Is Organ Trading Moral or Immoral?

I have recently been actively debating on the Straits Times Online Forum concerning the aforementioned issue. The following are some of my thoughts on this matter. (In view of the parliamentary sitting, I have submitted this letter recently to the Straits Times, and is published online here at ST Online Forum 22nd July 2008)

Why I Oppose Legalisation of Organ Trading

THERE are several reasons why I oppose legalization of organ trading.

a. Commodification in bioethics

First, there is the problem of commodification of humans and their body parts which, as ethicist Paul Ramsey has aptly commented, 'will only erode still more an apprehension that man is a sacredness in the biological order'.

Unlike altruistically motivated donation, the sale of organs with the expectation of financial incentives is to commodify humans as mere objects or things, thereby violating the sanctity, dignity and respect due to humans within the living, biological order.

This point is further elaborated by Dr Thomas George, an orthopaedic surgeon, in the Indian Journal Of Medical Ethics, “On a superficial level it does appear that the sale of human organs benefits both the buyer and the seller. The sale of a kidney undoubtedly provides financial relief to a family in abject poverty. I am sure that many poor individuals in India and other Third World countries will exercise their ‘autonomy’ and ‘consent’ to sell their organs. When we oppose the sale of kidneys, we do so in the full realisation of this fact but also feel that humankind should not be thus degraded. We believe that by equitably distributing wealth and curbing the greed of the industrialised West, it is possible to provide a reasonable standard of living for all. This is not wishful thinking, it is a political agenda. We are aware that in the meantime there is much pain for many. Wishy-washy liberals with their piecemeal reform miss the wood for the trees. They are busy applying a BandAid here and some medicines there, ignoring the basic causes that compel large segments of mankind to live in such degradation.” - George, “Organs for sale, philosophy for hire,” Indian Journal of Medical Ethics 4 (1996)

b. Ontology and metaphysical concerns

In conjunction with the problem of commodification of humans is the ontological question, how should we view human beings within the biological order, and what about the purported sanctity of human life? I suspect that how we value humans (and their bodies), and whether we perceive them as sanctified creations or evolved organic molecules, will somehow determine the way we understand the issue of organ trading.

I am convinced that humans, and particularly human lives, have intrinsic value, and thus should not be degraded by means of their commodification.

c. Victims of circumstances, or recipients of distributive justice?

Ceteris paribus, what would be the main reason for the sale of one's organs? From current statistics and a study of the much-touted Iranian model of organ 'sharing', it seems clear that poverty is the chief motivating factor. I believe that even liberal bioethicists like Janet Richards would agree on this point.

The existence of such financial duress in the procurement of organs as commodities from the poor communities is a travesty of distributive justice. Surely something can be done by the Government to avoid this.

Another question we have to address is, should we ration organ availability by need or ability to pay? This is another key issue in the discussion of organ trading and distributive justice.

d. Social justice for the poor

The argument that money received helps the seller-donor rise above his poverty is gravely flawed. It must be the duty of a civilized society to ensure that none of its citizens is in such a dire state of poverty that the poor have to be reduced to selling themselves piecemeal for survival.

e. A genuine slippery slope which is not a fallacy

If we do permit the sale of body parts piecemeal, what then is the overarching moral or ethical principle which would furnish us with a limit to such organ sales? Hypothetically, if we were to respect the autonomy of organ donors-sellers ad infinitum, should we then permit the sale of a kidney, and subsequently the cornea, a limb, the liver and so on?

In other words, if the commodification of human organs is allowed as an ethical practice in Singapore, what then should be the transcendental moral basis to disallow such a slippery slope in the piecemeal disassembly-cum-commodification of a human being?

In view of these points, I seriously think organ trading must remain an unethical vestige of human exploitation.

PS: These points are open for debate and discussion. A guiding discussion framework which we can use are the four principles espoused by Raanan Gillon - autonomy, beneficence, non-maleficence, and justice. Please let me know your thoughts on this, if any.