Medical Self-Defense, Compensation for Organ Transplants, and the Commodification Objection:

Here's my attempt to deal with the "commodification" objection to compensation for organ transplants. I'd love to beef it up, in future versions of the article (if there are some) even if I lack the space in this version. Any suggestions?

What then about the argument that compensation is just inherently wrong? "The human body and its parts cannot be the subject of commercial transactions," the argument goes. Like "a desired legal verdict, a Pulitzer Prize, or a child," organs are goods that "have a meaning and value that places them outside the market." In the words of leading conservative bioethicist Leon Kass (for three years the chair of the President's Council on Bioethics), "the human body especially belongs in that category of things that defy or resist commensuration -- like love or friendship or life itself":

[C]ommodification by conventional commensuration [through market exchange] always risks the homogenization of worth, and even the homogenization of things .... In many transactions, we do not mind or suffer or even notice. Yet the human soul finally rebels against the principle, whenever it strikes closest to home....

We surpass all defensible limits of such conventional commodification when we contemplate making the convention-maker -- the human being -- just another one of the commensurables. Selling our bodies, we come perilously close to selling out our souls. There is even a danger in contemplating such a prospect -- for if we come to think about ourselves like pork bellies, pork bellies we will become.

Yet, once we look past the figures of speech to see what is really being asserted, this analysis is unpersuasive. Love, friendship, and prizes can't properly be gotten for money because paid-for love, friendship, and prizes aren't "love," "friendship," and "prizes" as we define the terms. A paid-for kidney is a kidney, just as a paid-for transplant operation is a transplant operation. It has the same meaning and human worth regardless of whether it's paid for -- it can save a human life.

Nor is compensation for providing kidneys morally similar to selling "the human being." There's no despotic control over another human, as with slavery. There's no risk of a harm to a human who's too young to consent, as with sales of children. When an organ is taken from a cadaver, there's no soul to be sold out. And when an organ is provided by a living person, the organ is being provided, not the soul; there's no selling out of the soul in compensation for the organs, just as there's no giving away the soul in donating organs. We are no more pork bellies when organs are transplanted (whether for money or otherwise) than the paid transplant surgeon is a butcher.

Of course, such responses themselves have limited persuasiveness to those firmly on the other side. The anticommodification claim may be at bottom a philosophical and spiritual axiom -- a premise for an argument rather than a conclusion. Leon Kass's soul rebels against payment for transplants. My soul rebels against price controls that limit the supply of transplantable organs and thus lead people to die needlessly. When the test is soul rebellion, argument only goes so far.

Yet the presence of a constitutional and moral right ought to resolve this impasse. Something more demonstrably compelling than Professor Kass's conclusory assertions must be required to substantially burden such a right. Before limiting people's abortion-as-self-defense rights or lethal self-defense rights, we would demand more than just philosophical claims supporting a culture of life so unwavering that it never lets people use deadly force against viable fetuses or born humans. Likewise, before limiting medical self-defense rights, we should need more than Professor Kass's view of the soul.