Thursday, July 31, 2008

Banning Abortion Will Create More Problems? A Brief Logical Analysis.

The following is an informal reply to Dr Phua Dong Haur’s letter in Straits Times forum, “Banning abortion will create more problems (Aug 1).” The original writings of Dr Phua is in italics.

I REFER to Ms Tan Seow Hon's comments in 'Time for Singapore to relook abortion law' (July 24).

I refer to Dr Phua Dong Haur’s letter, “Banning abortion will create more problems (Aug 1).”

Although it is true that some legislation should be examined periodically to assess its current relevance, Ms Tan's arguments as to why we should relook the abortion law is one sided.

Fallacy of poisoning the well. You should show how her argument is “one-sided.” Disagreeing with your point of view does not imply that she is being “one-sided.” Isn’t your emphasis on the mother’s choice (i.e. pro-choice or pro-termination) extremely parochial and one-sided as well? (And the one-sidedness of which I will show in the following paragraphs).

She acknowledged that backstreet abortions are dangerous but stated that this reason does not justify legalising abortion. I would like to point out that the danger of backstreet abortion is one of the central issues in legalising abortion.

The key issue here is whether non-therapeutic abortion “simpliciter” is morally/ethically right or wrong. If non-therapeutic abortion is morally wrong, then both backstreet and “legalized” abortions for non-lifesaving reasons are wrong. This is the key issue which you should address first. Avoiding the relevant ethics of abortion only makes one’s arguments (if any) appear fatuous and misinformed.

Likewise, the danger or existence of backstreet euthanasia doesn’t make euthanasia morally right, right? Do we legalize euthanasia simply because they are patients doing it illegally (and of course, with the adherent or accompanying risks of therapeutic failure and complications)?

Dear Dr Phua, the fallacy you have committed is called the ignoratio elenchi. Your argument (thus far) does not even begin to address the central ethical issue of abortion; you have merely argued for its utilitarian value for the mother alone.

Backstreet abortions are done using dangerous techniques or oral ingestion, and they often result in injuries or death to the woman. If medically supervised abortions are banned or made difficult to access, women who want or need an abortion and are unable to travel overseas to do it, will inadvertently turn to backstreet abortions. The result will be tragic.

Your argument fails even the most simplistic of informal logic; therefore, I will not take the time here to discuss utilitarianism with you.

Your syllogism is as follow:

Form of your argument - If A, Then B.

“If medically supervised abortions are banned or made difficult to access (A), then women will inadvertently turn to backstreet abortions (B).” (If A, then B).

Valid forms include – A, therefore B.

It, however, does not follow that - not A, therefore, not B (a logical fallacy called “denying the antecedent”). That is, it does not follow that the following statement is logically true:

“If medically supervised abortions are not banned or made difficult to access (not A), then women will inadvertently not turn to backstreet abortions (not B).”

While there is evidence to suggest that life begins at conception, and various major religions hold similar views, we cannot justify endangering the life of a woman by forcing her to seek backstreet abortions, just to protect the life of the foetus. Similarly, the life of the foetus needs to be protected.

So is it justified that we deny the “right to life” to a child in order to satisfy the whims of the mother? Your statement begs the question, “Why does the mother want an abortion in the first place? Is the requirement therapeutic in nature i.e. to save the mother’s life” She would not be endangered in any way if she chooses not to have an abortion for whimsical reasons. Also, is non-therapeutic abortion ethical for any reason at all?

What so perplexes me is your apparent duplicity in arguing for the denial of the “right to life” of the child, and in the same breath, claimed that “the life of the fetus needs to be protected.” How so? By dismembering the child via abortive techniques? Indeed, the child needs to be protected from paralogisms originating from illogical minds.

Hence, I would argue that the decision to go for an abortion or not, should be left to the woman and the woman alone. This is because she is the one who has to bear the emotional and physical burden, and responsibility of either the pregnancy or abortion. It is not anyone else's place to decide for her, as long as she is mentally competent to make such a decision.

A non sequitur. If an action is inherently unethical or immoral, then society has the right to administer judgment and the necessary legislation. The autonomy of an individual cannot be divorced from societal considerations.

