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Beyond Fair Benefits: Reconsidering Exploitation Arguments Against Organ Markets

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Abstract

One common objection to establishing regulated live donor organ markets is that such markets would be exploitative. Perhaps surprisingly, exploitation arguments against organ markets have been widely rejected in the philosophical literature on the subject. It is often argued that concerns about exploitation should be addressed by increasing the price paid to organ sellers, not by banning the trade outright. I argue that this analysis rests on a particular conception of exploitation (which I refer to as ‘fair benefits’ exploitation), and outline two additional ways that the charge of exploitation can be understood (which I discuss in terms of ‘fair process’ exploitation and complicity in injustice). I argue that while increasing payments to organ sellers may mitigate or eliminate fair benefits exploitation, such measures will not necessarily address fair process exploitation or complicity in injustice. I further argue that each of these three forms of wrongdoing is relevant to the ethics of paid living organ donation, as well as the design of public policy more generally.

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Notes

  1. Notably, some ethical analyses of paid kidney do not argue that the trade is necessarily exploitative, yet nonetheless locate the wrongfulness of paid donation at least partly in the background conditions to the transaction [7, 16, 17, 36].

  2. In anticipating a similar objection to his own account of exploitation, Wertheimer has suggested that those who reject his definition of exploitation should treat his work as being about being some other concept—“mexploitation or shmexploitation or whatever” [44, p. ix] Wetheimer’s primary aim—and my own—is less about defining the concept of exploitation than about investigating “the moral character of certain sorts of transactions and relationships, whatever we want to call them” [44, p. x].

  3. Wertheimer intends the term ‘benefit’ to include any actions that further A’s purposes, goals or values [44, p. 210]. Others have suggested that it may be more accurate to say that A uses B to achieve A’s ends [18], or simply that A makes use of B [23].

  4. There is some ambiguity on this point. As Jansen and Wall point out, some of Wertheimer’s earlier comments on exploitation are consistent with what they call the ‘inclusive thesis’: that an unfair process and an unfair outcome are necessary and jointly sufficient for exploitation [18, p. 384]. My application of Wertheimer’s theory to markets in organs is ultimately compatible with either interpretation of Wertheimer’s theory.

  5. Although this paper focuses on Wertheimer’s account of exploitation, it is worth noting that there are other ways of defining a fair price. Angela Ballantyne, for example, suggests that in the context of international research, a fair transaction is better defined in terms of Rawls’s ‘maximin’ principle of distributive justice [1].

  6. This is not to say that a fair benefits account of exploitation entails that such transactions are necessarily unproblematic; they may be wrong, but not because they are exploitative.

  7. The extent of employers’ duties depends partly on the nature of the employment relationship; part-time employment and one-off employment relationships will tend to impose lesser demands on employers than full-time work [39, p. 397].

  8. Importantly, the inverse is also true; in contexts where political agents have fulfilled their political responsibilities (which on some views of social justice may already be the case in many countries), a market in organs would not be exploitative. I thank an anonymous reviewer for raising this point.

  9. While I follow Malmqvist in treating this as a distinct form of wrongdoing from exploitation, it is worth noting that others have discussed the wrongfulness of taking advantage of injustice in terms of exploitation [30, 37, 40, 41].

  10. Admittedly, ‘few’ does not necessarily mean ‘none’; as two anonymous reviewers pointed out, it is possible to imagine some people having a genuine preference for kidney selling because (for example) kidney selling provides immediate financial benefits and/or because they enjoy the sick role. While such transactions may raise moral concerns, these concerns are not necessarily connected to complicity in injustice.

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Correspondence to Julian J. Koplin.

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Koplin, J.J. Beyond Fair Benefits: Reconsidering Exploitation Arguments Against Organ Markets. Health Care Anal 26, 33–47 (2018). https://doi.org/10.1007/s10728-017-0340-z

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