Ethical Markets?

 

After having examined the relevant literature, discuss the relevant ethical issues with regards to the creation of a market either for the sale and supply of human organs.

Introduction:

The ever increasing demand has resulted in the unlawful trafficking and sale of human kidneys. Despite the best efforts of national and international authorities to curtail the human organ market they have thus far been unable to eradicate illegal practice. The shortage of available organs is a global feature of organ transplantation and has been a challenge almost since the inception of organ transplants. As long as abject poverty exists than exploitation will take place wheater it is the manufacturing, clothing, labour industries, or indeed the human organ market. The issues around any potential life saving apparatus, regardless of its form are always bound to raise considerable ethical and practical questions. Negotiating attainable solutions to these problems are complicated by religious, cultural and economic hurdles. The following discussion orbits around the ethical matters emerging from the suggestion “to create a market for the sale and supply of human organs”.

 Rights of deceased:

In cases where kidneys of recently deceased family members are objecting to the donation the donor’s wishes should be upheld provided that he/she was of sound mind when signing. The recently deceased has rights, and actions of family members have no right to change the wishes of a person who is not. However this raises further ethical questions. When one’s actions affect another’s, where do you draw the line. The deceased family’s members may be extremely upset about the possible degradation of the body. The deceased will not be affected in any way by the refusal to carry out his/her wishes. As the deceased will not be affected it is then possible to argue that he/she is committing a selfish and therefore unethical act. However one posits that motivations and ignorance are deciding factors in deciding whether an action is ethical or otherwise. Using this case as an example, if the deceased was unaware of his family members objections then he/she should be cleared of any unethical wrong doing. Opposing this, if the now deceased person was aware of the upset his actions would cause but chose to continue anyway as he was motivated to help others i.e. he was choosing the greater good. However no one is omnipotent and the deceased has taken it upon himself to decide which need is greatest. Nevertheless upon nearing death everybody is forced to make a decision either actively or passively. Upon death the issue of ownership is questionable even by law, nevertheless the problem surrounding personal choice remains the real ethical quandary.

 Arguments for:

Kishore asks how do we decide is what is good and what is bad. How are we to measure the moral content of a particular act, he proposes that morality is always contextual. According to Kischore the “act of donation is irrevocably affected by considerations of personal relationships, choice, and preference” (Kishore,363). In other words the donation is not a candid act of altruism; rather it is motivated by the desire to save the life of a near and dear one, which may, at times, be for personal gain e.g. to secure one’s own comfort and future. Kishore posits that even the act of anonymous donation is influenced by personal motivations e.g. guilt.  Therefore as no donation is made for wholly altruistic impetus the creation of a monetary market is just a commercialization of an already existing intangible market. Arguments exist which posit that it is not the wealthy man’s “fault” that he is wealthy, or that other men did not use their intelligence to produce great value. Likewise, one cannot claim that the “organ was bought by the wealthy man at the expense of those who are not wealthy” (Kishore,365). He did not buy the organ at the expense of anyone; he bought it for his own benefit, and to that of the seller. This argument is rather simplistic and ignores the simple fact that organs are not simply commodities like computers. Unlike commercial products where the supply can be shifted in line with demand human kidneys are a rare resource. In the article “Human organ transplantation: economic and legal issues” Walter Block and Co. point out that there are over twenty-five different organs and tissues that can be transplanted under current technology with success rates for such surgeries are as high as 95+%; the amount of resources available in a human body is amazing; but yet, ten people die every day in the U.S. while waiting for an organ transplant that never comes. The queue grows each day, but the number of organ donors does not”. Walter Block and Co are adamant that a free market for the sale and supply of organs be created. Using a metaphor they relate the process of buying an organ to that of purchasing an automobile , arguing that Under the market system, the wealthy will have first call on organs. Using the automobile analogy they argue that “those at the bottom of the U.S. income distribution have more and better access to automobiles than even the middle class of most nations. Under markets vastly enhanced supplies will be forthcoming given economic incentives. No patient at any income level will be consigned to death for lack of human tissue”.

