewer, then I agree that the people who would otherwise have got them are indeed worse off, and that their being worse off in those ways counts.

    Moving onto the more interesting question, I take it that you are saying I have not understood the nature of the harm you think arises. If I have you aright, you are conceding that losing an organ is not intrinsically harmful and that it is morally permissible to sell organs. Rather, you are saying that, whilst there is no harm or wrong in selling an organ, there is a harm in being (socially) obligated to sell the organ and the entire harm is in the being (socially) obligated.

    To take this further I need to know your answer to these questions: First of all, I don’t know what work is being done by ‘socially’ here, especially when it is in brackets. Can we leave it out? Or do you mean that you are harmed because although you are not in fact obligated to sell the organ people expect you to sell it? Secondly, taking my case, is it a harm to be obligated to feed your children? If not, suppose because you are a wastrel all that is left to you in order to feed your children is to sell your kidney. Why is the obligation to sell you kidney a harm when the selling of it is not and the obligation is based in the obligation to feed your children?

  • Simon Rippon says:

    Hi Nick, I think you’re being a bit dismissive of respected empirical research which contravenes your worldview, but let’s agree to leave behind those economics issues and stick to the philosophical ones.

    You’re right that I think you didn’t understood the nature of the harm I was pointing out – because you mistakenly assumed it must be derivative from some other prior harm or wrong. I have not “conceded” that losing an organ is not intrinsically harmful or that it is morally permissible to sell organs, but rather pointed out that my argument did not take the falsity of either of these claims as premises.

    Here’s the reason I put “socially” in parentheses when I said “it would be a harm to a person to (socially) obligate them to p”: when we decide to introduce a market in p, the market redefines what people expect of each other with respect to p-ing (that is, it changes what I call their “social” obligations) but need not change their moral obligations with respect to p-ing. Indeed, you might plausibly think that for many values of p, these social obligations simply could not *morally* obligate people to p. (Consider a society that develops a flourishing market in child labour, for example – you might be socially obligated,in the sense I have in mind, but are surely not morally obligate to send your 6-year-old child to the sweatshop to work all day.) So I think for clarity it’s well worth being careful to separate moral and social obligation.

    You might now ask: Is it always a harm to someone to socially obligate them to do something that they are not already morally obligated to do? The answer to this question is obviously ‘no’ – to take a simple case, in the UK you’re socially obligated to drive on the left hand side of the road, and there would be no moral obligation to do that prior to the social obligation. But it doesn’t harm you to socially obligate you to drive on the left. In fact, the existence of the social obligation plausibly generates a moral obligation to drive on the left that wouldn’t have existed otherwise.

    This leads us to a more refined version of that last question: Is it always a harm to someone to socially obligate them to do something they are not also morally obligated to do? I don’t know the right answer – and there’s a related deep debate in the philosophy of law about the normative force of the law that indicates that others disagree about how to answer it. Some people think we’re always morally obligated to obey a just law, others do not.

    So let’s ask a third question: Can it ever harm someone to socially obligate them to do something they are not also morally obligated to do? The answer to this question seems to me to be a clear ‘yes’. Social obligations restrict the options available to me to either doing the socially obligatory things or being subject to censure; and sometimes this restriction of options is harmful. If my social obligations require me to to something immoral, this is typically harmful to me. If they significantly restrict my options, then even when if they leave a permissible option open to me, they may still harm me – for example when they restrict my options for no good reason at all.

    What about your example of being obligated to feed your children? Well, arguably it never harms you to be socially obligated to do what you would be otherwise morally obligated to do. One case in which this seems certainly true is your being socially obligated to feed your children, which does not harm you, because censure is a permissible response to your failure to meet this obligation.

