Abstract
Referring to Kant’s arguments addressing the moral relationship between our bodies and ourselves is quite common in contemporary debate about organ selling, although he does not provide us with any specific arguments related to this debate. It is widely argued that the most promising way to show the moral impermissibility of organ selling is to mount an argument on Kantian grounds. This paper asks whether it is possible to argue coherently against organ selling in a Kantian framework. It will be shown that by mounting the argument on Kantian grounds no compelling argument can be given against sale of organs, either because the arguments apply to donation of organs, too, or the arguments are not convincing for other independent reasons. In the first section, it will be argued that donation and selling are not distinguishable in a Kantian framework, since the concern about commodification of the body and its parts shall be raised by both actions. In the second section, some contemporary accounts inspired by Kant will be presented and discussed separately. It will be argued that the reasons for promoting organ donation while arguing against selling clash with each other in an unconvincing way.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Kant’s principles encompass the duties towards one’s own body, and hence the moral relationship between person’s bodies and their selves, while the persons are still alive. With regard to that, this paper keeps the focus on live donations and offering organs for sale while the donor is still alive.
Gerrand emphasized the duty of self-preservation with its link to Kant’s view of personhood, but a further clarification is needed.
Abbreviation for The Metaphysics of Morals by Immanuel Kant.
Abbreviation for Groundwork for The Metaphysics of Morals by Immanuel Kant.
Abbreviation for Lectures on Ethics by Immanuel Kant.
This point was also mentioned by Taylor in his book, Stakes and Kidneys (2005, pp. 154–155), to which I will refer again in the second section’s last part.
By the subject of morality, he refers to, for instance, the brain. Although parts of the brain necessary for one to be a rational being are distinguishable, they are not separable. Otherwise, one would lose capacities, such as consciousness, memory and cognitive capacities, which would sustain her personhood (p. 25).
It should be made clearer what well being encompasses. Although it might mean many things, here it refers to one’s quality of life.
It should be noted that it is not necessarily harmful if there is a proper post-treatment for the kidney donor (Geddes et al. 2008).
The argument referring to the duty of self-preservation, I think, is the most convincing argument, in order to present a more plausible Kant inspired approach to give away an organ, which I will refer to in the next sub-section in detail. However, here the authors do not make use of the argument in a convincing way, so I disagree. In the following, I will give my reasons for why I do not agree with the authors.
To donate an organ appears to be a purely altruistic act, however I wonder whether any act of donation or giving away an organ for the sake of someone else can be ‘purely’ altruistic. As Kishore states also (2005, p. 363), donation cannot be a pure altruistic act. When a person decides to donate an organ to one of her terminally ill relatives (this can also be the child or the parents of the donor), it is not devastating to think that the donor wants to do it to pursue her own happiness (to avoid loneliness and the thought of living without that dearest one), possible benefits (i.e. socio-psychological benefits) and outcomes (i.e. saving the life of the receiver).
This point was also made by Sandel (2012) in his book What Money Can’t Buy when he was mentioning the concerns raised by Titmuss (1970) about blood markets. Sandel points out that a market system would not prevent a person from donating her blood. However, he seems to agree with Titmuss that the market values would have an erosive effect on the norm of giving (pp. 123–124).
Humans are not exchangeable by something of equivalent value, but they have dignity. Since one’s body and herself constitutes the person herself, treating a body part as a commodity would lead to treatment of herself as a commodity which can be replaced by something which has a price or an equivalent value. Such treatment of a body part (for instance, selling an organ or a limb) would end in degrading a person (i.e. replacing a body part by money). That would mean denying a person’s moral worth and dignity, which would be immoral. However, Taylor states that Kant shows inconsistencies about which parts of the body constitute personhood (i.e. amputation and circumcision). In these cases, the person does not treat herself as if she was a thing and therefore giving away those body parts are allowable (pp. 149–150). “[S]ince [Kant] wrote that circumcision is ‘particularly’ acceptable if it is done to save the life of the person whose body part it is, it seems that in some cases of circumcision—that is, some instances of giving up a body part—would be acceptable ‘even if’ self-preservation were not the motive behind them” (p. 150). Hence, he argues, this arouses suspicion about the classes of body parts that are constituted by those that are ‘needed’ to be treated as things to protect personhood or the classes of body parts that are constituted by those that ‘can’ be treated as things without treating one’s self as a thing. In this sense, it is not obvious ‘when’ treating body parts as things is morally impermissible for Kant (i.e. when a body part constitute a part of personhood) (ibid.).
