by publius
I missed the latest round of the “should we sell our kidneys” debate. To recap, various libertarian conservatives say yes, arguing that the donors’ health risks are small and that people really need kidneys. The real challenge then, as John Schwenkler notes, is to justify the ban on kidney selling.
So I’ll try. I’m not sure I can justify the actual ban – I lack the philosophical chops. But I can get in the neighborhood, and maybe someone in the comments can punch it over the goal line.
The kidney debate interests me because it touches upon a much deeper and fundamental philosophical divide between modern progressives and conservatives (particularly libertarians). The divide turns on one’s view of markets and, more precisely, freedom. This divide, I think, is the original source of disagreement on several issues, particularly health coverage reform and labor law.
Modern libertarians subscribe to the old classic liberal worldview. Under this view, there is a heavy emphasis on individual freedom. Markets free from government intervention are good because they allow people to freely exchange goods, enter contracts, and generally do what they want – which has numerous benefits (efficient allocations, etc.). The underlying assumption is that people can indeed act freely within this system.
One of the main critiques, however, of (classical) liberalism is that this underlying assumption is unrealistic, or even fraudulent. It’s absurd, the argument goes, to treat people as being "free" within markets – to assume they are islands of self-contained free will exercising their rights equally.
The truth, critics argue, is that “free” markets obscure vast disparities in wealth, power, information, bargaining position, etc. In this sense, the assumption of “freedom” is a helpful ideology, but not one that accurately describes the relative power of contracting parties.
Here’s an example. Let’s say Wal-Mart decides to start offering people $5,000 per finger. (Let’s assume scientists have found a chemical in finger bones that helps break unions). Under the liberal view, everyone is “free” to take that offer or to decline it.
But this “freedom” isn’t all it’s cracked up to be. From an opportunity cost perspective, Wal-Mart’s offer exerts more force on someone with a salary of $25,000, than it does on someone who makes $100,000. The former is essentially throwing away 20% of their yearly salary, while the latter is throwing away 5%. Both individuals are “free” – but the lower income makes the offer harder to refuse for the $25K person. It exerts more force on that person. To say, then, that these two people are both “free” misses an important difference between them.
Of course, you can take this logic to some dangerous and absurd extremes. You could, for instance, argue that Big Macs should be priced according to one’s income, or that various types of markets (e.g., house cleaning) should be prohibited. But these are not things I want government to do. I believe in markets, not necessarily because I completely buy the idea of “freedom,” but because I am skeptical that the government is competent to address these problems through central planning, extreme redistribution, etc. The remedies are often worse than the problems.
But that said, there are areas where we need to draw the line on markets. Just as liberalism’s goal was to carve out a realm of freedom from the state, it’s also important to carve out realms of freedom from coercive market logic.
Market failures are a different issue. I’m sure a market for kidneys would work pretty well. I’m just not sure I want market logic – which is necessarily coercive on some more than others – to intrude into the realm of body parts, or selling children.
At the end of the day, I’m not sure any of this is helpful. I’ve basically said “there should be a line,” but I haven’t established whether kidney selling crosses that line. Maybe someone else can. But this hopefully at least explains where some liberals are coming from – not just on this issue, but on a whole host of political issues.
The skepticism that everyone is free under classic liberalism is one of the foundational assumptions that leads me to root viscerally (often too viscerally) for progressive policies. It also makes me relatively more inclined to favor regulation in certain contexts.
At the end of the day, I guess I feel similarly to Kevin Drum – it’s not so much kidneys that bother me. It’s that I can easily imagine this logic spreading to things like eyes, or even children. I can’t quite justify it, but the inherent coercion on poorer people seems like a bigger deal when we start trying to commodify body parts. If only we had a real philosopher who blogged here….
Two comparisons, before I get up and get busy, to show that "one size fits all" needn't apply:
We restrict "loan sharking", loans at very high interest, because a person at need entering into such nightmare loans is crippling himself or herself to a degree we find excessive. But we do let people get loans. People take risks for money or for other reasons. It is not obvious that the iatrogenic/medical-error risks of the surgery, or the evidently quite small risk incurred by losing one kidney, puts a kidney sale out of the scale of risks that we should accept that people take.
The question of selling a hand would be a different question: no matter how good a mechanical replacement (and would you get one?), you would be giving up the use of one hand. This would be a downside-taking, literally a crippling one, that we might decide was too much, along the lines of not letting a person go to a loan shark. The loss of one's second kidney doesn't entail this sort of curtailment of options.
Posted by: Alex Russell | August 06, 2009 at 11:02 AM
"russell - Actually we are meat. Or we are souls that live in meat, depending."
Yes, that's true. But as I see it, the "depending" part means that we should not treat each other as meat.
Your comments on the distinction between selling a kidney and selling yourself into chattel slavery are apt, however I note that they're less relevant to, frex, selling yourself into indentured servitude, which is something we no longer tolerate.
Allow me to also say that I appreciate your point of view here:
"For offending "the way the world should be", in my feeling or yours - and not having hurt anyone or violated anyone's rights - purely for outraging me or you - a person deserves not. One. Day. In. Jail."
You're quite right to note that the basis for my objection to selling organs is rooted in my understanding of the proper moral relationship between humans. You're also quite right to note that not everyone will share that.
My language in this thread has been somewhat strident. To some degree, that's a liberty I've granted myself -- a self-indulgence if you will -- because I know that my words will have absolutely zero chance of affecting actual public policy. We're all just talking around the water cooler here, and that gives us, perhaps, some room to vent.
