Unethical 'Ethicists'

by Don Boudreaux on May 15, 2006

in Health

Richard Epstein argues, in today’s Wall Street Journal, for greater reliance upon markets to supply human kidneys for transplant.  He’s especially effective at exposing unethical "biomedical ethicists" who, as Epstein rightly says, "have convinced themselves that their aesthetic sensibilities and
instinctive revulsion should trump any humane efforts to save lives."

Some of the best work on this important issue is done by my GMU colleague, law professor Lloyd Cohen.  Other good research is by William Barnett, Michael Saliba, and Deborah Walker here, and by David Kaserman and my former professor Andy Barnett.  My own modest contribution, co-authored with Adam Pritchard, is here.

It bears repeating: A person who endorses a policy of blocking voluntary exchanges that save lives just so that person doesn’t have to suffer qualms knowing that such exchanges take place is, shall we say, morally questionable.  In fact, just knowing that such people and their narrowly self-centered preferences exist gives me the willies, qualms-cubed.  Perhaps my personal qualms about the very existence of such people — my qualms about the existence of such ugly, greedy, and lethal preferences and their manifestations (i.e., unnecessary deaths) — is reason enough for me to call upon government to stifle expressions of their thoughts.

Of course, I don’t believe that government should stifle the thoughts and expressions of anyone.  But if the need to protect Sam’s aesthetic sensibilities is used to justify preventing Bill and Mary from engaging in voluntary exchange that saves Bill’s life, on what principle would Sam stand to demand that my own qualms about his ugly and arrogant behavior not be used to justify my petitiioning government to shut him up — to put an end to his unseemliness?

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Christopher Meisenzahl May 15, 2006 at 6:35 am

All good points as usual, thanks Dr. Boudreaux .

Mr. Econotarian May 15, 2006 at 12:05 pm

In Hippocrates "Epidemics", he wrote, "As to diseases, make a habit of two thingsā€”to help, or at least to do no harm."

Killing people through the regulation of market of organs is not "doing no harm."

Noah Yetter May 15, 2006 at 12:18 pm

"…on what principle…"

That would be Mob Rule… er, Democracy.

Jeremy May 15, 2006 at 1:29 pm

I actually wrote a paper back in college about this very subject (who knows where it is now) but I do remember writing it and arguing for an incentive/market for organs. I think I might have even cited one of those papers.

Trumpit May 15, 2006 at 2:47 pm

What is so voluntary about poverty striken individuals selling their kidneys or eyeballs out of sheer desperation? If the rich person donated his or her kidney or eye to the dying poor man, I'd be extremely impressed. Rich people rarely do that because they're not desperate or fools.

I think you set the record for the number of times the word 'qualms' has been used in a paragraph. Shouldn't one have qualms about such stark inequities in the world? I have major qualms about people who have no qualms about that. Now, I have to qualm myself down now or I'll qualm apart at the seems. In that case, all my vital organs will be up for grabs to all qualmers!

happyjuggler0 May 15, 2006 at 3:46 pm

If the rich person donated his or her kidney or eye to the dying poor man, I'd be extremely impressed.

Two points. First, no one is suggesting maiming anyone living by having them sell an eye or something like that. We all have two kidneys, we need only one.

Second, I agree with you that it is highly unlikely that someone rich would give up a kidney to help someone he does not know. The same is true about a middle class or poor person giving up a kidney for someone they don't know. This is why thousands die each year for lack of a kidney donor.

If you can reduce the number of deaths by cancer by 10%, or 20% or 50% or 80% or 100% per year, would you do so? Of course you would. So hy not the same percentages with death by kidney failure? Because more poor people would be selling their spare kidney than people with more money? Seems like a good deal for someone who otherwise remains poor. Also seems like a good deal for those who receive kidneys.

The only unethical part of a for-profit kidney market is the fact that it does not exist because it is "unseemly". Why should even one person die needlessly because of something you find unseemly?

Trumpit May 15, 2006 at 4:24 pm

Let's get down to brass tacks. When are you going to donate/sell your kidney? You only need one, you know. I didn't think so. Go back to your juggling.

happyjuggler0 May 15, 2006 at 4:43 pm

Let's get down to brass tacks. When are you going to donate/sell your kidney? You only need one, you know. I didn't think so. Go back to your juggling.