Since the body parts together with the self constitutes the person, they cannot be treated separately. However, it seems that Kant “allows that person[s] can treat their body parts as things if it is necessary for the preservation of their live[s]” (p. 153). Kant’s example of circumcision implies that it is not immoral to have a non-essential body part be treated as if it was a thing if it is done to save one’s life. Therefore, Taylor argues, any non-essential body part can be regarded as separately (ibid.).
In Kant’s moral philosophy, there are cases where intentions are relevant (MM 6: 423). Self-preservation, which is the only intention for the removal of diseased organs and parts, is relevant for our discussion. Removal of diseased organs is allowed in Kantian terms. Amputation cases present the relevancy of intentions and this works for self-preservation argument.
Here, one might argue that it seems implausible that Kant claimed the same thing for any sort of body part. That is, for instance, it is allowed to cut your hair only if it is done for the sake of self-preservation. However, I think, I made myself clear about this point in the first section. It is about whether it is given away for a discretionary end (i.e. for the sake of someone else, for making money out of it), which would mean to debase “humanity in one’s person” (MM 6:423). That is, the person would dispose of her body parts (therefore, herself) as a means (viz. to treat one’s self as if she was a thing having a price, which is relative to others’ interests and needs).
His main difference between body parts mentioned is about whether the tissue can regenerate itself after it is taken off. So, blood and marrow are also included in the third type of body part. According to his interpretation of Kant’s argument, one can “renounce the use of one of [one’s] organs”, but one cannot give them away, since then one cannot get it back (p. 96). However, with renewable tissues it is different. Since the person who donates blood, marrow or skin does not give away the organ producing them, they will be generated again in a short time. The person is just renouncing to use them for the time being. Therefore, the person’s freedom of choice will not be harmed, according to Merle. He also states that Kant would not permit transplantation of renewable tissues, but he endeavors to avoid over interpretation of self-maiming and partial suicide, of which he accuses Gerrand (1999).
Since the argument from “non-essential parts of the body” is already discussed in “the separable parts of the body” subsection, I will not go through it in detail again.
In the same line of reasoning, which is also mentioned in the first section, when an organ is donated, it is treated as if it were a thing, too. It does not seem to be plausible to argue in favor of donating an organ (i.e. kidney) ‘whilst’ arguing against selling it if one wants to mount her argument on a Kantian framework.
It might be argued that such cases include amputation or life-saving surgeries where one is harming one’s self but also preserving one’s self. However, taking into account that we are ‘not’ in a Kantian framework, extracting a healthy organ to give away is certainly a different case compared to amputation or life-saving surgeries. In amputation or life-saving surgeries an operation is made in order to save the life of the person, whereas in the other case, an intervention is done not directly to save the life of the person in question.
It does not mean that Kant grants dignity to a body part, but, as I argued, in Kant’s moral philosophy, there is a moral relationship between persons’ bodies and their selves. Neither the body nor its parts can be separated from the person for Kant. Thus, whatever is done to the body or its parts is done to the person herself. Hence, when one treats her own body part as if it was a thing by giving it away, she also treats herself, who carries dignity, as if she was a thing, although the body part does not carry dignity on its own. This would lead to a crime against one’s own humanity. It should be noted that the verb to ‘transform’ does not used interchangeably to mean to ‘convert’ into something. Thus, it does not mean that any substantial changes would occur in the person. However, it is used to emphasize a form of self-debasing.
References
Altman, M.C. 2011. Kant and applied ethics: The uses and limits of Kant’s practical philosophy. West Sussex: Wiley-Blackwell.
Budiani-Saberi, D.A., and F.L. Delmonico. 2008. Organ trafficking and transplant tourism: A commentary on the global realities. American Journal of Transplantation 8: 925–929.
Carpenter, C.B., E.L. Milford, and M.H. Sayegh. 2005. Transplantation in the treatment of renal failure. In Harrison’s principles of internal medicine, 16th ed, ed. D.L. Kasper, E. Braunwald, A.S. Fauci, S.L. Hauser, D.L. Longo, and J.L. Jameson, 1668–1674. New York: McGraw-Hill.
Cherry, M.J. 2005. Kidney for sale by owner: Human organs, transplantation, and the market. Washington, DC: Georgetown University Press.
Cohen, C.B. 1999. Selling bits and pieces of humans to make babies: The gift of the Magi revisited. Journal of Medicine and Philosophy 24(3): 288–306.
Cohen, C.B. 2002. Public policy and the sale of human organs. Kennedy Institute of Ethics Journal 12(1): 47–64.
