Sunday, 18 December 2016

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 he 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. Additionally, 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.

The 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 http://www.practicalethics.ox.ac.uk/audio/kidneysales260208.mp3.

Originally at http://blog.practicalethics.ox.ac.uk

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