The “right to life” of a child (or any patient) must always be considered in such ethical debates. In the same vein, the “mental competence” reasoning can be used to justify all forms of voluntary euthanasia – it is, after all, the dying/suffering patient who has to bear the main “emotional and physical burden” of the illness/sufferings.

Autonomy must be subjected to and balanced with the other guiding principles of medical ethics - justice, beneficence and non-maleficence. And one of the responsibilities of being a doctor is to save life, not destroy it. This is basic “non-maleficence” as stated in the Hippocratic Oath, “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion.” I guess the Oath is now only repeated as a lip-service to your alma mater. Besides, most abortions are not performed to save a patient’s life.

In the case of therapeutic abortions, most cases of eclampsia/pre-eclampsia and other life-threatening obstetric conditions occur after 20 weeks of gestation, and medical technology today can maintain the life of most 20 plus weeks old children till maturity. Thus, abortion (i.e. to kill the child) even for most life-threatening obstetric conditions is unnecessary.

The rational approach to the dilemma of abortion is not to disallow women to make their own choice, but to educate the public on proper methods of birth control, and alternative avenues other than abortion in an unwanted pregnancy, for example, adoption.

But what if that choice is unethical and causes harm to the unborn child? Furthermore, two wrongs do not make a right. The failure to practice birth control and the consequential unwanted pregnancy does not make abortion (or more precisely, the killing of the unborn child) morally right. We shouldn’t be correcting a “mistake” (i.e. the unwanted pregnancy) with another “mistake” – that of taking the life of the unborn child.

The approach to reducing abortion rates is in education and not legislation.

A false dilemma. The approach to reducing abortion rates is in education AND legislation (and many other means).

Finally, I would like to add that relooking the abortion law is not the method we should adopt to increase the birth rate. The idea is to make people want to have more children and enjoy having more children.

How does the legalization of abortion enable people to desire or enjoy having more children? Have I misunderstood the fact that it is exactly because such people do not desire or enjoy having that child that they chose to abort him or her (at least in most cases today)?

Making abortion illegal or difficult to access certainly does not increase the desire or enjoyment of having more children.

As an analogy, do you mean that making euthanasia illegal likewise does not increase the desire or enjoyment of taking care of our incapacitated parents? Should we therefore legalize euthanasia such that, whenever the care of our severely handicapped parents becomes an overwhelming burden or torment to our physical or mental health, we can have the option to “abort” them? And this (i.e. legalization of euthanasia) is alleged to increase the desire and enjoyment of taking care of our incapacitated parents?

What about the “right to life” of every human being which you have so conveniently ignored in this discussion?

Friday, July 25, 2008

Non-Existent Objects and Russell’s Theory of Description

Certain philosophers (e.g. Colin McGinn) defend the view that there are non-existent objects. McGinn follows Austrian philosopher, Alexius Meinong, who espoused the doctrine of the non-existent. Beginning with the philosophy of mind, particularly with Brentano’s thesis of intentionality, Meinong worked towards a theory of objects that embraces possible objects (e.g. the golden unicorn), impossible objects (e.g. the round square), and incomplete objects (e.g. something tall). Meinong argued that any subject of a true predicate is an object. So, for Meinong, “the round square is square” is true and meaningful, so there is a round square. These objects, including the round square, are mind-independent, yet are all potential objects of thought.

From the mere fact that a subject term is meaningful, and is featured in true, meaningful sentences, it does not follow that it refers to something. Russell writes:

“It is argued, e.g., by Meinong, that we can speak about ‘the golden mountain’, ‘the round square’, and so on; we can make true propositions of which these are the subjects; hence they must have some kind of logical being, since otherwise the propositions in which they occur would be meaningless. In such theories, it seems to me, there is a failure of that feeling for reality which ought to be preserved even in the most abstract studies. Logic, I should maintain, must no more admit a unicorn than zoology can; for logic is concerned with the real world just as truly as zoology, though with its more abstract and general features. To say that unicorns have an existence in heraldry, or in literature, or in imagination, is a most pitiful and paltry evasion.” Bertrand Russell, “Descriptions” in Introduction to Mathematical Philosophy (New York: Simon & Schuster, 1961), 169.