Arguments Against:

Walter Block and Co’s argument which uses the automobile analogy is a rather crude and offensive as it is based on a completely different commodity. Cars can be bought and sold second hand, and this is one of the main reasons which enable the financially less well off people to afford cars. Organs cannot be bought, sold and transplanted multiple times. Nevertheless Kishore have a reasonable argument to suggest that the introduction of a market system will discourage body snatchers (Kishore,363). The greater the potential profit to be made on the black market for selling of organs it is far more lily that criminals will engage in body part snatching.  While this is true to a certain extent it ignores the fact that the vast majority of organ snatching is done by those who are already in or associated with criminal gangs. If one is to look at the history of such gangs a clear pattern emerges. In their early days they made vast money from racketeering and theft, went into distribution of alcohol during prohibition, and in the late 80’s to 90’s the business of the importation of illegal drugs. I argue that a market may stem the flow of illegal body snatching it will not result in the breakdown of criminal organizations, as they will find a new market to inflict further pain and misery on society.

Some argue that the selling of organs would put transplants out of reach for many

and allow the rich to outbid all others. If a market was created it may encourage the more wealthy to act irresponsibly. There are countless examples of famous sports stars such as Paul Gascoigne who used and abused donated livers which he received. If he did not enjoy the same status of being a former English footballer it is highly unlikely that he would have ever been eligible for a liver transplant due to his drug and alcohol addictions. In many cases wealthy and especially wealthy people are using their power to move up the que, causing pain and insult on many individuals who know that they have very little hope, despite following the rules and  living a healthy lifestyle. The creation a market for any organs would be vulnerable to even further corruption & distortion. Currently the guidelines state that the person who most likely to properly take care of the organ and gain the most value from it should receive it. The rich would simply be able to receive organs without the proper vetting with regards to aftercare and responsibility.

Vulnerability of the poor:

Under the market system, the wealthy would rule. In the U.S those who come from poorer backgrounds suffer from not being able to afford the basic medical treatments. While in Ireland healthcare is free, but those who can afford medical cover receive a far better standard of care than those who opt to go public. A patient who is using e.g. VHI has to wait only a matter of weeks for a scan while a member of the public could be waiting for the same scan for anything up to a year. By getting that scan much earlier the private healthcare patient already stands to have a far greater chance of survival as the problem can be identified much sooner.  Medical treatment already vastly favors the wealthy. The introduction of a free market system would further skew the healthcare system towards the wealthy putting increasing pressures on family’s to buy already expensive health insurance.

 Vulnerability of sick:

There are several arguments which would oppose the sale of organs on legal, ethical and practical considerations. Many of these arguments have made much of the exploitation of potential donors who may come from an economically disadvantaged areas, one must also consider the vulnerability of the person who requires an organ. The sale and supply of organs is not simply a two part transaction. In almost all cases the organ is sold to a dealer who in turns sells to the highest bidder. In this sales model both the donor and the recipient of the organ are in danger of being exploited. The person in need of the organ may be terminal and offered hope by an organ dealer may be willing to sacrifice anything. The intrusion of and third party other than a National Health Service procurement agency is bound to facilitate corruption. Any individual who faces death for want of an organ is an extremely vulnerable position; to what lengths would these individuals go in order to save their own lives. Perhaps the consequences from these potential actions would be far worse for society as a whole.

 Repercussions of creating market:

With regard to the concern that once organ sale is legitimized organs will mainly be sold to those who can afford to buy them, no person should be given preferential treatment because of personal wealth. The creation of a competitive market for human organs may establish a culture of non donation, as potential donors may choose to sell rather than undertaking a wholly altruistic act. Medical concerns such as; age, expected quality of life, personal profile e.g. (alcoholism, drug addict etc) would become less and less important, and vital organs may be wasted. While there are arguments for and against a market one thing is certain; that is health insurers arguably stand to gain the most from such an initiative. I think it is fair to note that the creation of a free market would drive up health insurance prices as the companies would look to cover themselves from the extra claims which they would expect if the number of transplant operations was to increase dramatically.

Conclusion:

In order to come to a comprehensive ethical conclusion one must first decide on what ethical framework that one wishes to adhere to. If one chooses to adopt a kantinistic utilitarian, motivational or a consequential theory that will in turn form their ethical values. Given the sheer seize and scale of the problems it is impossible to come to a solution which is accepted by all parties. The creation of a market for the sale and supply of organs remains a complex issue; each individual will have to retain the right to chose his her own viewpoint as the probability of an accepted resolution remains unattainable for the foreseeable future. However human nature is to survive, it is interesting to note people’s changing viewpoints when placed in different settings. While personal moral beliefs should be allowed to change, they should not do so out of necessity, but rather serious examination of the issues. Currently I believe that the creation of a market to buy and sell human organs is totally immoral, however placed in a situation whereby I faced certain death, I am ashamed to say that I without question would do anything and everything in order to stay alive, and that includes purchasing an organ. However morality doesn’t change just people acceptance and perception levels.

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