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Health Care Analysis
Published in: Health Care Analysis 2/2015

01-06-2015 | Original Article

Kidney Sales and the Analogy with Dangerous Employment

Author: Erik Malmqvist

Published in: Health Care Analysis | Issue 2/2015

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Abstract

Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
Footnotes
1
In addition to the authors already quoted, see Andrews [1, p. 32], Dworkin [11, p. 157], Harris [18, p. 161], Radcliffe-Richards et al. [31, p. 1951], Savulescu [35, pp. 138–139], Wilkinson [40, p. 108], Taylor [38, ch. 6], Matas [23, p. 2010] and Matas [24, p. 1131].
 
2
The main exception is Taylor [38], who dedicates a whole chapter of his book Stakes and kidneys: why markets in human body parts are morally imperative to the analogy. For shorter but nonetheless useful discussions, see Audi [5, pp. 143–146], Zutlevics [43, pp. 298–299] and Nuffield Council on Bioethics [29, pp. 142–143].
 
3
For more on incommensurability, see Chang [9]. My very rough characterisation of the problem differs from some of the characterisations in that volume, but should be suitable for the purposes of this paper.
 
4
I bring up seatbelt, drunk driving and public drunkenness laws to illustrate the point that liberty-limiting policies have different rationales. Whether actual such laws are or should be based on the rationales I attribute to them is not my present concern.
 
5
Authors who explicitly make the connection to paternalism include Dworkin [11], Audi [5] and Taylor [38].
 
6
For contemporary expressions of this old worry, see Radin [32] and Satz [34].
 
7
A different, but structurally similar, challenge worth mentioning relies on an analogy with unpaid living donation rather than hazardous employment. If the paternalist thinks that people should be permitted to give up a kidney for free, how can she consistently deny that they should be permitted to do so for pay? After all, payment would not make the exchange any more dangerous [30, 40]. A thorough discussion of this challenge would require another paper. Let me just note that paternalists could respond by employing the same strategies that I shall employ against the analogy with dangerous jobs. In brief, soft paternalists could argue that selling is more likely than donation to be non-voluntary, and egalitarian hard paternalists could argue that the risks of selling are likelier than the risks of donation to be borne by the worst off.
 
8
This rough characterisation is compatible with major more elaborate accounts of paternalism [6, 10, 13].
 
9
I say “primarily” for two reasons. First, as pointed out above, soft paternalists hold that the dangerousness of a choice is indirectly relevant to whether it should be permitted in the sense that riskier choices require higher standards for ascertaining voluntariness. Second, group soft paternalist policies must justify interfering with both competent and incompetent agents. The restricted freedom suffered by competent agents is not justifiable by appealing to potential harms to them. However, it is justifiable by appealing to harms to other, incompetent agents—and more so the greater these latter harms are. (For discussion, see [22]). Nevertheless, voluntariness, not harm, remains of first importance.
 
