A week ago in the Guardian, John Harris – of my own university – put forward the argument for ‘a strictly regulated and highly ethical market in live donor organs and tissue’. It isn’t my purpose, in this post, to arrive at a conclusion on what is a difficult question. I just want to highlight one problem, as I see it, with the case as made by John.
The most powerful features of his argument are that the proposal is a life-saving one and that the donors choosing to sell would be choosing freely. The strongest argument against, I think, is the worry, which John tries to meet, that such a market would be exploitative. Here is what he says about that:
Some people say such a market would exploit the poor. First, it is hypocritical to think that denying poor people an opportunity to sell one of their few saleable assets is doing them any favours, at least so long as no attempt is made to alleviate their poverty in other ways. No one is exploited by an offer of money simply because they do something for pay which they would not otherwise do. I am sure I am not the only Guardian reader who would be unlikely to go to work if I was not paid for what I do! But I am not exploited by the University of Manchester (at least not in that way). The reason is that I freely choose my part in the purposes of the university as one of my own projects. So long as would-be organ vendors freely choose to provide an organ, knowing the risks and aware of the benefits, then they are not exploited, even if they would not provide the organ but for the money.The problem I have with this is that the claim in the middle of the paragraph, ‘No one is exploited… etc.’ is supported only by the example which follows it and I think the example is problematic in the circumstances. For it contains not only the element of working for the University of Manchester by free choice and for payment, but also the element ‘as one of my own projects’ – something suggesting that the choice may also be rewarding to the chooser in other than financial ways. If one were to take a different example – say, prostitution, as chosen by a single mother in dire economic circumstances and not because it was seen by her as rewarding in other than financial ways, but despite the fact that it wasn’t – then the picture doesn’t look so clear to me. It’s going to depend, obviously, on how one defines exploitation, a rather large question which I don’t intend to embark on here.
The other consideration, raised in a Guardian leader the same day, is how far the alternative proposal – that is, ‘”presumed consent”, under which it would be assumed that individuals wished to donate organs after their death, unless they registered an objection during their lifetime’ – would go towards meeting the relevant need.