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.
Ella and Cyrus thought that the inequality between buyers and sellers makes kidney markets ethically dicey. Either the desperately poor do not have a genuine choice about selling their organs or there is something about inequality that rankles.
Martin referred to the Goyal article as offering partial support to their points (Goyal et al. 2002). The overwhelming majority of people interviewed would not do it again and many of them were lied to. For more evidence, we could add this harrowing tale from the LA Times: “Duped into selling his kidney, this 23-year-old exposed an illegal organ racket in India.” Yikes!
I say this gives partial support because it leaves room for a suitably regulated market. If people were not lied to and were paid adequately, the market might be OK. I think that Cyrus and Ella were aiming a little higher: that poverty alone makes the choice unfree, even if it is fully informed (but I might be wrong about that).
Jennifer saw the attraction of Satz’s view. There is something creepy about selling your body parts; that should be off limits. I had the sense that the room was not quite buying it, so I tried to come up with an example that would at least make you uncomfortable: what if people could sell an eye or a nose? My thought was that a visible disfigurement would seem more icky. Will saw that I wasn’t getting the job done so he offered up a better example: what about a contract in which you get a lot of money and then are killed at the end of the year? If that doesn’t illustrate Satz’s point nothing will! Of course, Will thought a contract like that would be OK. But he recognized that this probably the most extreme case: if he can defend this case, everything else will be easy.
As a group I think we settled on a distinction between allowing sales of kidneys post-mortem and sales of kidneys from living donors. Will came up with a nifty insurance plan that could give the insurer a claim on your organs if you die at a “harvestable” age. Cyrus felt better about post-mortem sales than sales from living donors. But Ella asked why the poor people shouldn’t be able to benefit from the sale of their organs while they are alive? (They would benefit under Will’s insurance plan, but not as much as if they could just trade the organ for cash.)
All in all, it was a first rate discussion. Well done!
They’re making artificial kidneys at Vanderbilt. There goes the kidney market! (I kid. Sort of.)
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.
Satz, Debra. 2008. “The Moral Limits of Markets: The Case of Human Kidneys.” Proceedings of the Aristotelian Society 108: 269–88. doi:10.1111/j.1467-9264.2008.00246.x.