Geddes, C.C., A. Henderson, P. Mackenzie, and S.C. Rodger. 2008. Outcome of patients from the west of Scotland travelling to Pakistan for living donor kidney transplants. Transplantation 86(8): 1143–1145.
Gerrand, N. 1999. The misuse of Kant in the debate about a market for human body parts. Journal of Applied Philosophy 16(1): 59–67.
Gill, M.B., and R.M. Sade. 2002. Paying for kidneys: The case against prohibition. Kennedy Institute of Ethics Journal 12(1): 17–45.
Goyal, M., R.L. Mehta, L.J. Schneiderman, and A.R. Sehgal. 2002. Economic and health consequences of selling a kidney in India. JAMA 288(13): 1589–1593.
Heubel, F., and N. Biller-Andorno. 2005. The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis. Medicine, Health Care and Philosophy 8: 5–18.
Kant, I. 1996. The metaphysics of morals, ed. M. Gregor (trans: Gregor, M.) New York: Cambridge University Press.
Kant, I. 1997. Lectures on ethics, ed. P. Heath, and J. B. Schneewind (trans: Heath, P.). New York: Cambridge University Press.
Kant, I. 2002. Groundwork for the metaphysics of morals, ed. Jr. T. E. Hill and A. Zweig (trans: Zweig, A.). New York: Oxford University Press.
Kishore, R.R. 2005. Human organs, scarcities, and sale: Morality revisited. Journal of Medical Ethics 31: 362–365.
Merle, J.C. 2000. A Kantian argument for a duty to donate one’s own organs: A reply to Nicole Gerrand. Journal of Applied Philosophy 17(1): 93–101.
Morelli, M. 1999. Commerce in organs: A Kantian critique. Journal of Social Philosophy 30(2): 315–324.
Munzer, S.R. 1993. Kant and property rights in body parts. Canadian Journal of Law and Jurisprudence 6(2): 319–341.
Naqvi, S.A.A., B. Ali, F. Mazhar, M.N. Zafar, and S.A.H. Rizvi. 2007. A socioeconomic survey of kidney vendors in Pakistan. European Society for Organ Transplantation 20: 934–939.
Örs, Y. 2011. Organ Aktariminin Temel Etik Yönleri. In Etik’in Anlami ve Anlamsizligi, ed. Z. Alpinar, 270–272. Ankara: Efil Yayinevi.
Phadke, K. D., and U. Anandh. 2002. Ethics of paid donation. Pediatric Nephrology(Berlin, Germany) 17: 309–311.
Rizvi, A.H.S., A.S.A. Naqvi, N.M. Zafar, and E. Ahmed. 2009. Regulated compensated donation in Pakistan and Iran. Current Opinion in Organ Transplantation 14(2): 124–128.
Sandel, M.J. 2012. What money can’t buy: The moral limits of markets. New York: Farrar, Straus and Giroux.
Scheper-Hughes, N. 2003. Keeping an Eye on the global traffic in human organs. Lancet 361: 1645–1648.
Taylor, J.S. 2005. Stakes and kidneys: Why markets in human body parts are morally imperative. Hampshire: Ashgate.
Titmuss, R. M. (1997). The gift relationship: From human blood to social policy, ed. A. Oakley and J. Ashton, 57–315. New York: The New Press.
Unna, Y. 2003. Kant’s answers to casuistical questions Concerning self-disembodiment. Kant-Studien, 94. Jahrg.: 454–473.
Wilkinson, S. 2003. Bodies for sale: Ethics and exploitation in the human body trade. New York: Routledge.
Zargooshi, J. 2001a. Iranian kidney donors: Motivations and relations with recipients. Journal of Urology 165(2): 386–392.
Zargooshi, J. 2001b. Quality of life of iranian kidney ‘donors’. Journal of Urology 166(5): 1790–1799.
Acknowledgments
I would like to express my gratitude to Hoger Baumann, PhD for his valuable comments and suggestions, which helped me to develop and structure this paper. I also would like to thank to Prof. Dr. med. Dr. Phil. Nikola Biller-Andorno and Prof. Dr. Peter Schaber, who have seen en earlier version of this paper and gave me substantial feedback. This research is a part of the project titled “Human Dignity and Autonomy—The Limits of Self-Ownership” that is supported by the University of Zurich Research Priority Program for Ethics (URPP for Ethics) and the Swiss National Science Foundation (SNSF).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alpinar-Şencan, Z. Reconsidering Kantian arguments against organ selling. Med Health Care and Philos 19, 21–31 (2016). https://doi.org/10.1007/s11019-015-9623-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-015-9623-z