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.