    Arguably, your “wastrel” who can only feed his children by selling a kidney is not harmed by being socially obligated in this way to sell his kidney, because his selling the kidney would have been permissible anyway. But it’s worth noting the differences between your hypothetical “wastrel” and the many people in the real world in places like Pakistan, who through not fault of their own find that their only economic option is to sell a kidney on the black market. Our question is not whether a broad, legal market in organs would harm hypothetical “wastrels”, but whether it would harm real people.

    Sorry for the rather long reply!

  • Dennis Tuchler says:

    A question raised in the original post is whether the supply of organs decreases when organs are on sale. I think the answer is probably “yes” in part because people will feel less obliged to sign organ donor cards if they think that the organ donation will turn into an item on sale. Moreover, if the market provides, there will be less pressure on people to provide. On the other hand, supply here is a temporary measure. Organs have a useful life. The number of organs available does not equal the total number of organs that will be used. I don’t have any idea as to whether the match between available and useful organs would be improved by putting them on the market.

    One final not. The objection comes up from the left that putting organs up for sale victimizes the poor, who will be under particular pressure to sell their organs. The objection extends to all transactions with poor persons. It is better directed at the quality of the organs prtocured and the danger to those into whom the organs are transplanted..

  • Peter Wicks says:

    With regard to supply and demand, I don’t see why the “burden of proof” is either on Simon or Nicholas. As has been accepted by both, this is an empirical question and if we want to know the answer we need to look at the empirical evidence, and perhaps perform some experiments. Like Dennis, I myself don’t have a clear position on this issue.

    On the question of harm, I have somewhat more sympathy with Nicholas’ position within the framework of the arguments being proposed. The most compelling of Simon’s arguments, for me, is the reference to real kidney-selling in Pakistan, but it still falls short in various ways. Firstly, Simon has not provided evidence that such cases result from an actual social obligation (in the sense he defines it) as opposed to the simple wish to provide for one’s children. Secondly, it is not clear that these people are worse off than they would be if there was no black market to sell into. Thirdly, a legal market led and supported by developed countries, and properly regulated, could plausibly be expected to maximise the net benefit of such transactions and reduce any associated harm.

    What may be missing from the above, however, is a consideration of the genuine distress and disgust that the idea of a market in organs generates for some, and I would tend to believe most, people in developed countries. Whether this is in itself a strong enough reason to oppose such a measure may be questionable, but it at least seems to be relevant, and therefore should be taken into account when considering our moral position on this issue.

  • Simon Rippon says:

    Dennis, for an explanation of why my argument does not extend to all transactions with poor persons, please see the discussion following my original post:

    Peter, you misunderstand my point in referencing real people in Pakistan. I wasn’t claiming that people selling organs onto the black market are now subject to social obligation, or are harmed by that. I was merely suggesting that *if* a broad, legal market were introduced, it would be many more people just like them – typically, hard-working poor people – that would be harmed by the imposition of new social obligations, having their options restricted to either selling their organs or (at best) facing social censure. Speaking of hypothetical “wastrels” trivializes this.

  • My thanks to Dennis and Peter for their comments. I think you’ll find the talk by Janet (see post scriptum above) addresses many of the points you raise. For that reason I’m going to focus on the issue of social obligation as now explained by Simon.

    Simon: It seems that the work being done by ‘social’ is partly that of negation: being socially obliged is not being obliged, it is merely some people having expectations which they’ll complain about if they are not fulfilled. But people have all sorts of silly expectations that they will complain about if not fulfilled. Calling them social obligations obscures what is going on. For a start, expectations are not obligations. Worse, the phrase lumps together expectations that people have a right to because they are expectations that someone will fulfil their obligations with expectations they have no right to. It also destroys the usefulness of the phrase. We should reserve ‘social obligation’ for obligations that are social, not waste it on expectations that need not be obligations at all.

    So the harm you are concerned with is not an obligation at all, but a social expectation. You accept the wastrel is not harmed (which by the way is not a hypothetical case—there are plenty of wastrels in the world) and contrast him with someone like a peasant who through no fault of their own finds that their only economic option is to sell a kidney. My first thought is that if the peasant wants to sell his kidney and we had a proper international market the outcome of selling it would be one sick person cured and one peasant, previously in dire economic straits, significantly better off. That sounds like win-win to me.

