Reason Writers in the Boston Review: Matt Welch Responds to the Claim That Markets Are Crowding Out Morals (and That Kidney Sales Should Be Banned)

Boston Review has a cover package out centered around a lead essay by Harvard University professor of government Michael J. Sandel on "How Markets Crowd Out Morals." Sandel's piece starts like this:

We live in a time when almost anything can be bought and sold. Markets have come to govern our lives as never before. But are there some things that money should not be able to buy? Most people would say yes.

Consider friendship. Suppose you want more friends than you have. Would you try to buy some? Not likely. A moment's reflection would lead you to realize that it wouldn't work. A hired friend is not the same as a real one. You could hire people to do some of the things that friends typically do—picking up your mail when you're out of town, looking after your children in a pinch, or, in the case of a therapist, listening to your woes and offering sympathetic advice. Until recently, you could even bolster your online popularity by hiring some good-looking "friends" for your Facebook page—for $0.99 per friend per month. [...] Although all of these services can be bought, you can't actually buy a friend. Somehow, the money that buys the friendship dissolves it, or turns it into something else.

This fairly obvious example offers a clue to the more challenging question that concerns us: Are there some things that money can buy but shouldn't? Consider a good that can be bought but whose buying and selling is morally controversial—a human kidney, for example. Some people defend markets in organs for transplantation; others find such markets morally objectionable. If it's wrong to buy a kidney, the problem is not that the money dissolves the good. The kidney will work (assuming a good match) regardless of the monetary payment. So to determine whether kidneys should or shouldn't be up for sale, we have to engage in a moral inquiry.

I was among the people invited to respond to said inquiry. An excerpt from that:

Every day, eighteen people die in the United States while waiting in vain for a kidney transplant, according to the National Kidney Foundation. The Department of Health & Human Services reports that nearly 92,000 patients were on the kidney waiting list as of April 6 (up from 66,000 six years ago), but that only 16,812 transplants were made in 2011. That deadly math is part of the reason that, according to the National Institutes of Health, more than 380,000 Americans are on dialysis, a punitively expensive and physically grueling death-postponement procedure. The imbalance cannot be meaningfully addressed via cadaver-harvesting alone. As the writer (and kidney donor) Virginia Postrel observed in 2009:

If every single person who died the right way became an organ donor, an optimistic estimate would be that 7,000 more kidneys a year would be available for transplant. Since the [waiting] list is now increasing by 6,000 a year, that would be enough to end it—in 80 years.

So we know that maintaining prohibition—letting the law be guided by our moral revulsion toward placing price tags on human organs—will certainly increase the body count. We know that boosting the number of kidney donations from the living is the only real way to whittle the waiting list down. And we also know, from such procedures as egg donation, that legalizing monetary rewards is a guaranteed method for expanding the pool of living donors. Your morality may vary, but mine says that sentencing more than 6,000 people a year to an avoidable death falls well short of the Golden Rule. My inquest therefore concludes that the burden of argumentative proof on the legality of kidney sales should fall squarely on those who back the lethal status quo.

My whole response here, the entire package here. Read Reason's archive on organ sales, and watch this old-school Reason.tv video on the topic:

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  • JW||

    My inquest therefore concludes that the burden of argumentative proof on the legality of kidney sales should fall squarely on those who back the lethal status quo.

    Very nice, Matt. I wonder what kind of taste that left in their mouths?

  • Heroic Mulatto||

    The mealy taste of kidney beans, I'd guess.

  • fried wylie||

    died the right way

    what the fuck is that supposed to mean?

  • ||

    Not damaged to the point that organ recovery is impossible.

  • Heroic Mulatto||

    died the right way

    what the fuck is that supposed to mean?

    In defense of the Motherland, of course.

  • Auric Demonocles||

    That there death wasn't something that would make the kidney useless for donation (e.g. a renal disease, a car crash that ruptured the kidneys, etc).

  • deified||

    Does everybody else also prefer fat Drew Carey? Am I weird for liking both fat Drew Carey and skinny Elvis?

  • fried wylie||

    Thx Auric and JoeM, still too early for reading comprehension (not too early for jumping to incorrect conclusions of overt moralization though.)

  • Almanian's Evil Twin||

    Your comment died with its boots on....

  • Mo' $parky||

  • Auric Demonocles||

    You only die once.

  • fried wylie||

    I need help comprehending this comment too.

  • ||

    The Department of Health Human Services reports that nearly 92,000 patients were on the kidney waiting list as of April 6 (up from 66,000 six years ago), but that only 16,812 transplants were made in 2011.

    But selling organs cheapens the feeling of giving, or something.

  • fried wylie||

    Well, it's all about the donors, right?

  • MJGreen||

    Plus, poor people, particularly in other countries, might think they know their situation well enough to decide that selling an organ is a good bet. How could you possibly allow that to happen?

