On the Morality of Organ Sales

The commodification argument contends that the sale of body parts is wrong, on account of undermining the symbolic value and purpose of body parts, by treating them as commodities – goods bought and sold in markets.

Whilst other versions of immoral commodification have previously been proposed, those presented by Cynthia Cohen and Elizabeth Anderson remain the most compelling. Likewise, sale policy is not considered, as this is superfluous if commodification is proved immoral in principle.

In this essay, I argue that the commodification argument remains unconvincing, as it first fails to establish morally-significant symbolic value, and second to prove that commodification necessarily leads to ‘mere commodification’ or an immoral use of body parts owing to their ‘type’ of good.

First, Cohen (1999) argues that the sale of body parts is immoral, as it violates the “profound respect” that they deserve (2001:7). From Kantian foundations, Cohen argues that since humans have inherent dignity, their constituent parts also contain a ‘derivative dignity’, symbolic of the whole. Whilst this dignity is less than human dignity, it still ought to be treated by the same standard – as an ‘ends’ rather than simply a ‘means’ (2001:6). Cohen further argues that just as commodification threatens the derivative dignity of body parts, it also threatens the dignity of humans constituted from them. This argument initially seems compelling; treating humans as commodities – such as slavery – is widely recognised as violating moral respect, and so, consistently, parts of humans also deserve recognition. Indeed, in cases of missing persons, multiple funerals are often held – for the person, and again later for any body parts that are recovered; if body parts did not have symbolic value, then this practice would be incoherent.

However, as David Resnick (2001) identifies, symbols are themselves contingent on “social choices, circumstances, and historical events” (2001:6). As a result, the exact symbolic value attached to something is at best “arbitrary and biased” towards their history; certain objects are rightly symbols in one culture, yet rightly mere commodities in another (2001:9). Despite symbolic value clearly existing in both, Resnick argues that this ought not receive moral consideration. Indeed, whilst this value may be consistent within moral relativism, it provides weak grounds for the commodification argument to judge the sale of body parts. Instead of attributing value to body parts extrinsically, then, an account of the intrinsic value of body parts is needed to convincingly judge commodification immoral.

Anderson (1990a, 1990b), also following the Kantian approach, attempts to provide this intrinsic account by arguing that types of goods in society are valued differently. Anderson presents three types: economic, personal, and political goods. Each has specific modes of valuation; economic goods – as in the case of commodities – have “use”, whereas personal goods have “respect” (1990a:72). Here, ‘use’ is characterised as impersonal, individual, fungible, and subordinating intrinsic worth to the will of the buyer; body parts are treated as a “mere commodity” – only in terms of personal desire, and without regard to personal or political modes (1990b:181). For Anderson, this commodification is immoral, as it misidentifies the good’s type as economic, and so treats the object improperly to its intrinsic moral worth (1990a:72). For example, Anderson argues that “love, admiration…and appreciation” are all modes of valuing the good of marriage; valuing marriage as an economic good alone, however, by “marrying just for money” is immoral, as it treats the union of two people as a ‘mere commodity’ and further risks normalising this corruption of marriage’s purpose (1990b:185). This argument is certainly more convincing than Cohen’s formulation; for instance, robbing graves for valuables, or vandalising purchased artworks for pleasure, seem uncontroversially immoral on account of treatment inappropriate for the good’s ‘type’. In much the same way, selling kidneys and blood seems to treat life-altering donations as merely goods to be sold, without regard as personal or public goods – since body parts could justifiably be seen as a public good for those in critical need, or a generous gift made from compassion.

On the other hand, Jason Brennan and Peter Martin Jaworski (2015) argue that the purpose objections raised thus far are better described as “semiotic objections” – objections to the attitude expressed when body parts are sold (2015:1054). Against Anderson’s economic goods, the authors describe two actions during ‘mere commodification’: the sale of a body part, and the attitude that it “has no noninstrumental value and is…only an object for personal satisfaction” (2015:1059). Brennan and Jaworski note that whilst pets are bought and sold, most do not view their family dog as having merely instrumental value. In this way, the authors argue that the sale of something is insufficient to determine a good’s ‘mere commodity’ status. Despite Anderson’s apparent “loading the definition” of economic goods for ‘use’ only, Brennan and Jaworski’s argument is more compelling, as it is entirely possible that someone may sell a kidney out of the need for cash, and also value their sale as a public service or act of individual kindness (without ‘mere commodification’) (2015:10:60).

Furthermore, Brennan and Jaworski point out that Anderson’s further risk of corrupting the purpose of goods in society is flawed. Instead, Anderson’s assumption of Western notions of the purpose of body parts, is immoral – by “let[ting] people die because we imbued certain acts with negative [purpose]” (2015:1069). For this concern, whilst Anderson does not require any particular attitudes during sale, the authors argue that there is “no essential meaning to market exchanges” (2015:1061). For instance, whilst the ancient Greeks saw eating the dead as disrespectful (instead of burning them), the Callatians saw eating the dead as the only way to show respect (as burning them was “to treat them like mere trash”). This is highly convincing, as whilst certain cultures perceive the sale of body parts as “impersonal or thoughtless”, other cultures may equally see the free donation of blood or kidneys as a violation of its purpose (2015:1063). In this way, the commodification argument fails to establish a burden on the sellers of body parts – over social practices more widely – to alter their behaviour on account of the good’s purpose, and so their sale cannot convincingly be seen as immoral.

In conclusion, we have seen how whilst body parts have certain symbolic value in society, that its culturally-contingent nature excludes it from moral consideration. Likewise, the commodification argument fails to prove why the sale of body parts necessarily entails ‘mere commodification’, or an immoral alteration of the purpose of body parts in society. As a result, the commodification argument against the sale of body parts remains unconvincing.

Bibliography:

• Anderson, E. (1990a), “Is Women’s Labor a Commodity?”. Philosophy & Public Affairs, Vol. 19, No. 1, pp. 71-92.
• Anderson, E. (1990b), “The Ethical Limitations of the Market”. Economics and Philosophy, Vol. 6, No. 2, pp. 179-205.
• Brennan, J. and Jaworski, P. M. (2015), “Markets without Symbolic Limits”. Ethics, Vol. 125, No. 4, pp. 1053-1077.
• Cohen, C. (1999), “Selling Bits and Pieces of Humans to Make Babies: The Gift of Magi Revisited”. Journal of Medicine and Philosophy, Vol. 24, No. 3, pp. 288-306.
• Resnick, D. (2001), “Regulating the Market for Human Eggs”. Bioethics, Vol. 15, No. 1, pp. 1-25.