    I therefore take it that you think the harm arises if the peasant doesn’t want to sell the kidney but the people around him expect him to sell it and will complain if he doesn’t. Two possibilities arise here: either there is an obligation for him to sell it. In this case they have a right to their expectation and I find it difficult to see what the harm is.

    That leaves only the case in which there is no obligation for him to sell it but people still expect him to and will complain if he doesn’t. This kind of harm arises whenever people have false beliefs about other people’s obligations. I agree that if people expect something of you to which they have no right then you are harmed, and you are also harmed if on that basis they unfairly blame you. Let’s call this harm the harm of unfair expectations.

    This is how it now looks to be. The harm of unfair expectations is not intrinsic to a legal organ market, nor specific to such a market. Provided people don’t expect others to sell organs except when they want to or when such an obligation exists, the harm won’t arise. Consequently, the harm that you are concerned with is irrelevant to the ‘pure’ question of whether there should be a market in organs.

    However, because people are fallible it is likely that sometimes someone will be expected to sell an organ even though they don’t want to and there is no obligation to. In general that kind of thing is just a normal part of life we have to put up with. Furthermore our morality already has second order norms that are responsive to the problem of unfair expectations. Because we know we are fallible, both in knowing what the obligations are and in performing our own, we are obliged to moderate our judging and blaming—‘let him who is without sin cast the first stone’.

    Finally, if we think the harm here is likely to be severe then at the policy level we can deploy the techniques we already have to deal with such fallibility in drafting laws. In this case the laws could be drafted with restrictions to minimise such unfair expectations arising. I doubt if this is a case where that should be done. The good to be got from legal international organ markets is plainly enormous and should not be restricted if at all possible. These harms are secondary to the pure issue and it is unlikely to be severe because we have second order moral norms that restrain unfair expectations.

  • Nicholas, you deny that a market in organs would lead to obligations to trade on a market:
    “It seems that the work being done by ‘social’ is partly that of negation: being socially obligated is not being obligated, it is merely some people having expectations which they’ll complain about if they are not fulfilled.”

    This is far too quick, and it turns out to be false. In David Lewis’s seminal work Convention, he proposes and defends a structure where expectations of the appropriate sort can be properly normative. There are qualifications involved (just the brute fact that somebody expects something isn’t good enough), but market conditions tick all of those boxes (at least, if we believe in classical economics at all). His work is couched in game theory, so it’s imminently the type of consideration that’s of interest here.

    A quick, simplified gloss on Lewisian conventions: there is a convention to do C (and we should do C rather than not) when almost everybody expects people in the relevant circumstances to do C (and expects people to expect doing C), prefer doing C given this expectation, and would prefer some other action C* if almost everybody expected to do C* instead. This gives rise to straight-forward obligations because when I act against these expectations, I frustrate everybody’s ability to co-ordinate towards mutually preferred ends. This is all pure game theory to this point, so I don’t expect you have much to object to here. So, for the organ market case, it would go: for any legitimate market, I expect that trading occurs on that market and I prefer there being trade on a market over no trade (otherwise there wouldn’t really be a market), which covers the 1st and 2nd conditions. If there were no market, or if it were banned, I prefer no trade on it, like I do for the market for hard drugs or illicit weapons (the 3rd condition). Because the three conditions are met, there is a convention to trade on the organ market. Thus, if I am in the relevant circumstances — needing money and having something to trade on the market — there is a convention to make use of the market, and an obligation to do so, otherwise I am arbitrarily frustrating people’s attempts to reach the type of scenario you describe as win-win in your latest reply. But this means that a market in organs leads to at least some obligations.