  • Almanian's Evil Twin||

    No sales of human organs! Because that's icky! Or something!!11!

  • Fist of Etiquette||

    Always with the kidneys. Don't people need other organs?

  • Restoras||

    Well Congressmen need brains but I doubt the transplants would take hold long enough for them to begin governing sensibly.

  • Mo' $parky||

    People do need other organs, but those are more expensive.

  • SFC B||

    What other organs do people have which they can live a generally healthy and complete life without?

    I'm not a doctor but I thought I'd seen something where the only two organs people had, which can be harvested and used by someone else without serious risk to the continued health of the donor is the kidneys and part of the liver.

  • robc||

    spleen?

    gall bladder?

  • robc||

    Also, the appendix.

  • Auric Demonocles||

    Perhaps he should have specified organs that a recipient would actually need to get.

  • robc||

    Perhaps.

    But he didnt.

  • ||

    Spleen, gall blender (HT Tulpa), eyes, axial skeleton, appendix, colon (not easily, but it is done), small intestine is possible but very iffy since that is the site of most of your nutrient absorption, stomach (but you will be living on Total Parenteral Nutrition for the rest of your life), uterus and ovaries, penis and testicles, bladder (also, not easily, but can be done), one lung, one kidney, and parts of the face (think Roger Ebert). These are just off the top of my head.

    Other parts of the body can be reduced or foreshortened, but will greatly reduce normative "quality of life".

    Pretty much anything non-redudant (CNS with an intact brain stem and heart and at least one lung) around the thorax and cranium is needed to be technically alive (think General Grevious). Be it design or macro-evolution, the organs are placed where they are for a reason.

  • ||

    Oops, I forgot the larynx.

  • ||

    Addendum: Appendicular skeleton (arms and legs). Drat! I just caught that. Need the axial to live.

  • ||

    Humans don't have many redundant organs, so:

    1) Kidneys

    2) Liver via split liver in situ techniques

    3) Lungs (yes, you can live with one lung)

    4) Skin grafts, in the case of identical twins. Fun fact: the integumentary system, skin, is the largest organ of the human body.

    5) Bone marrow (not an organ per se, but part of the skeletal system. Depending on which histologist you ask, the skeleton could be considered an organ).

    6) For the ladies, ovaries in the case of identical twins, as there have been successful ovary transplants performed in the UK.

    There is always, always, serious risk with any type of surgery, especially invasive procedures for both the donor and the recipient, and this cannot be stressed enough.

    A definition of "complete" here would probably be helpful.

  • fried wylie||

    Lungs (yes, you can live with one lung)

    Duh, anybody who's seen ST: Voyager knows that.

  • ||

    In the context of a healthy donor scenario postulated by SFC B, wylie. Don't you owe me a bill?

  • ||

    Kidneys have the huge advantage of being, you know, two. Not a lot of other duplicate organs in your body.

  • Mo' $parky||

    Plus the fact that your body can run just fine with some fraction of one.

  • Fist of Etiquette||

    Well, aren't all you multi-kidneyed people so smug and superior?

  • ||

    I'm afraid to look at the comments.

  • Trespassers W||

    The friendship example is horrible. Does the writer not see that these two points

    you can't actually buy a friend

    the money that buys the friendship dissolves it

    are contradictory?

    And if buying a friendship is impossible, how can he make an analogy to buying an organ, which is possible?

  • Trespassers W||

    This fairly obvious example, in which we demonstrate that there are some things money can't buy, so there is no question of should or shouldn't, offers no clue to the more challenging question that concerns us: Are there some things that money can buy but shouldn't?

    Fixed that for him.

  • Proprietist||

    Money can buy a good-looking wife pretty easily, I hear. Also, rich kids I know tend to have a lot of people hanging around them because they're rich.

    His postulation is easily falsifiable.

  • Proprietist||

    And what does he think people hire escorts for anyways?

  • Trespassers W||

    Your wife example would have been better for this guy to use. That's logically possible, and actually happens.

    I'm going to have to invoke the True Scotsman about friends, though. Friendship isn't defined by a legal arrangement or a set of services. You might be able to pay someone (explicitly, or implicitly as in your rich-kid example) to hang around you, and they might end up becoming your friend, and you can pay someone to do things that a friend would do for free, but I just don't see how it's possible to pay someone to be your friend.

    Of course, even if you could, that's a long way from showing that the practice should be made illegal.

  • Brandon||

    He doesn't have a logical point, so he reverts to emotional appeal.

  • robc||

    But are there some things that money should not be able to buy? Most people would say yes.

    Kant covered this already. Everything has either a "price" or a "dignity" (I bet the german word has a more direct meaning, but even in english, I get it). Things with prices are exchangable. But if you are unwilling to put a price on something, it cannot be sold, then it has a dignity.