What is the point of that post may I ask? If I had to guess, you are assuming I am not poor, and therefore under a system where you are allowed to sell a kidney I would not be selling my spare kidney.

Even if true, so what? The point I am trying to make is that under a market system for kidneys, we might not have any kidney deaths at all, while we definitely have a large number of them each year now. Or maybe we only reduce that number by 50%, or 20% more than now. Same point applies.

I suspect your point boils down to: "But who cares if we can end a certain type of death if the way we end it doesn't burden the rich more than others?"

Am I close?

Trumpit May 15, 2006 at 5:49 pm

We could save just a many lives if generous, life-saving people like you were to rush out tommorrow to donate (okay, sell, if you must make a buck) your kidney to a very sick person in dire need of a healthy kidney. So you won't voluntarily contract to do that? Does it give you qualms? I guess you're not the life-saving, qualm-free person that I thought you were.

Lisa Casanova May 15, 2006 at 6:57 pm

We could save just as many lives if you donated all your income to starving people in the third world. What does that have to do with anything? I might sell my kidney or give it away if the circumstances were right. Why shouldn't anyone else do the same?

RWP May 15, 2006 at 11:46 pm

I need funds for grad school any takers?

Jon Trenchard May 16, 2006 at 1:06 am

I can sympathize with concerns over live-donors being paid, but the mere fact that richer people aren't willing to sell THEIR organs is irrelevant. Imagine substituting something else for organ donation:

"Scrubbing toilets is such dirty, unpleasant work, that only the very poor are willing to do it for money. Therefore, I propose that we make it illegal to pay people to scrub toilets. We should only allow volunteers to scrub toilets."

"But aren't you virtually ensuring that toilets will go largely unscrubbed?"

"Are YOU willing to scrub toilets?! If YOU aren't willing to do it then you don't have the moral authority to say that poor people should be paid to do it."

Obviously we would recognize that argument as absurd. My concern with paid live-donors (who will tend to be poor) is that they may become a burden on public health services later in life and end up having tax-payers reimbursing them for a risk they voluntarily chose to take. Of course, in the presence tax-financed health services, this argument could be used to justify the regulation of any risky behavior, so perhaps it's more of an argument against the state as a health provider than against paid live organ donation.

One thing that everyone SHOULD be able to agree on it that people should be allowed to arrange for their organs to be sold AFTER death (with the money going to their estate). In that scenario you don't have to worry about undue influence or future burdens on taxpayers. I'll bet a lot more people would sign up to be organ donors if they knew it would mean $20,000 (or whatever) for their families after they died.

Trumpit May 16, 2006 at 3:20 am

I purchased a million dollar office building once and the first thing I did as the new owner was to unstop a toilet (the previous owner kindly handed me a plunger). You're comparing that unpleasantness to giving away a major body part. So I don't get your analogy at all. One shouldn't be in the unlucky position of having to sell a body part to survive. Just to say, "let the free market solve the problem," creates the offensive problem of desperate people mutilating themselves. Also, under your scenario of a purely free market, a poor person wouldn't be able to afford a kidney if she needed one short of a largess. That "disparate treatment" between rich and poor is also more offensive to me than scrubbing a toilet. I do agree with the concept though of Bill Gates having to pay society a billion dollars for a kidney transplant because saving his life should be worth that much to him. I really don't agree with him paying the market price for anything, most certainly not for his life. But then again if I were king, Billy would long ago have been relieved of his billions. He can't be richer than the king, now can he?

happyjuggler0 May 16, 2006 at 3:51 am

Well Trumpit, thanks for making explicit what you had already more or less made implicit. You are a socialist. I was right earlier, you don't want to solve the organ transplant shortage, your goal is solely hurting the rich.

