The Ethics of Human Rights (68): The Case Against the Sale of Human Organs

Or, better, a case against it. I believe that trade in human organs is morally wrong, at least if this trade is free and unregulated (but perhaps also when it’s regulated in some way). I don’t think the same case can be made against the sale of body products such as blood, hair etc., although some of the arguments against the sale of organs may also apply to the sale in body products. I will bracket this problem for now and concentrate on organs.

I make the argument against organ sales knowing full well that there’s a huge problem of organ shortages and that some people will benefit from free organ trade, and may even lose their lives if free trade is not allowed. Hence, if I claim that free organ trade is morally wrong, then I’m not necessarily making the claim that it should be forbidden in all circumstances. If there are other wrongs, such as people avoidably losing their lives, that overwhelm the wrongs resulting from organ trade, then the former wrongs may be preferable all things considered. However, I believe that the latter wrongs are commonly underestimated by those defending the legality of organ sales. I also believe that there’s a blind spot common among those who claim that the wrongs resulting from a ban on sales typically outweigh the wrongs resulting from a free organ market: it’s not as if the only choice is the one between the status quo – which is in most cases a ban on sales resulting in organ shortages – and a free organ market. There are other and perhaps better solutions to the shortage problem, even in the short term.

Here are some of the reasons why I believe a free organ markets causes serious wrongs:

1. Coercion by poverty

Not a single wealthy person will ever need or want to sell his or her organs. In a system of free organ trade, it’s the poor who will sell their organs to the rich. Maybe a legalized market will reduce the wealth disparity between buyers and sellers to some extent, given the fact that the number of potential sellers will be higher in a free market and that the number of potential buyers will not. This increase in supply compared to demand, following legalization, will reduce prices somewhat, making it feasible for more people to buy organs. Still, it will almost always be the relatively rich buying from the relatively poor, especially if the market is a global one (and I find it hard to understand arguments in favor of a free market limited to national borders).

Many of these poor will be desperately poor, particularly if the market is globally free. A decision to sell an organ isn’t made lightly, and requires some level of financial desperation. The extraction of an organ still carries a substantial risk (e.g. 1 in 3000 die from a kidney extraction even in the best medical circumstances), and few will be willing to take this risk from a baseline situation of wellbeing or happiness that is moderately high and that can not or need not be substantially improved by financial means.

Hence, if organ trade is allowed, many sellers will be desperately poor people, and there will be more of those in a legalized market than in a black market. Now it’s clear that desperation can be coercive: it forces people to do things that they would not otherwise do, that entail risks that they would avoid at higher levels of wellbeing, that may be harmful for them, and that go against their better judgment. If coercion is wrong, then free organ trade is wrong because free organ trade multiplies the number of desperately poor people that feel coerced to sell their organs.

2. Trade instead of justice

It’s reasonable to assume that rich people are responsible for the poverty that exists in the world, if not directly through their actions (trade policy, colonization etc.) then through their failure to prevent or remedy poverty. It will almost invariably be the same rich people who will want to buy organs from poor people. Now, if you first create poverty (or fail to do something about it, which in my mind is equivalent) and then tell poor people that you’ll give them money but only if they give you their organs in return, then you add insult to injury: you have a moral duty to give them your money unconditionally. Insisting on the possibility of trade while neglecting the necessity of justice is wrong.

3. Objectification and instrumentalization

There are some other good reasons why it’s wrong to buy an organ from someone, even if this person willingly agrees to the sale on the basis of informed consent, and even if he or she isn’t coerced into the sale by his or her poverty and isn’t someone who has a moral and unconditional right to the money he or she would get from a sale. For instance, buying an organ from someone means treating this person as an object and a means. It’s a failure to respect the person’s dignity as a being that should be treated as an end in itself rather than as a shop or an organ factory. It’s not outrageous to view organ trade as a new form of cannibalism.