    This is missed in Emminent Domain cases, there is no fair market value of dignity.

  • robc||

    Ive said this before, but it bears repeating: The day it becomes legal to sell organs, I will sign my donor code and DONATE (for free!) my organs upon my death.

    I am holding my organs hostage, because I have dignity.

    As far as kidneys go, Im not donating one while alive unless a family member/friend needs it. I wouldnt be able to live with myself if I sold it and then a few years later my nephew needed it.

  • fried wylie||

    I am holding my organs hostage

    "Do exactly what I say, or NOBODY is getting outta here alive!"

  • Brandon||

    "I am holding my organs hostage"

    A SWAT team will be in shortly to assure that you die in the right way, and that, as a terrorist, you no longer have the right to decide upon the disposition of your organs.

  • ||

    You are technically alive when organ harvesting takes place (you need a functioning, intact brain stem to keep the ticker ticking and SPO2 flowing so the brain stem doesn't die from lack of oxygen). Once you die the decomposition process immediately takes place and renders your organs unviable.

    /pedant

  • sarcasmic||

    Obviously the author has no friends(Sandel, not Matt. Matt has The Jacket.) , or he wouldn't need a therapist.

  • ||

    As an alternative to organ sales, how about this:

    If you die and your organ is donated, how about you designating a financial beneficiary for the "sale" of your organ or organs?

    It would work much like a life insurance policy. You designate who gets the reward if you die. The organ recipient pays the market price, and that money goes to your beneficiary.

    So you aren't really incentivized to "sell" your organs while you are alive, but you are incentivized to leave more money to your heirs.

  • fried wylie||

    but you are incentivized to leave more money to your heirs.

    ahhh, the sweet sweet smell of tax revenues.

  • ||

    Could make money bequeathed from organ donations tax exempt.

    Basically it's not much different from being able to donate your organs tax-free to your heirs. Except you're essentially allowing heirs to benefit by selling those organs tax free to people who need them, instead of letting them go to waste. And you take the decision out of your heeirs hands. You make the decision while alive that your organs will be donated and that your heirs will get the money.

  • 0x90||

    I hear all this, you know, "Well, this is class warfare, this is whatever." No. There is nobody in this country who grew his organs on his own — nobody.

    You grew those organs? Good for you. But I want to be clear: you nourished them with food delivered on the roads the rest of us paid for; you were delivered by a doctor the rest of us paid to educate; you were safe sitting down to dinner because of police forces and fire forces that the rest of us paid for. You didn't have to worry that marauding bands would come and harvest your organs prematurely -- and hire someone to protect against this -- because of the work the rest of us did.

    Now look, you fed your body and it turned into something terrific, with a great pair of kidneys. God bless. Keep one of them. But part of the underlying social contract is you take the other and pay forward for the next kid who comes along.

  • Amakudari||

    So saith the Great Spirit.

  • fried wylie||

    Could make money bequeathed from organ donations tax exempt.

    And you could make pigs fly too.

  • Number 2||

    Wait a second here...

    Aren't the sort of anti-market and market-skeptical intellectuals, of the sort who writes for Boston Review and feels concern about markets "crowding out" morals, the same people who, in other contexts, claim that we "can't legislate morality?" The same people who respond to those who claim that an unborn fetus is a human life by asserting that one cannot "impose one's morality" on others? When is it acceptable to impose morality and when is it not?

  • ||

    When is it acceptable to impose morality and when is it not?

    It's acceptable when it's your morality, duh.

  • Jerry||

    The first time I read Sandel I thought I was reading a right-wing critique of free-market capitalism, you know, the ones Russell Kirk et al used to publish.

  • MJGreen||

    The kidney will work (assuming a good match) regardless of the monetary payment. So to determine whether kidneys should or shouldn't be up for sale, we have to engage in a moral inquiry.

    Or, you could step the fuck back and let people decide what is best for themselves. You know, presumption of liberty and all that.

  • BoscoH||

    Consider friendship. Suppose you want more friends than you have. Would you try to buy some? Not likely. A moment's reflection would lead you to realize that it wouldn't work. A hired friend is not the same as a real one.

    Fricking wow. Some of my best, longest term friendships have "bought". Ever work for someone or hire someone to work for you? Ever had such a relationship flourish because you became friends? What planet is this guy on?

  • Mo' $parky||

    To be fair to the writer, if you hired those people and ended up making friends then you didn't specifically hire them to be your friend. You weren't paying them a fee just to hang out with you and be your pal were you?

  • Amakudari||

    Still, the reason you can't buy friendship isn't because it's immoral or illegal but because that's not how people work. Normally, people can't summon emotions or construct complex emotional bonds on command. Friendship is then something that can't be purchased, but that doesn't mean it would be immoral if it were for sale.