Thus, Russell rejects the view that meaning is reference. For Russell, there is a restricted range of genuine singular terms which serves as referring terms (e.g. the first person pronoun “I”). The meaningful use of these terms, also known as logical proper names, guarantees that they have reference. According to Russell, other grammatical subject terms such as ordinary proper names and definite descriptions, are impostors.

Take for example the definite description (i.e. phrases of the form “the so-and-so”):

(1) The average 18th month old child speaks 10 words.

Grammatically, this is a subject-predicate (of the form “Fa,” where “a” is the subject term and “F” the predicate). Nevertheless, the subject term “the average 18th month old child” is a dummy singular term. That is, its function is not to refer to a particular 18th month old child who speaks exactly 10 words. Here, it is apparent that the grammatical structure and logical structure come apart.

The logical structure of (1) is elucidated by:

(2) The number of words spoken by 18th month old children divided by the number of 18th month old children = 10

Thus, the logical structure of (1) is of the form “a/b = c,” and not “Fa.” (1) is just a simpler and shorter way of expressing (2). The “average 18th month old child,” although grammatically a subject term, is not a genuine referring term. Hence, meaning does not guarantee reference (contra Meinong).

Russell’s theory of description argues that descriptions are merely disguised existential quantifiers. No description, be it definite or indefinite, is a genuine referring term. The grammatical structure of sentences containing descriptions is not their logical structure.

For example, the logical structure of “An A is B” is expressed as ∃x(Ax and Bx), that is, something is both A and B. “The A is B” can likewise be expressed as ∃x(Ax and (y)(if Ay then x = y) and Bx), that is, there is an x which is A, and uniquely so, and x is B. This analysis shows that, although the descriptions appear grammatically in the sentences as Fa, the logical structure reveals that the descriptions only function as existential quantifiers (e.g. “there is”). No object corresponds to “an F” or “the F” in the analysis.

In conclusion, certain terms which appear as referring terms turn out to function logically as quantifiers, and we know that quantifiers are not referring terms. When I tell you that “there is a surgeon in the operating theatre,” I am not referring to any particular surgeon, and what I say is true only if there is indeed a surgeon in the operating theatre. If Tom is in the operating theatre, and he happens to be a surgeon, then what I said is true. But if someone else i.e. Harry is in the operating theatre, and he is likewise a surgeon, then what I said is also true. Therefore, quantified sentences are satisfied, or not, by objects. In contrast, a sentence containing a genuine singular term (i.e. a logical proper name) is made true or false only by the states and doings of the object of reference. How things are with other objects is irrelevant.

Saturday, July 19, 2008

A Dialogue on Ethical Issues of Life and Death - Abortion

Brief Review of "A Dialogue on Ethical Issues of Life and Death."

This book is written by Rocco J. Gennaro, an Associate Professor of Philosophy at Indiana State University in Terre Haute. It attempts to approach the applied ethical problems of euthanasia, abortion, animal rights and capital punishment from the varied viewpoints of four fictional characters (Larry, Maria, Mark, and Carol). This approach is a refreshing and accessible method for beginning readers of applied ethics to acquire a “bird’s eye view” of what the key issues actually are.

The first chapter offers an introduction to the common ethical theories relevant to ethics. It discusses ethical egoism, utilitarianism (with the distinction between act and rule-utilitarianism), the Kantian categorical imperative, God’s command theory, and ethical relativism.

The author seems to hold a moderate view on the various ethical issues, but is nevertheless vocal against the religious conservative. Gennaro tries to be fair when evaluating the various positions. His attempt at fairness, however, does not translate to an equal treatment of all views. Although it is understandable that Gennaro has his preferred viewpoint, the reader will appreciate the fact that he does not actively promote a particular position. It would be nice to see a more balanced treatment of the minority positions, no matter how politically unsavory they seem to be.

