Satz considers three arguments against markets for kidney transplants. She concludes that the best argument concerns the effects that markets have on the choices available to people.
Here is her thesis.
If we think that there are some choices that people should have open to them as a right, then we may think that it is inappropriate to ask people to pay a cost for making these choices. I think that this is the strongest argument against allowing kidney markets in more ideal circumstances than our own: that they make people incur a price that they can reasonably think that they shouldn’t have to pay. That is, the strongest argument against such markets must ultimately rest on our judgment that a person’s relationship with their body (and its parts, or at least most of its parts) is so important that it is not something that we should allow markets to influence. (Satz 2008, 283–84)
As an illustration of the price that people have to pay when there are markets for kidney transplants, Satz mentions loans. Someone who doesn’t want to put their kidney up as collateral for a loan will have to pay a higher price for the loan in a world where kidneys can be sold than in a world where they cannot be sold.
Prof. Brown noted that the vast majority of kidney sales (about 70%) reported in the Goyal study came from women (Goyal et al. 2002). She suspected coercion: the sale isn’t genuinely voluntary, but rather the women are being forced to make it by their husbands. This led her to be very suspicious of something that Satz seemed to accept: kidney donations after death. Prof. Brown thought that the husbands would just kill their wives if that was the rule. (Prof. Brown had some other, extremely dark thoughts on this day that I simply cannot, in good conscience, share with the internet. We will all remember them, I’m sure.)
We would need more data to settle some of this, I think. According to Goyal, most kidney sales are made to pay off debt (Goyal et al. 2002, 1590). Maybe the husbands are the ones who earn an income while the wives do not (note: maybe). If so, taking the wage earner out for several months would defeat the purpose of selling the kidney.
But suppose Prof. Brown’s suspicions are right. Then I think we’re dealing with a society with some really fundamental problems. If men are willing to murder their wives to sell their organs then they’re presumably willing to do a whole host of other awful things. Blocking kidney sales might prevent one kind of abuse, but I suspect there would be others to take its place. And, of course, there is a healthy black market in kidney sales, so a legal prohibition isn’t necessarily effective in blocking this particular kind of abuse either.
At one point, Satz brings Sen and Anderson into her argument, asserting that people have entitlements to what they need to become full members of society. This is going to be tricky, however, because markets for kidneys save lives: they mean more kidneys are available for transplant than there would be without the market. You can’t participate as a full member of society if you’re dead.
This raises a tricky problem for Anderson and Nussbaum. They are in favor of a threshold that everyone has to cross. But what do they tell us to do when there is a trade-off between different people below the threshold? Nussbaum has some remarks about what she calls tragic choices (2011, 37–39). But it’s still a problem, I think.
I think Satz means to avoid the problem by putting her thesis in terms of rights not to have to pay a price for making certain choices. I don’t think she wants her case to turn on the idea that there is a threshold of functioning that everyone has to meet.
We talked about how one might go about reforming the market to eliminate its undesirable features. We thought it was so interesting that we made it a paper topic.
Goyal, Madhav, Ravindra L Mehta, Lawrence J Schneiderman, and Ashwini R Sehgal. 2002. “Economic and Health Consequences of Selling a Kidney in India.” JAMA 288 (13): 1589–93. doi:10.1001/jama.288.13.1589.
Nussbaum, Martha C. 2011. Creating Capabilities: The Human Development Approach. Cambridge: Harvard University Press.
Satz, Debra. 2008. “The Moral Limits of Markets: The Case of Human Kidneys.” Proceedings of the Aristotelian Society 108: 269–88.