My language is also, deliberately, strong because, to be honest, I hadn't really seen the basic moral quandary of organ selling discussed, and IMO it's a pretty important part aspect of the debate. The conversation seemed to center on either a pragmatic calculus -- a risk/benefit analysis -- of what the seller might get out of it, or a libertarian argument that selling your own bodily organs should be considered simply another form of contract between consenting people.
Both of those arguments fail, IMVHO, to account for the brutal and dehumanizing aspect of selling yourself off by the pound to the highest bidder.
I'll go perhaps one step further afield in the interest of trying to explain where I'm coming from.
To me, the most toxic aspect of American culture now is the tendency to view all social interactions as various forms of commercial contract. We live in a society whose most urgent social impulse is to monetize everything that isn't nailed down, and even most of what is nailed down.
Our goal as a nation appears to be to turn the entire freaking given world into money.
The end result of this will, IMVHO, inevitably be a brutal, cruel, and callous culture. IMVHO, we're already there.
Selling your bodily organs just seems like another species of this, to me.
I appreciate your objection to having public life governed by the whims of what some folks find personally offensive. I recognize that my argument is open to that interpretation.
What I'll say is that we all do, or at least ought to, draw the line somewhere.
Selling your organs for money falls on the other side, from my point of view.
Fortunately for us all, my influence on public policy is negligible.
Thanks -
Posted by: russell | August 06, 2009 at 11:11 AM
"Maybe not structurally different, but so what? They're different in that one can be justified for maintaining military order necessary for defending the country and the other can't."
So the means are okay as long as the ends are justifiable - which you say they are in this case. You don't have a problem with selling yourself, just that it has to be for the 'right reason'. The 'right reason' in this case is that there is a human being dieing whose life this transaction could save.
The Right to Private Contract gets trotted out to justify all manner of ugliness.
"Ugliness" is apparently anything which produces an end you do not agree with but whose means you admittedly have no problem with, as in the case of military contract.
These mere concerns for the well-being of our fellow man cannot stand in the face of the All-Mighty Contract!
Your fellow man has his own set of concerns that are subjective to him. He seeks only to better himself by signing the contract.
You know, it was all so obvious all along. Why didn't anyone consider that selling your kidney was a type of Contract? It's okay! It's a Contract! ...See?
The paper merely represents the intentions of the signers. I'm not sure everyone IS considering the intentions of the donor. If you were, you'd let him express it with his signature rather than substituting your preferences for his.
Posted by: I_am_a_lead_pencil | August 06, 2009 at 11:19 AM
The difference is that the long term harm of slavery is demonstrable, while the long term harm of selling your kidney is not (or at least has not been demonstrated).
Posted by: Sebastian | August 06, 2009 at 11:29 AM
Surely, in my view, that - whether the activity is actually bad for you, or is actually destructive to one's interests if one engages in it, and how much it is - is the defining thing as to whether the activity should be called exploitative or exploitation. Begging the question of that, and saying it's supposedly a matter of worship of almighty Contract excusing exploitation, seems to me to tack away from the center question, which I don't think is really branded.
I agree, Alex. I was responding to an argument that seemed to turn on "worship of almighty Contract excusing exploitation." And it was not yours.
The 'right reason' in this case is that there is a human being dieing whose life this transaction could save.
That's certainly a valid argument, but not one that I recalled you explicitly making, my good pencil. If I missed that, my apologies.
"Ugliness" is apparently anything which produces an end you do not agree with but whose means you admittedly have no problem with, as in the case of military contract.
Okay. How about "unnecesary ugliness?" There is some amount of ugliness that goes along with military service. But without it, we have no defense of state. Without a state, we have no state defense of person or property. It's an imperfect world, I know. That doesn't justify all ugliness, but it does some.
Your fellow man has his own set of concerns that are subjective to him. He seeks only to better himself by signing the contract.
That's nice. Sometimes people are exploited, and other people would like to prevent that. Just show that there isn't a potential for a level of exploitation that would justify a ban. Maybe there isn't. I don't claim to know for sure.
The paper merely represents the intentions of the signers. I'm not sure everyone IS considering the intentions of the donor. If you were, you'd let him express it with his signature rather than substituting your preferences for his.
People, by way of law, prevent others from doing damage to themselves for various reasons. Sometimes it's because of the potential for exploitation due to an imbalance of information or resources that can't otherwise be compensated for. I think that's okay. Maybe it's not necessary in this case, but I don't have a problem with it as a matter of general principle.
Posted by: hairshirthedonist | August 06, 2009 at 01:05 PM
Is that lights out, then?
That was good talk, anyway.
Posted by: Alex Russell | August 07, 2009 at 11:11 AM
Less radical then either mandatory organ collection from the deceased or the creation of an organ market would be to switch driver license sign-up as an organ donor from optional to the default.
As effort thresholds tend to do, this should greatly increase participation & hence organ availability while allowing opting out for whatever personal reasoning applies.
That it also avoids the unattended consequences of establishing another humans-as-means market should appeal to the Burkeans in the audience.
Posted by: BFSCR | August 11, 2009 at 03:02 AM
"Less radical then either mandatory organ collection from the deceased or the creation of an organ market would be to switch driver license sign-up as an organ donor from optional to the default."
And it's almost as if this has been mentioned various times before in this thread.
Posted by: Gary Farber | August 11, 2009 at 03:20 AM
The difference is that the long term harm of slavery is demonstrable, while the long term harm of selling your kidney is not (or at least has not been demonstrated).
You'd better coordinate messaging with the other conservatives out there. The argument now is that being sold into slavery and transported to America rescued black people from generations of misery in Africa, and that over the long run they were better off.
Posted by: Phil | August 11, 2009 at 06:19 AM