The ethical issue of abortion gets the most detailed treatment in this book when compared to the other issues. Gennaro is right in stating that the concept of person in ethics is the crux of the problem. This book presents the person as one who has consciousness, reasoning ability, self-motivated or voluntary behavior, the ability to communicate, and self-consciousness. But such a concept of person would easily be repudiated with reductio ad absurdum. For example, some patients with severe dementia, mental retardation, or in a coma would not qualify as “person.” Hence, they do not have the right to life, and the killing of such patients would not tantamount to murder. Surely the law and conscience (and many bioethicists) would not agree with such a conclusion. Gennaro makes the distinction between genetic humans and persons, as well as potential and actual persons. He also briefly addresses the problem of rape and incest, and discusses abortion within the guiding principles of autonomy and beneficence.

From the Christian perspective, it is clear from Scripture that life begins at conception with the zygote (also known as conceptionalism; cf. Psalm 139:13-16, Jer. 1:5). From God’s perspective, the zygote is a person with both body - albeit not fully developed - and soul. From such theological reasoning alone, the Christian reader ought to understand that the right to life begins with conception. Of course, the obvious theological or pastoral dilemma lies in the clinical decision to abort the conceptus in order to save the mother’s life. Even so, as John Frame has rightly commented, “Is it in fact justifiable to kill one human being to save the life of another? This question is one which I cannot now resolve. At any rate, our decision even in such a case must be based on the as­sumption that the child is indeed a human being.” And I, too, will not pretend to have any answers to that clinical dilemma at this moment in time.

In any case, it would be troubling at best to know that a particular Christian doctor has approved of, or even performed, abortion. If abortion is rightly called murder in the eyes of God, then the Christian doctor or mother who has willfully aborted the child cannot escape the judgment of Scripture.

I would advise my Christian friends to get hold of this book, and to familiarize themselves with the common philosophical and secular arguments for and against abortion. Finally, I would like to urge all my Christian colleagues and friends to support relevant bioethical, political and legal decisions that is consistent with their faith in the Bible as the Word of God.

PS: This book is available in the libraries belonging to National Library Board of Singapore.

A Presentation on Abortion at the Various Trimesters of Pregnancy

Saturday, July 12, 2008

Get Off Your Dead Horse, Moral Arguments a Necessity

Logical Fallacies Rampant in Bioethics Debate on Organ Trading

An essay which was recently published in the Straits Times is an excellent example of such logical fallacies. The article, written by Michelle Tan Su May, is entitled, "Get Off Your High Horse, Moral Arguments a Luxury." As the title insinuates, when it comes to certain dire circumstances in life, we are justified in putting our moral values aside. Worse, such moral or ethical arguments are not even relevant to the bioethical issue at hand. Tan Su May wrote, "Moral arguments are a luxury that healthy people indulge in before misfortune befalls them too." This is one of the most ridiculous statements made in any bioethics debate in organ trading.

The writer's original words are in italics; my comments follow each paragraph of Tan's writings.

Get Off Your High Horse, Moral Arguments a Luxury
by Michelle Tan Su May

(The writer is a businesswoman in her mid-30s. A lawyer by training, she runs a property investment firm and owns an antiques shop. She is married with two children.

This article was first published in The Sunday Times on July 6, 2008.)

I am so sick and tired of hearing people who truly know nothing about the situation debate this issue in a vacuum, in principle, in theory, as a hypothetical ethics essay.

Comments: This is an ethical issue, and moral philosophers have to address the bioethical aspects of organ trading. Morality is about right and wrong. If morality has nothing to do with organ trading, then there is nothing right or wrong about it. Why, then, are you complaining about the status quo? There is nothing right or wrong (amoral) about the status quo then.

I was 14 when my dad's kidneys started to fail. It was the realisation of our worst fears, the culmination of a lifetime of worrying.

Comments: Not to sound too callous, but what has your father’s Chronic Kidney Disease to do with the question, “Is Organ Trading Moral or Immoral?” Aren’t you appealing to pity (argumentum ad misericordiam)?

My whole childhood was filled with fear that my dad would die. Having been a diabetic since he was 20 years old, potential loss of sight, loss of his limbs and subsequent kidney failure were the perennial phantoms that lurked in the shadows of his entire adult life, and thus my whole childhood.