I wonder, exactly when did you learn to stop caring about the poor? Was it at the Party meetings?

happyjuggler0 May 16, 2006 at 4:13 am

Um, change "poor" to "needy", and my comment still applies. :x

Ann May 16, 2006 at 8:10 am

It's clear that, if Trumpit were king, inequality would be drastically reduced and we'd all be living in poverty. Do you prefer the Chinese solution to this problem, Trumpit? There, the government sells the organs of those it executes and the money goes to "the people" (at least in theory). With the 2008 Beijing Olympics coming up, there should be plenty of spare parts for sale there in the next few years.

Jon – I like your toilet comparison, and I especially like your idea about people being able to get money (for their estate) for donating organs after death. Or perhaps they could even get a small amount now in exchange for committing to donate (but this may be too hard to monitor and enforce).

I also think that the presumption should be in favor of donating organs, unless people explicitly opt out. Make it easy for them or their family to opt out, but make the presumption in favor of donation unless someone objects.

Now, loved ones that may still be in shock over an unexpected death have to take the responsibility to actively donate, and it places a burden on them. Instead, make it as easy as you want for them to prevent it but make it clear that donation is the norm, and that they have to take action to prevent it. That alone might increase donation rates for all organs.

Jon Trenchard May 16, 2006 at 1:40 pm


The problem with giving even a small amount of money up front is that there's no way to predict who will die in such a way, and under such conditions, that their organs will be suitable for donation.

LifeSharers sounds like a good program and certainly a "best practice" until paid donations are legalized. Ultimately I don't think it would be as effective as paid donations because the perceived (if not actual) chance that one will be able to avail themselves of the incentive. I think people tend to imagine themselves dying under the relatively peaceful conditions that make organ donation possible. The possibility of actually needing an organ transplant seems more remote, even if statistically the difference between the likelihood of needing a transplant and being suitable to donate isn't huge (I have no idea what the actual probabilities are). Where one event seems more likely than another, folks are probably more likely to respond to the incentive tied to the likelier event. Of course, this is all just speculation.

Finally, Trumpit should realize that his "no chewing gum unless you brought enough for the rest of the class"-approach to the organ donation problem will have the same result in the surgical theater as it has in the classroom: discouraging the activity rather than allowing everyone to participate.

Francois Tremblay May 16, 2006 at 5:08 pm

"Trumpit"'s comments once again remind us how much statists hate the poor, while pretending to want to help them. It's always the same story.

Sameer Parekh May 16, 2006 at 6:26 pm

As I understand it, the deaths that are most conducive to organ donation are not very peaceful. That's why they call them donorcycles, right?

ben May 16, 2006 at 6:38 pm

Trumpit's position is outrageous, in my opinion, and all too common. But his argument is circumvented if payments are permitted only for organs from the deceased. This is second best, but at least it would improve the supply of organs that are otherwise thrown away with burial or cremation.

True_Liberal May 17, 2006 at 9:00 am

For those who choose to class their fellow humans as either "poor" or "rich":

The distinguishing characteristic of a free society is the ability of its citizens to complete transactions which better their own status.

If a "rich" person can better his status (i.e. save his own life), and if the "poor" can better his status (i.e. become a good bit richer) though an organ transplant transaction, who are we to declare it immoral or unethical?

Or is it more ethical to keep the poor in their place?

Al May 17, 2006 at 10:11 am

Modest Proposal/Trial Balloon:

First of all, I support free market organ markets. I was thinking, though, how does this impact cannibalism?

Cannibalism, if done correctly, can be a victimless crime. A death-bed patient agrees to sell his legs to a local cannibal after his death to pay for his son's college. Is this acceptable? Do the same principals apply? I'm not making a slippery-slope argument, I'm just proposing a thought experiment.

Mark May 17, 2006 at 12:17 pm

Those of you that are opposed to a free market in kidneys should read the article by Barnett, Saliba, and Walker that Prof. Boudreax mentioned in his post. It addresses both efficiency and equity issues. As they demonstrate, current law, not a free market in kidneys, is inefficient and immoral.

rachan khurana June 15, 2006 at 8:59 am

if someone wants money ,to donate kidney what's the harm u r saving a life.think if it's for the relative if u take money no one knows.u can consider the acceptor as relative if doctor accepts ur view.so again u r saving a life.

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