    You are committed to this result exactly because you describe someone improving their economic condition through organ trade as a win-win situation. For you to deny that somebody would prefer trade to non-trade (denying the 2nd condition I outlined above, and the only plausible response) would mean you deny that such an exchange, even at full market value, would be fair, and that would be to deny the good of the organ market. You talk about second-order norms, which are certainly present and in effect, but for there to be such norms describing even trade at full market value as an unfair expectation would mean that there are constraints on the fairness of trade which goes beyond what determines fair market value. Those of us who are more skeptical of the goodness of such a market have that option available to us, but you do not.

  • Simon Rippon says:

    Thank you Marinus, I think you picked up on a weak point in Nick’s reply. I have two simple questions for Nick:

    1) When you say someone is “obligated”, do you mean just the same as “morally obligated”?

    2) Would the peasant in the “win-win” situation you mention still be significantly better off, on your view, if the rent he had to pay for his land had risen in accordance with the ability of peasants in general to earn extra income through selling their organs? If not, what makes you think this kind of thing would not happen if there were a real-world free market in organs?

  • Mark Tancredi says:

    Because so much discussion here surrounds what qualifies as a harmful obligation and what sorts of features would make even a voluntary action (such as one made to provide for one’s children) harmful, I want to offer a comment on the idea of “obligation”. First, no matter what we consider harmful — whether it’s economic situation, the view of the human body presupposed and reinforced by market-selling of organs or whatever else — the obligation that a wastrel or any other person has to his family members does not derive from a consideration of benefits and detriments, pros and cons. If all we are interested in is harms vs. benefits, then why situate the question about organs in the context of a desperate family? The obligation of mother or father to son or daughter is not defined by utility, and the question about what a desperate parent should do to provide for a child is not adequately answered by it. If we see an emotional or even ethical force in this example, then we need to expand our terms of debate; utilitarianism does not provide imperatives and it does not explain families.

    Second, just as I suspect what we’re really talking about in the wastrel example is not reducible to pros and cons, I also suspect that we need not quibble over “social obligation” vs. some other obligation to understand “harm”. The argument here has been good between Simon and Nicholas, but there have really been two disagreements about harm, with one viewing it in light of a supply-and-demand curve and the other as involving the freedom or coercion of choices.

    For the former, why can we only consider harmful what is first inefficient? Is the debate here really just over whether or not a market-based system of organ donation can supply for all those who need organs? If it is, then we’ve just appropriated the word “harm” to describe a situation where organ needs cannot be met or alternately to describe a market that faces opposition from the population. This is, essentially, an economics debate in which the word “harm” is a rough fit. For the latter, it’s hard to imagine how a market could obligate someone to sell an organ, and I think Nicholas is right that the harm from misunderstood obligations is a normal part of life. So why concern ourselves with this? Is it possible, instead, that we are worried about the view of the human body that would have to be presupposed to justify an organ market? And if so, are we worried about something other than a weighing of harm vs. benefits, something more metaphysical and involved with questions about the human person?

  • Peter Wicks says:

    Mark’s question about why we should concern ourselves with the “harm from misunderstood obligations” seems to be addressed by Marinus’ comment, although I have yet to form an opinion on whether it does so convincingly, and will be interested to see Nicholas’ reply in this context.

    In the mean time I see a link between Mark’s suggestions about what we are *really* worried about and my earlier comment about the distress and disgust that the idea of a market in organs generates for people in developed countries. One reason why I made this point was that I’m interested in exploring the extent to which emotions should be seen as playing a legitimate role in the formation of moral positions. In this context I find Mark’s suggestions convincing because they go to the heart of our sense of identity as people, and therefore can plausibly be expected to arouse strong emotions.