Comments: I sympathize with your childhood fear. Perhaps you could have seen a child counsellor or psychiatrist. But again, what has your “fear” to do with the question at hand, “Is Organ Trading Moral or Immoral?” Could you be attempting to sway public opinion on this issue by appealing to the sympathy of the readers (playing the victimization card)?

His burden of daily injections of insulin, never being able to eat anything sweet and a strictly restricted diet were suddenly compounded by kidney failure. Now, in addition to no sugar, he could not take any salt or water. His daily quota of water was only two tiny shot glasses a day - and these small mouthfuls had to wash down more than 10 pills daily.

Comments: What has your father’s insulin usage, daily dose of secretagogues, and low eGFR to do with the question, “Is Organ Trading Moral or Immoral?”

The simple things that we take so much for granted became unattainable luxuries to him. Drinking, eating, walking without assistance, being able to urinate normally, being able to see your kids finish their O levels or PSLE (my younger brother).

Comments: Argumentum ad misericordiam, again.

He was only 39 at the time. He went on the two types of dialysis available to cleanse his blood of toxins. The first type (peritonial dialysis), which involved having a tube dangling out of a hole cut into his tummy, worked quite well for him but because of his diabetic condition, the hole kept becoming infected. So after a few months, he had to go on the more tedious type - hemodialysis. This involved him being hooked up to a machine daily for up to three hours at a time after having metal tubes the size of knitting needles inserted into his arm.

Comments: Again, for the umpteenth time, what has your father’s dialysis experience to do with the question, “Is Organ Trading Moral or Immoral?”

This did not work for him. So the symptoms of kidney failure returned full force. Constant retching, yellowed eyeballs, constant weakness, the inability to walk without assistance, and the inability to work. He was a Simex trader, and an outgoing man.

Comments: We get the picture. So he was a retching Simex trader with jaundice and uremia. What is the point?

After a few months, we were given the bad news and the worse news. The bad news was that the dialysis was not working for him and he needed a transplant. The worse news: Because he had diabetes as well, he was not eligible to be placed on the Singapore organ waiting list! Without dialysis or a transplant, he would die within months. The doctor was basically delivering the news of a death sentence.

Comments: Do you know the clinical reasons which made him ineligible for waiting list placement?

Fortunately, we were informed that it was possible to find a donor in India and have a transplant operation carried out there. After months of blood tests and groundwork, my dad flew to Mumbai to have the transplant. Despite putting on a brave front, he was terrified that he would not survive the operation. He told me later that he had brought extra money, 'in case I had to come home in a box'. I can only imagine what it feels like to say goodbye to your children at the airport thinking it may be the last time you ever see them.

Comments: An appeal to consequence.

So, getting a new lease of life via organ trading makes organ trading morally right?

The donor was a poor young man with a young family from India. He earned approximately $30,000 for his kidney. He used the money to buy a shop and start a business to support his young family. This young man and my dad gave each other a new lease of life.

Comments: Again, appeal to consequence

So, earning $30,000 morally justifies organ trading, right?

My dad lived for seven years after that transplant. He died aged only 49, but he lived to see my brother turn 20 and to attend my university graduation. Never a day went by that he wasn't grateful for this second chance at life. Seven years is a lifetime when you have faced death and managed to get a second chance. Going through all that has also made me a stronger person today.

Comments: Appeal to emotions. So what has that got to do with the question, “Is Organ Trading Moral or Immoral?” We are not wondering if organ trading brings great dividends, or if organ trading can lend you seven more years to see the kids grow up. Is organ trading moral or immoral?

Madam Lam Yar Ee, in The Straits Times Forum page, said: 'The Health Ministry should discipline Singaporeans who return after participating in organ trading.' I say she should visit the homes of dying people who have no other option before she spouts such nonsense. She should look into the eyes of their loved ones, their young children, and get off her high horse.

Comments: Appeal to emotions; argumentum ad odium.

What “nonsense” are you referring to? What if Madam Lam is promoting that which is moral?

You mean, if we look into the eyes of our loved ones, we will find the impetus to do that which is immoral?

