If market matching is OK, what’s the moral objection to selling?
When Adam Smith, the father of economics, spoke of the universal urge to “better one’s condition,” he certainly never imagined that selling a kidney might be one possible route.
That organ transplants are now a commonplace is just one of the technological wonders Smith could never have conceived, but which he helped set in motion by explaining and espousing the benefits of free markets. However, what is likely no less controversial today than it would have been in the 18th century is the prospect of selling a kidney.
That issue was inadvertently thrown up by Monday’s announcement of the Nobel Prize in economics, which went to Lloyd Shapley and Alvin E. Roth for “the theory of stable allocations and the practice of market design.”
Mr. Shapley in fact makes no claim to be an economist. His specialization is game theory. He once worked with John Forbes Nash, Jr., another game theorist who won an economics Nobel that might have puzzled Adam Smith (Nash subsequently featured as the central character in the movie A Beautiful Mind).It was Prof. Roth who began to apply Prof. Shapley’s mathematical insights. One of the most intriguing applications has been to design a market matching system for kidney transplants, since many donors are not biologically compatible with their desired recipient. Prof. Roth’s system is undoubtedly a step forward in making the present system in the U.S. more efficient. (Canada has a similar kidney-matching system.) The intriguing question is why kidney sales are banned. Most peoples’ reaction would probably be: “Well, it’s obvious.”
In fact, given the present state of medical science and that most healthy people can live with only one kidney, a well-regulated market could save many lives, and help people in financial difficulty. However, the suggestion of organ sales is almost invariably met with reflexive horror.
The transplant policy issue recently arose in Canada due to an acute organ shortage in P.E.I. It was suggested that a “negative option” might be introduced: that is, that unless you stipulated otherwise, your dead body would become spare parts for the health system. As the Post’s Marni Soupcoff so beautifully put it: “Surely permission for something as invasive as removing a person’s still-beating heart should be held to a higher standard of consent than selecting a cable package.”
What is intriguing is that people appear to be less exercised by the thought of the state expropriating their body than that someone might freely choose to sell a superfluous part of it. Organ sales are prohibited in Canada, as in most countries.
Just why this is so, and what this says about our moral psychology, is explored in a cogently argued and wonderfully written book, The Ethics of Transplants: Why Careless Thought Costs Lives, by Oxford professor Janet Radcliffe Richards.
She notes that her thesis is not based on a “libertarian” view that people should be allowed to do what they like with their own bodies, but on the fact that the “ethical” arguments of opponents of organ sales don’t make sense according to the principles they claim to espouse themselves.
She brings up the arresting point that thousands of Indian farmers commit suicide each year because of their debts. Presumably they would be more than willing to sell a kidney to survive. As for being “exploited,” she notes that seeking to stop exploitation by banning well-regulated organ sales would be like trying to cure slum dwelling by bulldozing slums.
The ultimate question she addresses is: Where do such immovable but problematic moral assumptions originate?
It is surely impossible to think about the removal of an organ under any circumstances without a reflexive wince. Put that together with trade, which has long been morally condemned (although Prof. Radcliffe Richards suggests that it is “morally neutral,” one example where I would beg to differ) and you have a truly repulsive mixture. The issue is whether such moral repulsion may be inappropriate in terms of the objectives it claims to promote. The key is that our morality was designed for, and by, very different circumstances from those in which we now live.
Prof. Radcliffe Richards lacerates failure to think about the practical consequences of unquestioned moral assumptions.
“It may be bad to live in a society where people really do need to sell their organs,” she writes, “but it seems still worse to live in one where they cannot do even that because the rich and healthy make themselves comfortable by prohibiting this conspicuously unpalatable manifestation of poverty and sickness, and by endless rationalizing to keep the contradictions in their moral systems out of sight. The price for such moral comfort is paid by the very people who are the supposed objects of moral concern, and it is too high. This is why serious ethics cannot be left to intuition.”
Prof. Radcliffe Richards does a wonderful job of skewering the reflexive condemnation of the 1% in complaints that kidney purchase will only help “the greedy rich.” She notes that “The language rather gives the impression that the rich in question, tired of gold-plating their bathrooms and surfeited with larks’ tongues, have now turned to collecting kidneys to display with their Faberge eggs and Leonardo drawings…. Greedy is not a word anyone would normally use to describe someone who was putting their resources into desperately trying to save their own life.”
Prof. Radcliffe Richards concludes that “moral seriousness” does not depend on profound moral commitment, but on willingness to examine whether your profound moral commitment might be inappropriate. As such, she raises particularly pertinent questions about attitudes towards economics as the study of alleged “greed and selfishness,” and which are obsessed with “market failure.”
Perhaps she deserves a Nobel.