  • Lewis’s result that conventions lead to obligations (which I’m summarising quite a bit — the whole list of conditions on conventions, all five of them, is on p 78, and the full account of their normative power is on pp 97-100 of ‘Convention’) is a strong one, but it’s secured by how strong the premises are. Market conditions satisfy all the conditions. For any existing legitimate market, I prefer that trade happens on it rather than not, and so do everyone else. Furthermore, when I have goods for sale, I prefer trading it on the market to not trading. I also prefer that other people make their goods available for sale (at the appropriate price). And everybody else prefers that I do the same. Furthermore, given the existence of the legitimate market, everybody expects everybody else to trade on it (and expects everybody to expect others to trade on it, etc.) Thus, we all have a series of expectations about the goods on the market being available, the expectation that people will make their goods available, and everybody prefers that it be available (as Nicholas is committed to admitting, since he thinks organ trade allows for win-win situations). When I do not make my organs available (in the appropriate circumstances — fair price, no external coercion, etc.), I am going against the reasonable expectation that I would do my part in the legitimate trade. By not doing my part, I am harming other people by frivolously not allowing them to reach their desired ends, in the way I would expect them to allow me to reach mine in this context.

  • Marinus: You say it is all far too quick. Closer attention to what I actually said should slow it down: (a) not only did I not deny that a market in organs would lead to obligations to sell organs, I actually affirmed it (wastrel case), (b) in any case I was analysing what Simon meant by ‘socially obligated’, which turns out need not mean being under any obligation at all and is just a misleading way of referring to expectations that people may have and (c) I specifically distinguish such expectations when there is an obligation and such expectations when there isn’t, and discuss the question of harm.

    Fulfilling the conditions of Lewisian conventions alone cannot lead to obligations. Wicked conventions impose no obligations to conform to them, even if people mistakenly think they do; indeed, in the face of such a convention your obligation may well be precisely to frustrate everybody’s ability to coordinate towards whatever wicked end is mutually preferred.

    You seem to be offering an argument that any legal market obliges people to trade on it whether they want to or not. Nonsense. No one is obliged to trade merely by the possibility of trade. For example, the reason I think wastrel is obliged to sell his kidney is not because the existence of the market obliges him but because he has some other obligation which he can only fulfil by selling his kidney.

    I note that you have some weird preferences about markets: you should not assume they are shared. I don’t care whether people buy and sell stuff or not. That’s up to them. It’s true that I expect the shops to have stuff I want to buy in them but they are under no obligation to meet that expectation just because I have it. Nor do I think that just because a trade benefits both parties they are obliged to trade. So I doubt your premisses. But even if I must grant them, since the conclusion is nonsense the argument as a whole is merely a reductio of the premiss that behaviour conforming to the conditions of a Lewisian convention is thereby obliged.

  • My thanks again to Mark and Peter for their remarks. Once again I’m going to focus on Simon’s questions

    Simon: (1) No. Here is a truth about obligation: Someone is obliged to do something only if they ought to do it.

    (2) Yes. I don’t see that peasants being able to access the wealth locked up in their kidneys need result in land rents rising, but if it does that isn’t necessarily a bad thing. If you think it must be a bad thing then I think you’ve got a false belief that the economy is a zero sum game. Land becomes more valuable as a society gets wealthier. If the price of the land goes up it is probably because the value of the income off the land has gone up. Peasants only pay their rent if it is worth it to them. If it is not they leave and do something else. If they can access the wealth locked up in their kidney there are more ways they could leave and more things they could do instead. They might even buy the land and no longer have to pay rent!

  • Simon Rippon says:

    On (1): I think there can be different senses of obligation, and different senses in which you correspondingly ought to do something. For example, there can be things you ought to do legally speaking, or in virtue of the role responsibilities that come with your job, or in virtue of your social/financial responsibilities, even when it’s not the case that you ought to do them morally. I’m not sure whether you want to deny this. If you accept it, as I do, then there are ways in which the introduction of a new law, or of a new market, can subject you to obligations to do something that you wouldn’t otherwise be obligated to do. I’m not merely concerned with people’s mistaken expectations of others, I’m concerned about the genuine social obligations that different social arrangements can impose on people. I think sometimes imposing these obligations on people is harmful to them in unjustifiable ways.