Mr Jeffrey Chan said organ sales are wrong because they are 'exploitation of the poor'. Let me ask him this: If you were told that you could have someone abandon their children for years to come and live in your house and to wash your dirty underwear, to wait on you hand and foot, and to clean up your bedridden relatives' faeces, for up to 16 hours a day at 60 cents an hour, wouldn't you think such a situation sounded inhumane and unacceptable? Yet that is what our foreign domestic workers are forced to accept by coming here to work in Singapore.

Comments: OK. So two wrongs make a right? Does the alleged "exploitation" of the domestic helper justifies your exploitation of the poor in organ trading?

Plus fallacies of fake precision & dicto simpliciter.

You mean all maids clean feces for 16 hours each day? You mean every one who employs a maid employs them to clean feces 16 hours each day? You mean every maid in Singapore is married with children?

Do they like it? No.

Comments: How do you know that? Are you omniscient? Emotional appeal and victimization card.

Do they have a choice? Yes and no. They could stay at home and have nothing to feed their children. Or they could come over here in the hope of a better future eventually for their children. Yes, they are poor. Yes, they are desperate. By the same token, Mr Chan would have to argue that we ban the use of domestic workers because it is also exploitation of the poor.

Comments: False dilemma (false choice).

You sure those maids come to Singapore simply because they have nothing to feed their children with (oh, and how do you know if all of them have children?)?

And how do you know if their children would have a better future in Singapore? Aren't these statements mere bare assertions?

It is time to wake up. The world is unfair, life is unfair. It is unfair that some people can live in good health until their 90s, while others like my father die at 49 or earlier. It is unfair that we get to be surrounded by our children and loved ones, while people like my Indonesian maid (whom we treat as part of our family and pay $500 a month instead of the standard $350) have to leave their kids for years in order to eke out a living in a foreign land so their children won't starve.

Comments: So what has this apparent unfairness to do with the question, “Is Organ Trading Moral or Immoral?”

Inequality is a fact of life. Therefore, the role of a sophisticated society should be to regulate all dealings to ensure that the poor, the unhealthy and the desperate know their rights, and their risks versus their potential returns before they embark on any life-changing decisions. Taking the choice out of their hands in the name of protecting them is paternalistic and patronising. Being poor does not equal being stupid.

Comments: But taking that Hobson’s choice out of their hands is to protect them (the poor) from exploitation by moneyed patients like yourself. Since inequality is a fact of life, all the more we should see to it that distributive justice is upheld. That means that donor kidneys should not come only from the poor.

I wonder, did your kidney matched your father’s MHC complex? Never considered that option, yes?

My stance is: 'Get off your high horse.' Till something terrible happens to you, you don't know what you would do to survive.

Comments: Again, an appeal to consequence. Oh, if something terrible happens to me, it justifies my immoral dealings, whatever that might be.

Life is unfair. Poverty is unfair. Ill health is unfair. But we can do something to alleviate the misfortunes of those who are unlucky by allowing them the freedom of choice to save a life and better their own at the same time.

Comments: You mean we ought to "alleviate the misfortunes" by doing something inherently immoral? That’s fantastic advice from a mother of two. No wonder Singaporean kids are behaving like demons.

Freedom of choice results in human beings maintaining their dignity.

Comments: Dignity in what? In doing something immoral? So you gain your “dignity” by performing immoral acts with your autonomous “free” choice?

The dying man who can buy a little more time, and the poor man who can better his family's life by selling an organ that he will be perfectly healthy without - they can both regain some dignity by entering into such a transaction with their eyes wide open and being well-informed of their rights.

Comments: Finally, how does that answer the question, “Is Organ Trading Moral or Immoral?”

Moral arguments are a luxury that healthy people indulge in before misfortune befalls them too.

Comments: Logical fallacies ad infinitum ad nauseam. This is a scare tactic and argumentum ad metum (appeal to fear).

They are some who choose to do that which is morally right even when “misfortune” befalls them. Your statement reminds me of that doctor who hides at home during the SARS crisis.

By ignoring the morality of one’s actions, one becomes a cancer of society, a tumor that seeks to justify its own evil with pragmatic considerations and financial incentives divorced from ethics, altruism and justice. Surely no civilized society wants to be part of that tumor.

Thursday, July 10, 2008

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.