Does a legalized market for kidneys in Singapore violate hum
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Does a legalized market for kidneys in Singapore violate human dignity?
By Lester Lim
Published: August 31, 2009
This is the first part in a series of articles arguing for the legalization of a market for kidneys in Singapore.
Singapore — It has been almost close to a year since the incident involving an illegal transaction for a kidney from an Indonesian donor to the local wealthy retail magnate Tang Wee Sung happened. At the end of this were suggestions that a legalized market for kidneys should be established in Singapore. However, one of the key difficulties in establishing a market for kidneys in Singapore is the issue of human dignity. Does a legalized market for kidneys violate human dignity?
An integral part in arguing against the creation of a legalized market for kidney transplants involving a monetary payment to the donor is the assertion that the very act of paying donors for an organ violates intrinsically the dignity of human beings. Such an argument rests its foundations on the view of the Kantian Categorical Imperative that we ‘ought not to treat human beings as a means in themselves.’ This argument is further extended by the claim that a monetary value can never suffice to quantify the loss of this human dignity. Is it possible to present an alternative interpretation of Kant’s definition and argue that dignity would not be compromised – but rather would be preserved– in the creation of a legalized market for kidneys?
Kant describes that dignity is anything that is ‘exalted above all price and so admits no equivalent’, and an authority on medical ethics, Cynthia Cohen, states her interpretation of Kantian dignity as the “unconditioned worth that all people have just in virtue of being human”. In such a regard, no amount of price or quantifiable material value can be adjudged to completely replace the value of a human being – if, “something else can be put in its place by an equivalent,” then we are justified in arguing that such an object does not have dignity. An important and prior qualification here should, however, surround the ambit of this argument: that we should not see ourselves as being detached from our internal organs and any body part that is necessary for the functioning of the whole should be attributed with dignity.
The Kantian definition of human dignity is therefore characterized by two salient aspects: human dignity is inherent in all humans in their so being as humans, and no monetary value can be quantified out of it — simply because it is priceless. Three main arguments against the creation of a market for kidneys can be constructed here: (1) selling a kidney is tantamount to a violation of human dignity, (2) monetary amount does not compensate for the loss of this dignity, and (3) this leads to humans viewing each other as a means to an end, contravening the Kantian ethical principle.
The question of whether selling a kidney is equivalent to a loss of human dignity hinges on how narrowly we choose to interpret the scope of a successful kidney transplant. While it has been empirically proven that human beings can function as rational and healthy individuals with minimal disruptions to their quality of life, the facts are also that there is a countless amount of otherwise healthy individuals who desperately require a kidney transplant in society, and society faces a serious imbalance between the supply and demand for kidneys.
An action that saves the life of a person who is fighting to survive should be accorded absolute moral importance. We ought to carry out actions to save a person’s life in a situation whereby he is in great danger of dying, and wishes to live. Any action that can be done to save this person’s life cannot be seen as violating human dignity. Given the highlighted situation above of a serious imbalance between the supply and demand of kidneys prevalent in society today, a considerable amount of otherwise healthy individuals are left to suffer and slowly die without ever receiving a suitable kidney transplant. Would not such a situation be rightfully construed as being contrary to the sustenance of human dignity? As noted further in the local case of Tang Wee Sung, the current system not only persecutes individuals who have resorted to means contravening the existent laws to obtain a kidney, but also prevents medical procedures performing the transplant from going through. Such a legal system that denies or obstructs the chance for an individual to live cannot be said to be consistent with the maintaining of human dignity.
Receiving a monetary payment in a legalized market for kidneys does not also necessarily mean that this action is attempting to compensate for the loss of human dignity. A monetary incentive in this respect is not endeavoring to commodify human dignity — rather, while recognizing that some aspects of an act cannot be quantified, it attempts to do so for at least a certain portion of it. For instance, there are procedures involved in which the family of the victim of a car accident is compensated for the loss of a life, or even in minor accidents, whereby the victims themselves are compensated for the loss of a limb. No one would argue that this compensation fully captures the complete value we put to a human life, or to an important body part; it merely attempts to quantify a certain aspect of it. Such a line of reasoning applies equally to financial rewards offered for a kidnap victim: nobody would argue that the kidnap victim is actually worth as much as the reward offered. Monetary compensation, in this regard, can neither fully compensate, nor attempts to, a human body organ such as the kidney.
Does the establishment of a legalized market for kidneys cause humans to view another as a means to achieve an end, contravening the Kantian ethical principle? It may be worthwhile to first examine this assertion from the perspective of a critically ill kidney patient waiting for a successful transplant. In such a dire situation, the likelihood is that this individual would view all others as potential ‘means’ to his end of survival, and the natural response would be to magnify this importance beyond other seemingly unimportant things such as the dignity of the others. This argument could be objected on the grounds that it seems to apply to the entire practice of kidney transplant itself; not only in the scenario of a legalized market for kidneys.
In the final analysis, one may expect that if a legalized market for kidneys were to be established, the needs for kidney transplants would be more easily met and more lives would be saved. In allowing for a symbolic monetary compensation that does not attempt to fully represent the intrinsic worth of a bodily organ to function as an incentive, the imbalance between the supply and demand for kidney transplants may be more efficiently addressed and human dignity may not be compromised.