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Their pound of flesh >> Kidney-commerce philosopher Janet Radcliffe-Richards says the Earth's poor should be allowed to trade organs for food by JACQUIE CHARLTON
But growing attention is being focused on a highly controversial article in a British medical journal, the Lancet, which proposes that the worldwide ban on organ sales be rethought, and that trade in things like kidneys once again be considered as a means of increasing the far-too-scant supply. Shocked and horrified at the idea? The vast majority of people undoubtedly are. But what the author of the article, Janet Radcliffe-Richardson, is asking us to do is to get over our feelings of disgust and look at the logic behind the ban--a logic, she says, that doesn't hold up. Radcliffe-Richardson, a philosophy professor at the Open University in England, was in town last week to speak at the 17th congress of the Transplantation Society--an organization whose ethical policy statement recommends that all countries enact legislation forbidding the commercial traffic in organs. If nothing else, give Radcliffe-Richardson credit for being brave... Mirror: Why is the Transplantation Society against organ sales? And why are you arguing the debate on organ sales should be re-opened? Radcliffe-Richards: People give a whole list of reasons why they object. They say it's exploiting the poor, they say these people don't really understand what they're doing, they say organ donation ought to be altruistic. The line our argument takes is, if you forbid the sale of organs, some people are going to die or remain on dialysis--a lot of people, in fact. And they say, well, it's the poor who sell their organs. Then we say, well, what exactly is your objection to the poor selling their organs? And they say, they have too few choices open to them. So then the question is, why do you go in and reduce their choices even further by taking away the option they regard as best? The whole point is that if you look through the objections people bring up, they all run into logical problems like that. They're saying, that we want to protect these people with too few choices by giving them even fewer! Are you going to say that people who are poor shouldn't be allowed to decide for themselves? And anyway, why do you think it's bad for them? If you were in that position, wouldn't you rather sell your kidney and get lots of money to send your children to school? When people produce a string of bad arguments, and if, as soon as you demolish one argument they come up with another one, it means they have a strong emotional reaction and they're determined to find reasons for it. We're getting rid of our feelings of discomfort, but the cost of this is that people die who might otherwise have lived, poor people are deprived of their best option, mature adults are deprived of the freedom to negotiate arrangements to their mutual benefit. And furthermore, why shouldn't you be allowed to decide your own level of risk? When we have rich people who want to take up risky sports just for fun, we say, "Yes, of course you can; that's your decision." But when we have a poor person who wants to take a much lower risk for a much greater return, we say, "Oh no, you don't know how to decide for yourself, we have to decide for you." M: But a poor person doesn't do it for fun like a rich person... RR: No, but if you have a need for it, that's the better reason for doing it. If somebody is put in the position of doing something that they don't really want to do, you don't improve their situation by diminishing the number of choices. If you say these people shouldn't be in need, and so then they wouldn't have to make this choice, the only way to solve that is to stop them being in need and give them money! M: Here in Montreal, tens-of-thousands of people perform medical testing for research organizations in exchange for money. Is this the same thing as selling kidneys, albeit on a milder scale? RR: I don't think they are the same. That's another argument the opponents of organ sales can use: we don't pay people who donate blood, and if people can sell a kidney, what's to prevent them from selling a heart? And so on. You don't have to be all or nothing. In everything else in life we say this end of the spectrum is good and this end of the spectrum is bad and there's a grey area in the middle. There may be good reasons for not selling blood: because we can get enough blood without buying it, because it's renewable, because most of the people who wanted to sell would not have good quality blood. But the argument is completely different for kidneys, which are not renewable. M: Would organ sales occur in industrialized nations if they were legalized in the Third World? RR: The principle would apply here, too. There are people who would sell their organs for a good enough price in North America. You'd obviously have to pay them a better price. But the issue is just the same for a rich person who might want to sell his kidney so he doesn't have to work. M: What has been the response to your article? And what's the buzz at the conference? Are people talking about it? RR: Yes, they are. And there was dreadful press coverage, but then there was good press coverage, too. But there's been a lot of interest. Rather to our surprise--it was hostile at first--but as people realize what the arguments are, they gradually seem not so resistant. M: Are people in the Third World demanding this sort of commerce? RR: They were when it was legal. It was happening in some places even before it became legal. People spontaneously spotted a market and would advertise in newspapers and write to transplant surgeons. There were offers to sell eyes from people who were poor enough. Yes, it's a horrible idea. But if you're so poor that you want to sell an eye, are we doing you a favour by refusing to let you so that you die of hunger instead? In fact, one of the things I've argued is that if people are so disgusted by it, then they'll realize how bad poverty is and do something about it. I mean, can you imagine how badly off you must be to want to sell an eye? But we don't think about such a thing as poverty because it doesn't disgust us in the same way taking an eye out does.
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Last week, doctors in Ottawa considered and then promptly denied the request of a 51-year-old paraplegic who wanted to trade one of his kidneys for a kilo of marijuana, a substance he used to control pain. The marijuana aspect of the deal was presumably bad enough for the doctors, but the idea of a kidney being swapped like a second-hand lawnmower must have been what really killed the idea for good.