    On (2): I think there’s a great divergence between your view of economics and mine, but I certainly don’t need the silly “belief that the economy is a zero sum game” to think that your rosy view is mistaken. Of course, wonderful things of the kind you indicate *might* happen to peasants if there were a free market in organs. But it’s perfectly coherent to think that even if on aggregate we would be economically better off if there were a free market in organs (I’ve given no reason to doubt this), the worst off would probably be even worse off than they are now: they would lack organs as well as wealth and access to opportunity.

  • Peter Wicks says:

    This is an interesting debate and I would like to make the following points.

    1. On the issue of different kinds of obligation, I definitely prefer Nick’s simple definition. I say “definition” rather than “truth” because I think this is to some extent a semantic discussion, but imagine how one would apply in practice the idea that, for example, I am obliged to do something as a result of my job but I am morally obliged to do the opposite. What, then *ought* I to do? To me, the idea of a moral obligation only makes sense if it is something that I should in principle be guided by all the time. I say “in principle” because in practice there may be all sorts of ifs and buts, in particular unforeseen circumstances where the moral principles involved don’t quite apply as originally conceived, and we might also consider that we should not at all times try to be morally perfect. But this is not a reason to make a separation between moral and (for example) professional obligations. Rather, the professional obligation is one of the factors that determines what the (overall) moral obligation is.

    2. By contrast, on the economic discussion I’m rather with Simon. The classical economic idea that markets always efficiently allocate resources and thereby maximise total value is just wrong. Markets are basically emergent social phenomena, driven by the myriad human motivations that make people buy and sell things. To imagine that they somehow automatically maximise common welfare is…a useful theoretical model that has driven a lot of progress in economic thinking, but a dangerous fallacy when applied as policy. That’s why bankers are rather unpopular at the moment.

    3. I would be interested in a reaction to my point about the emotional dimension. To put it as a rather blunt question: is it at all relevant how people feel about this issue, or should we ignore this entirely when forming our own views on issues such as this one? This seems to me to be a crucial question in ethics, and I’m not sure that it has been adequately addressed (but would be happy to be proved wrong!).

  • Nicholas:
    You’re reply isn’t going to get your view out of trouble, for a few reasons. There can’t be wicked Lewisian convention. This is a very strong result, but it’s secured by the conditions: everybody must prefer conforming to the convention for it to count. Strong as these conditions are, markets tick all the boxes.

    The reason we are supposed to want markets and benefit from them is because they allow us means through which to better our station in life. They give us options for trading things we have for things we want. Given that the market is fair and legitimate we can only benefit from it being there. This means that everybody prefers a market for X rather than there not being a market for X (given it being fair and legitimate). We also expect trade to occur on this market — specifically, people trading on it for their benefit. This is just part of the definition of what a market is.

    This leads to there being a convention to trade on the market where it benefits you. We’ll take it that you benefit from a trade where you prefer having made the trade to not having done so. Its a very thin idea of benefit, but it’ll do for now. This means that there’s an obligation to trade on that market where it benefits you. This is because not trading for your own benefit not only spites yourself, it spites everybody else who depends on the market. Everybody else has a reasonable demand on you not to spite them in such a way, because of the convention. You’re correct that this does generalise to every (fair and legitimate) market, but that isn’t a problem. This result clearly holds for the labour market, for instance –by convention I am obligated to enter the labour market to make a living, given that that is how I am expected to earn my keep, and that I prefer having a job to not.

    Now, since there’s been a bit of to-and-fro, it’s worthwhile to re-iterate why this result is a problem for you, Nicholas. You want to make two claims. Firstly, we would benefit from actually trading organs — you repeatedly describe how we’d be better off trading a kidney for money in certain situations. Secondly, you want to say that we wouldn’t be obligated to make these trades. But you can’t have both of these claims at once. If we really did benefit from these trades, and they came on a fair and legitimate market, we would have obligations to trade in those conditions. Not knock-on obligations to look after our family or whatever else, like in your wastrel case, but obligations simply from the role the market would play in society. You would have to defend a situation where there is a norm of organ-selling. And many of us believe that can’t be done — I for one believe that an organ market can’t be fair and shouldn’t be legitimate.

