I’m starting to think that the answer is “yes”.
Scare stories about organ donation markets usually involve wide-eyed children in Desperate Poverty having their kidneys forcibly removed by Evil Capitalists, because money is such a horribly corrupting influence and that’s why we refuse to pay doctors and paramedics. But surely there are ways to compensate donors that don’t involve (shudder) markets and payments, aren’t there? I mean, if someone posthumously donates organs and saves or vastly improves several people’s lives, it seems like the least the grateful recipients could do is pay the donor’s funeral expenses, no?
Well, not in New Zealand:
- Free funerals! (Offsetting Behaviour)
Eric Crampton reports that while this is illegal in NZ, Britain’s Nuffield Council on Bioethics has hesitantly endorsed the practice. They still have serious reservations, though:
What we should be concerned about when it comes to incentives for organ donation is not the purity of donors’ motives, but the way that payments could facilitate coercion or exploitation of those in poverty.
Organ donation should be a fully free choice for each of us, and never an economically necessary one.
For this reason, it is important that organ donation never becomes the only way to pay for one’s funeral. The government currently provides funeral payments from the Social Fund to those in poverty. It must continue to do so as a safeguard against coercion and exploitation, if funeral expenses for donors are introduced.
I think I just sprained a muscle rolling my eyes. Never mind the fact that people in desperate poverty might be thrilled to be able to spare their families the expense of a funeral — or perhaps the ability to afford a better ceremony than that paid for by the Social Fund — by filling out an organ-donor’s card. Never mind that the mechanism by which funerals-for-donors payments could be turned into coercion and exploitation is never specified (and not because it’s so blazingly obvious that it need scarcely be mentioned). What particularly galls me is that organ recipients don’t figure at all into the ethicists’ moral calculus. As Eric notes,
I just don’t get how so much weight has come to be placed on the losses from very hypothetical coercion against the very very real gains to transplant recipients.
I could invoke Hanson’s Razor here and suggest that the Nuffield ethicists are more interested in signaling their distaste for markets than they are in, you know, actually advocating ethical institutions or behaviour. But I don’t think we can rule out the possibility that bioethicists are simply really bad people — that they delight in the idea of sick and injured people suffering and dying on months-long waiting lists for organ transplants, and of impoverished would-be donors forced to ever more desperate measures in the absence of an open and well-regulated legal market for donor organs, and spend their days dreaming up ever-more-absurd justifications for their sadistic tendencies.