Literature
1.
2.
Archard, D. (2002). Selling yourself: Titmuss’s argument against a market in blood. Journal of Ethics, 6, 87–103.CrossRefPubMed
3.
Arneson, R. J. (1997). Paternalism, utility, and fairness. Reprinted in G. Dworkin (Ed.), Mill’s “On liberty”: Critical essays (pp. 83–114). Lanham, MD: Rowman and Littlefield.
4.
Arneson, R. J. (2005). Joel Feinberg and the justification of hard paternalism. Legal Theory, 11, 259–284.CrossRef
5.
Audi, R. (1996). The morality and utility of organ transplantation. Utilitas, 8, 141–158.CrossRef
6.
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). Oxford: Oxford University Press.
7.
8.
Cameron, J. S., & Hoffenberg, R. (1999). The ethics of organ transplantation reconsidered: Paid organ donation and the use of executed prisoners as donors. Kidney International, 55, 724–732.CrossRefPubMed
9.
Chang, R. (Ed.). (1997). Incommensurability, incomparability, and practical reason. Cambridge, MA: Harvard University Press.
10.
11.
Dworkin, G. (1994). Morality, harm, and the law. Boulder, CO: Westview.
12.
Fabre, C. (2006). Whose body is it anyway? Justice and the integrity of the person. Oxford: Oxford University Press.CrossRef
13.
Feinberg, J. (1986). Harm to self. New York: Oxford University Press.
14.
15.
Glannon, W. (2008). Underestimating the risk in living kidney donation. Journal of Medical Ethics, 34, 127–128.CrossRefPubMed
16.
Goyal, M., Mehta, R. L., Schneiderman, L. J., & Sehgal, A. R. (2002). Economic and health consequences of selling a kidney in India. Journal of the American Medical Association, 288, 1589–1592.CrossRefPubMed
17.
18.
Harris, J. (1998). Clones, genes, and immortality: Ethics and the genetic revolution. Oxford: Oxford University Press.
19.
Horrobin, S. (2005). Stakes and ladders. Rejuvenation Research, 8, 258–263.CrossRef
20.
Lundin, S. (2012). Organ economy: Organ trafficking in Moldova and Israel. Public Understanding of Science, 21, 226–241.CrossRefPubMed
21.
Mack, E. (1989). Dominoes and the fear of commodification. In J. W. Chapman & J. R. Pennock (Eds.), Nomos XXXI: Markets and justice (pp. 198–225). New York: New York University Press.
22.
23.
Matas, A. J. (2004). The case for living kidney sales: Rationale, objections and concerns. American Journal of Transplantation, 4, 2007–2017.CrossRefPubMed
24.
Matas, A. J. (2006). Why we should develop a regulated system of kidney sales: A call for action. Clinical Journal of the American Society of Nephrology, 1, 1129–1132.CrossRefPubMed
25.
Matas, A. J., Bartlett, S. T., Leichtman, A. B., & Delmonico, F. L. (2003). Morbidity and mortality after living kidney donation, 1999–2001: Survey of United States transplant centers. American Journal of Transplantation, 3, 830–834.PubMed
26.
27.
Miller, F. G., & Wertheimer, A. (2007). Facing up to paternalism in research ethics. Hastings Center Report, 37(3), 24–34.CrossRefPubMed
28.
Naqvi, S. A. A., et al. (2007). A socioeconomic survey of kidney vendors in Pakistan. Transplant International, 20, 934–939.CrossRefPubMed
29.
Nuffield Council on Bioethics. (2011). Human bodies: Donation for medicine and research. London: Nuffield Council on Bioethics.
30.
Radcliffe-Richards, J. (1996). Nephrarious goings on: Kidney sales and moral arguments. Journal of Medicine and Philosophy, 21, 375–416.CrossRef
31.
Radcliffe-Richards, J., et al. (1998). The case for allowing kidney sales. Lancet, 352, 1950–1952.CrossRef
32.
Radin, M. J. (1996). Contested commodities: The trouble with trade in sex, body parts, and other things. Cambridge, MA: Harvard University Press.
33.
Rothman, S. M., & Rothman, D. J. (2006). The hidden cost of organ sale. American Journal of Transplantation, 6, 1524–1528.CrossRefPubMed
34.
Satz, D. (2010). Why some things should not be for sale: The moral limits of markets. Oxford: Oxford University Press.CrossRef
35.
36.
Scheper-Hughes, N. (2003). Rotten trade: Millennial capitalism, human values and global justice in organs trafficking. Journal of Human Rights, 2, 197–226.CrossRef
37.
Segev, D. L., et al. (2010). Perioperative mortality and long-term survival following live kidney donation. Journal of the American Medical Association, 303, 959–966.CrossRefPubMed
38.
Taylor, J. S. (2005). Stakes and kidneys: Why markets in human body parts are morally imperative. Aldershot: Ashgate.
39.
Titmuss, R. M. (1970). The gift relationship: From human blood to social policy. London: George Allen and Unwin.
40.
Wilkinson, S. (2003). Bodies for sale: Ethics and exploitation in the human body trade. London: Routledge.
41.
42.
Zargooshi, J. (2001). Quality of life of Iranian kidney ‘donors’. Journal of Urology, 166, 1790–1799.CrossRefPubMed
43.
Zutlevics, T. L. (2001). Markets and the needy: Organ sales or aid? Journal of Applied Philosophy, 18, 297–301.CrossRefPubMed
Metadata
Title
Kidney Sales and the Analogy with Dangerous Employment
Author
Erik Malmqvist
Publication date
01-06-2015
Publisher
Springer US
Published in
Health Care Analysis / Issue 2/2015
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-013-0270-3

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