About 15,000 to 20,000 kidneys are sold on the organ black market each year. Impoverished people from China, India, Brazil and the Philippines are usually the major providers, but in recent years, Spaniards, Italians, Greeks, Russians, Serbians and other Europeans have entered the market as sellers. The Internet has encouraged the practice, and European advertisements now appear for kidneys, lungs, bone marrow, corneas, hair, sperm and breast milk. Prices are high, often around $40,000 for a kidney and $250,000 for lungs. The practice continues because both sellers and buyers are desperate. The rich buyers will do anything to get the organ they need to survive, and the impoverished need the money. Sometimes, the impoverished voluntarily advertise for the sale of their organs, while other times, criminal groups facilitate organ trafficking, thereby preying on both the vulnerable buyers and sellers. Organ trafficking results in opportunities for the rich and powerful to receive transplants before others in need. It also can easily result in the exploitation of the impoverished around the world. These both present pressing ethical issues.
However, the impoverished sometimes feel that this is an opportunity for them. They would rather sell a kidney than be unable to feed and educate their children. One Serbian man who was advertising to sell his kidney noted, “It’s my body, and I should be able to do what I want with it.” Taking his argument into consideration causes me some hesitation; how can we mandate what this man can and cannot do with his own body, if the procedure will not cause harm to anyone else, and he accepts the risk of harm? How can we both deny him the right to do what he wants with his body and to take action to give his children a good life? When considering the ethics of the situation as they relate to the sellers of these organs, I think that the impoverished have a point that they have rights in regards to their own bodies and that selling their organs does, in some way, provide them with an opportunity. However, this does not mean that we should simply sit back and allow this practice to occur. There exists a similar responsibility in this situation as in the case of subjects for clinical trials. The impoverished might want to be subjects in clinical trials or want to sell their organs because they could make money to meet their basic needs. As a result, they might resent legislation and actions that disallow their participation in these activities. Nonetheless, it has been well established in ethical codes of conduct that we must make sure that the impoverished are not over-represented as subjects in clinical trials, because that would be exploiting their financial need. Overall, society has a responsibility to make sure that the impoverished are not forced to jeopardize their health to survive. Directly banning their participation in clinical trials or the organ black market does not necessarily help them though, since it both mandates what they can and cannot do with their bodies and denies them one of the last opportunities they have to meet their basic needs. Thus, helping those who advertise to sell their organs on the black market does not involve directly preventing them from doing so. Instead, it involves finding ways to remove their desperation and their incentive for wanting to enter the market in the first place. It means making sure there are programs that help the truly desperate so that they are not forced into theses activities in the first place. It also involves making sure that the impoverished that do not want to enter the organ black market are not coerced into doing so by criminal groups.
However, the impoverished sometimes feel that this is an opportunity for them. They would rather sell a kidney than be unable to feed and educate their children. One Serbian man who was advertising to sell his kidney noted, “It’s my body, and I should be able to do what I want with it.” Taking his argument into consideration causes me some hesitation; how can we mandate what this man can and cannot do with his own body, if the procedure will not cause harm to anyone else, and he accepts the risk of harm? How can we both deny him the right to do what he wants with his body and to take action to give his children a good life? When considering the ethics of the situation as they relate to the sellers of these organs, I think that the impoverished have a point that they have rights in regards to their own bodies and that selling their organs does, in some way, provide them with an opportunity. However, this does not mean that we should simply sit back and allow this practice to occur. There exists a similar responsibility in this situation as in the case of subjects for clinical trials. The impoverished might want to be subjects in clinical trials or want to sell their organs because they could make money to meet their basic needs. As a result, they might resent legislation and actions that disallow their participation in these activities. Nonetheless, it has been well established in ethical codes of conduct that we must make sure that the impoverished are not over-represented as subjects in clinical trials, because that would be exploiting their financial need. Overall, society has a responsibility to make sure that the impoverished are not forced to jeopardize their health to survive. Directly banning their participation in clinical trials or the organ black market does not necessarily help them though, since it both mandates what they can and cannot do with their bodies and denies them one of the last opportunities they have to meet their basic needs. Thus, helping those who advertise to sell their organs on the black market does not involve directly preventing them from doing so. Instead, it involves finding ways to remove their desperation and their incentive for wanting to enter the market in the first place. It means making sure there are programs that help the truly desperate so that they are not forced into theses activities in the first place. It also involves making sure that the impoverished that do not want to enter the organ black market are not coerced into doing so by criminal groups.
Looking at this problem from the buyers’ side presents even more ethical issues. It is not fair that the rich and powerful in need of organ transplants have a better chance of getting an organ and surviving than the poor. Thus, from this side, banning an organ black market makes sense. However, the major solution to dealing with this issue involves trying to increase the supply of organs. For example, a country could work to promote a sense that being an organ donor is the “normal” thing/the default option on a driver’s license, for example.
Thus, the main solutions to the organ black market involve finding better ways to make sure the impoverished are not forced into these activities and finding ethical ways to increase the legal organ supply.
1 comment:
The notion of worldwide solidarity for a common good is a beautiful thing to image, and it’s hard to argue against pushing for a realization of this dream. In this spirit, I eagerly agree with your proposals for removing much of what we perceive as the impetus for selling one’s own organs. To add to your list of protections for the vulnerable, I suggest a major campaign to spread public awareness about the risks of organ removal. In general, knowledge of basic medical truths and options is sorely lacking in this world and a stain on the record of the moderns. But anyway, this proverbial bi-bird killing stone would ease our conscience regarding the possibility of ignorance exploited by removing that ignorance, while also stepping out of the decisions of the poor and letting them act as they will now that they have the knowledge that we do.
We do have to face the reality of most humanitarian pushes: that it will not happen instantly. And so, returning to the realm of bioethics, we are left with the same question: do we allow the weak to sell themselves? As we consider this question, we have to carefully parse our use of key words like “exploitation.” In ethics, there is an intuitive feeling that exploitation is wrong, especially when applied to the impoverished. Unlike Luke, though, we cannot always trust our instincts. Is exploitation really always wrong? Consider the framework that capitalism yields. In such a model, exploitation can actually be critical; I exploit you, you exploit me, we’re a happy family. One company can exploit another to get certain optimal prices on materials, all the while that second company benefiting. In the same way, the members of our capitalist society in lower economic strata must be allowed this freedom to weigh pros and cons for themselves. The fact that others benefit, selfishly and greedily, from the choices of the poor does not mean that the poor do not also themselves benefit through the transaction. Offering them reliable information to balance their decision doesn’t infringe on this freedom, and I would posit that it is our moral duty to do so. At the same time, we have a duty as proponents of a free society to let everyone play by the same rules of the same game, all the time. If we’re not ready to embrace this kind of society, we should take full responsibility for the outcome of the poor. And I don’t think anybody wants that.
Lastly, concerning those on the other side of the spectrum, those awaiting organ transplants: the idea of the rich automatically receiving organs before the poor by virtue of their buying power comes across as unfair, certainly. In pragmatic terms, though, for everyone waiting for an organ, even for the economically lower classes, the black market is desirable. As you yourself said, it is crucial that we “increase the supply of organs,” and the black market does this. The rich buy organs and get well (or as is often the case, avoid death) faster, but they also remove themselves from the organ waiting lists, which is invaluable to anyone below them on that list. While it may strike the poor who are confined to the list as unfair, the fact remains that they will reach the top faster. Any supply of organs is a good supply, as far as they are concerned.
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