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Does organ selling violate human dignity?

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A Commentary to this article was published on 07 December 2018

Abstract

Shortages in the number of donated organs after death and the growing number of end-stage organ failure patients on waiting lists call for looking at alternatives to increase the number of organs that could be used for transplantation purposes. One option that has led to a legal and ethical debate is to have regulated markets in human organs. Opponents of a market in human organs offer different arguments that are mostly founded on contingent factors that can be adjusted. However, some authors have asked the question whether we still have a reason to believe that there is something wrong with offering human organs for sale for transplantation purposes, even if the circumstances under which the practice takes place are improved. One prominent argument regarding this appeals to the notion of human dignity. It is argued that organ selling violates human dignity. This paper presents a systematic discussion of dignity-based arguments in the organ selling debate, and then develops a social account of dignity. It is argued that allowing the practice of organ selling inherently runs the risk of promoting the notion that some persons have less worth than others and that persons have a price, which is incompatible with dignity. The approach is defended against possible objections and it is shown that it can capture the notion that autonomy is linked to human dignity in important ways, while dignity at the same time can constrain the autonomous choices of persons with regards to certain practices.

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Notes

  1. For some studies supporting these concerns, please see: Zargooshi (2001), Cohen (2002), Goyal et al. (2002), Phadke and Anandh (2002), Scheper-Hughes (2003), Naqvi et al. (2007) and Budiani-Saberi and Delmonico (2008).

  2. Please see: Wilkinson and Garrard (1996), Wilkinson (2003), Cherry 2005, Taylor (2005), Daar (2006) and Radcliffe-Richards et al. (2006).

  3. The Metaphysics of Morals (1996).

  4. Groundwork for the Metaphysics of Morals (2002).

  5. Please see: Gill and Sade (2002), Cherry (2005) and Taylor (2005).

  6. Lectures on Ethics (1997).

  7. Here it might be argued that this position seems to be quite impossible, since, apparently, no such crime would occur by cutting one’s hair, which is also a body part. However, although cutting one’s hair does not appear to be morally impermissible, giving it away for some ‘discretionary end’ (that is, for the sake of someone else making use of it or making money out of it) is a blameworthy act (MM 6: 423). In that case, the person disposes of her body parts (and hence, herself) as a means (that is, treating herself as if she was a thing having a price, relative to others’ needs).

  8. Beyleveld and Brownsword (2004, pp. 25–27) mention the case of the French dwarfs when they discuss the differing implications of understanding dignity as an empowerment and dignity as a constraint. They state that the dwarfs that were being tossed expressed that they were willing to be tossed and it was not a degrading act, whereas the Conseil d’État affirmed that dignity was among the public values and although nobody intended to demean the dwarfs by throwing them, it was an undignified practice that was incompatible with respect for human dignity.

  9. We do not claim that the accounts that have been stated so far were not true at all. As mentioned earlier, there is not just one but many different approaches to dignity supporting opposing positions. However, adopting these accounts falls short for grounding the worry regarding the moral impermissibility of buying and selling human transplantable organs. The account presented here acknowledges that dignity is linked to autonomy in important ways, but is not limited to the ‘respect for one’s autonomy’ principle and can be argued to be a constraint on persons’ autonomy with regards to specific social practices.

  10. It should be noted that although referring to dignity as an unconditional and incomparable worth is influenced by Kant’s approach, Kant does not here consider the relations of people to each other. For him, as mentioned in the relevant section, it is the capacity to be rational which gives persons an incomparable worth (MM 6: 434–6: 435; G 4: 434–4: 436).

  11. This specific understanding of dignity that we are after is different from what is known in the literature as social dignity. Put briefly, compared to a social understanding of dignity, social dignity can be lost or gained and can be increased or decreased through the actions of the persons. Besides the qualities that the person attaches to herself, it can be created through interactions with others. It is quite subjective in the sense that one can describe a kind of behaviour, as being, in a certain sense, undignified although the action itself is not necessarily understood as leading to a violation of dignity. For a more detailed account of this type of dignity, please see: Gewirth (1992), George (1998), Nordenfelt (2004) and Jacobson (2007, 2009).

  12. It should be noted that it was Margalit (1998), who introduced this idea in his book The Decent Society, although his concern was more about how social institutions should not humiliate their citizens.

  13. Kerstein (2009) represents a social understanding of dignity. According to him, when acts ‘tend to encourage or promote this notion’, that is ‘the notion that he [a person selling a tooth or an intimate part of his body] himself—i.e. his humanity—or that of those like him was available for the right price for others to use as they will’, a violation of dignity occurs (ibid., p. 160).

  14. The account presented here might be claimed to be a “semiotic objection”, as put by Brennan and Jaworski (2015). They argue that if we do not have any substantial reasons (i.e. possible moral objections that are based on contingent factors, as mentioned earlier) to argue against having certain markets, which is mostly held by many to be immoral or disturbing as it is stated by them, then we have reasons to evaluate the usefulness of such markets in the light of the benefits they bring along. They rather state that we should better revise our semiotic codes about considering certain markets as immoral. However, the account we defend is exactly about this point. The specific understanding of dignity that is presented in this paper provides us with the reasons why the practice itself is mostly believed to be wrong independently of any external factors and the consequences of a fair market.

  15. It might be argued here that some jobs or practices, regardless of the external conditions, carry an inherent property of being degrading (Sandel 2012). According to Sandel, some acts are necessarily degrading and condemned even when practiced under fair background conditions. For instance, prostitution demeans the women and hence is a form of corruption (p. 112). In that sense, having organ markets presents a case in which a degrading view of the persons is promoted. However, it should be noted that the jobs that are referred to here do not carry necessarily such a degrading property. Hence, if the background conditions are improved, then working at such jobs does not cause any violations of dignity.

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Acknowledgements

We would like to thank Dr. iur. Roberto Andorno for his valuable comments and suggestions. This research is a part of the project entitled “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).

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Authors and Affiliations

  1. Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland

    Zümrüt Alpinar-Şencan & Nikola Biller-Andorno

  2. The Center for Ethics, University of Zurich, Zurich, Switzerland

    Holger Baumann

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  1. Zümrüt Alpinar-Şencan
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Correspondence to Zümrüt Alpinar-Şencan.

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Alpinar-Şencan, Z., Baumann, H. & Biller-Andorno, N. Does organ selling violate human dignity?. Monash Bioeth. Rev. 34, 189–205 (2017). https://doi.org/10.1007/s40592-017-0070-x

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