    Sorry for the length, but this is an important point which I believe needs to be pressed and taken account of.

  • Peter Wicks says:

    Marinus: I don’t see how the existence of a market alone implies that everybody approves of it (and therefore prefers “conforming to the convention”. (I’m assuming this is what you meant by the phrase “markets tick all the boxes”.) The fact is that there are many people on this planet for whom the whole concept of markets is suspect, particularly when raised to the status of religion as has been the case over the past few decades.

    When you say “we are supposed to want markets and benefit from them”, I would ask, “supposed by whom?” and, “By what criteria are we defining benefit?” Some people may prefer to starve.

    “Given that the market is fair and legitimate”: which market, and how do we know it is fair and legitimate? By what criteria are we making this claim?

    “This means that everybody prefers a market…rather than there not being a market”: no it doesn’t. Some people may prefer there not to be a market, no matter how perverse or irrational we might judge their preference to be.

    I tend to agree with you that there can’t be a wicked Lewisian convention as you describe it, because I believe that moral values are ultimately a matter of choice, and you have set the (fantastically strong) condition that everyone has to approve the convention. But you seem to me to be a long way from demonstrating that markets satisfy this condition.

  • Peter:
    It’s not the brute existence of the market which does the work, it’s the fact that the market is supposed to be fair and legitimate. You seem to have misgivings about this possibility, and with good reason. This is another in a long line of strong conditions. But for a market in organ trade to be at all something worth considering it would need to be a fair and legitimate market. What I’m saying is that if it were, there would be a convention to trade on it. The point of what I’ve been trying to do is to force on the defender of such a market that they would also have to defend a norm of organ-selling.

    You could see what I’m doing as setting up a series of dilemmas for the defender of markets in organ trading. If there really were a legitimate market to the benefit of all, then we wouldn’t be free not to trade to it. Conversely, if we can reasonably resist entering the market, even if trading on it is supposed to be to everybody’s mutual benefit, then the market is either illegitimate or unfair.

    I haven’t specified what the standards of fairness are (a market being legitimate probably just is its not being a black market), because that’s fair too large a matter to tackle here. The discussion is also making use of very thin concepts — too thin to start to answer the types of questions you’ve asked about their emotional dimension, for instance. But there is some standard of fairness, and my point goes through whatever it is (except in the probably perverse case where not even win-win trades that Nicholas holds up as the paradigm goods of such a market are unfair). All that I need to make my point is that trades on a legitimate market either are unfair, or there are norms to trade on it.

  • Sorry, there’s a typo there. I wrote: “(except in the probably perverse case where not even win-win trades that Nicholas holds up as the paradigm goods of such a market are unfair)”. That should be “…not even win-win trades … are fair”.

    That clause is supposed to latch onto the logical possibility for a situation which is wicked or unfair even if it is the preferred situation of everybody involved (and of everybody likely to be involved in such cases in the future). In that case we could have wicked Lewisian conventions and the the win-win trades that Nicholas aims for would be unfair. But that possibility isn’t really credible, I believe.

  • Peter Wicks says:

    Marinus, I have several problems with this argument.

    Firstly, I don’t see why we should assume that for a market to be “fair and legitimate” it necessarily has to benefit everyone. I was certainly not assuming such a strong condition in my earlier comments.

    Secondly, even if it benefits everyone, I don’t see why this necessarily implies that everyone prefers it to exist. Some may, however perversely, prefer it not to.

    Thirdly, even if everyone wants the market to exist, why does this mean that they expect everyone to trade on it when it benefits them, even if they don’t want to? That’s certainly not the attitude I take towards markets even when I think they are fair and legitimate.


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