    Imagine, for example, an elderly person with no regular visitors. If it were available, friendship would be a mighty fine thing for her to purchase. Those are the people who would benefit most if friendship were a salable commodity, and it's to their disadvantage that it's really not. An attendant or a nurse can be found, but it's not the same.

    (IOW, folks like the writer appear to be ruminating on ickiness rather than considering the practical implications.)

  • ||

    In Victorian England they were called "companions".

  • Brandon||

    And they were secretly werewolves.

  • Mo' $parky||

    IOW, folks like the writer appear to be ruminating on ickiness rather than considering the practical implications.

    Yes, and?

    My response was to BoscoH's question, "Ever had such a relationship flourish because you became friends?", which is irrelevant. Paying someone to work for you and becoming friends is not the same as giving someone money for the sole purpose of being your friend.

  • Amakudari||

    I'm not disagreeing with your assessment. I'm saying that there's no need for fairness to the writer as the writer doesn't seem to understand why the transaction is impossible.

  • Mo' $parky||

    I think, in that case, it would be more appropriate to call the writer a giant douchebag instead of coming up with something that is totally irrelevant to his point.

  • Amakudari||

    Somehow, the money that buys the friendship dissolves it, or turns it into something else.

    Seems on-topic to me to point out why it's not about the money but how human bonds work. You discussed whether an example was fair to the author's point, and I added that the author's point wasn't reasonable to begin with.

  • Mo' $parky||

    I'll just assume you didn't read BoscoH's comment and just skipped right to my answer to it.

    Author: People don't buy friends because it wouldn't be the same as making friends.
    BoscoH: The author is an idiot, you can make friends with someone that works for you.
    Me: Making friends with an employee =! buying a friend.
    Amakudari: People would buy friends if they could but that's not how people work, also the author is an idiot.

    In essence, you and BoscoH have gone the long way around to call the author an idiot. My question was, why not just do that in the first place? My original comment to BoscoH merely pointed out that his comment didn't address the point about buying friendship.

  • MJGreen||

    I haven't read Sandel's books, but in these articles and essays he always looks to be battling this insane strawman. Who out there is seriously saying that friendship or the Nobel prize should be a commodity? Who denies that these things are valued on a non-pecuniary basis? Everyone agrees that there are limits to the market, that it exists only for certain purposes. Yet he writes as if this were some brilliant insight, part of a serious intellectual battle to keep market fetishism from swallowing society whole.

  • Amakudari||

    What's gone unmentioned a bit about kidney markets is that as long as they exist, for the right price, no one will go wanting. Right now, there's a huge risk to donors: what if they actually need that kidney? That risk is gone with an open market and likely bears only a small penalty. Banning kidney sales is the height of immorality, as you are demanding that others die to assuage your icky feelings.

    Also, you can absolutely "buy" friends. You don't get them for free, at least. You have to invest time and often do things for them in exchange for the same. Really, there's a matching market in finding friends and a maintenance cost for keeping them. It's not monetary, but it is a market and there's nothing immoral about it.

  • ||

    Yes, this is sort of the way game theorists talk about markets. Almost anything can be a market.

    Problem is that a lot of liberals let their icky feelings about money taint their perceptions of an entire field of inquiry just because it happens to use the word "market" to refer to social activity that is describable by economic rational choice models.

    I've heard them leap from the description of something as a market (in a game theoretic context) to the presumption that economists think we should be using money to pay for it.

  • Mo' $parky||

    Maybe we should stop having people call themselves neuroeconomists then.

  • Jerry||

    What is this even supposed to mean, when Sandel says "a friend who is real"? Are we all supposed to know how we can separate the real from the unreal? Seems to me Sandel is making a lot of implicit assumptions which he is not ready to share with us.

  • Brandybuck||

    The disparity between values received in this economic transaction are just too great for our emotions to accept. That explains our taboo on selling water to a man dying of thirst, selling organs, price "gouging" in disaster areas, etc. It even plays a role in the desire for non-commercial (ei. "free") education and healthcare.

    Intellectually we KNOW that selling body organs will save lives, but emotionally we cannot handle it. We would rather let people die than be emotionally discomforted. That's how we are wired.

    It's also libertarians will always remain a tiny fraction of the populace. The mere fact that we can comprehend the idea of selling tickets to lifeboats means we are an aberration.

  • ||

    I don't think it's just icky feelings about money though. It's that (a) the organs will go to the highest bidder, which means richer people, and (b) that middlemen often stand to make enormous profits off of price inelastic goods.

    You could have the discomforting situation of (say) someone speculating on the liver market and buying liver futures when the price is low, then making a killing when there's an outbreak of hepatitic C.

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