4. Unjust distribution

The previous 3 arguments against organ trade focused on the wrongs it imposes on the sellers. But even the buyers are treated unjustly in a system of free organ sales. If the distribution of organs is regulated solely by way of free trade, then the patients who are most in need of an organ are not the ones who will get the organs. It will instead be those patients able to pay most who will get them.

5. Crowding out altruism

There’s even an argument that points to possible harm to society as a whole. If more and more human relationships are brought within the cash nexus, then giving and altruism will be crowded out. It’s obviously the case that when people can get money for something, they will stop giving it for free. Human nature is what it is. But given what it is, we shouldn’t encourage its darker sides. It’s reasonable to assume that free donation of organs will all but disappear when people can get cash for them. And it’s also reasonable to assume that this reduction in altruism can have a ripple effect throughout society and in many other fields of life, especially when we take account of the fact that more and more activities have already been brought within the cash nexus: sex, reproduction, politics

No one assumes that everything should be tradable. Even the most outspoken proponents of organ trade draw the line somewhere: they won’t allow people to sell parts of their brains, I guess, or their children and wives, or the parts of aborted fetuses (perhaps fetuses specially conceived and harvested for their parts). So we have to stop somewhere and disallow the trade of some things. Why should it be evident that organs are not one step too far?

Alternatives

If organ sales do have harmful consequences, then what are the alternatives? If we don’t want to allow those willing to sell to go about and legally sell their organs to those capable of buying them, then how do we solve the shortage problem and save the lives of those in need of organs? We can do several things:

  • We can try to increase the number of free cadaveric donations, by improving the way we approach bereaved relatives, by introducing a system of presumed consent, by promoting explicit consent (for example through the introduction of regulations that allay fears that doctors will stop life support when they need organs, or through some sort of priority system in which those who have pledged cadaveric donation can jump the queue when they themselves need organs) etc.
  • We can try to increase living donation, by way of awareness campaigns.
  • We can hope for scientific breakthroughs that make cadaveric recovery of organs easier or live donations less risky, or that make it possible to grow organ in vitro.

Organ sale is certainly not the only solution to the shortage problem.

A final remark: given the fact that proponents of organ trade often rely on the right to self-ownership – the right to do with your body as you please – we may have to tone down the importance of that right. Which is something we’ll have to do anyway: for instance, there’s no welfare state if the right to self-ownership is absolute.

Migration and Human Rights (40): The Economic Efficiency Argument for Open Borders

Immigration restrictions are often defended on the basis of economic arguments. I’ve repeated often enough why these arguments won’t work (see here and here for example). What I want to do now is spell out one of the strongest economic arguments against immigration restrictions and in favor of open borders, and I mean completely open borders (which doesn’t mean that completely open borders are necessarily the right thing to do; there may be other arguments against completely open borders that override the economic ones in favor).

Restraining the movement of people between national territories creates the same inefficiencies as restraining the movement of goods and services. Free international trade in goods and services increases overall wealth and prosperity, as I’ve argued here and here. Trade enhances specialization and the use of comparative advantage. It’s easier to grow bananas in the tropics and then trade them, than to make every country grow its own bananas. Similarly, free movement of people makes it possible to make better use of people’s talents. Just as it was an inefficient waste to relegate women to the household – not to mention a gross violation of their rights – we are now depriving the world of good workers in all fields of life because of immigration restrictions. Potential immigrants have a hard time going to other countries in order to develop their talents, and can’t move freely around the world to use their talents. Those of you who worry about the effects of a so-called brain drain should read this.

More on open borders is here.

The Causes of Poverty (54): Lack of Trade Liberalization

I mentioned before that trade liberalization – the removal of trade barriers such as tariffs, subsidies and other distortions of international trade – is, on aggregate and in the medium term, a powerful mechanism for poverty reduction. I say “in the medium turn”, because some structural adjustment may be necessary, and “on aggregate” because some may lose while others gain.

The usual fears about trade liberalization – that it reduces government revenues necessary for redistribution, that it leads to labor competition, lower wages and higher unemployment rates, or that it raises prices in developing countries – are, in general and on aggregate, unfounded (an overview of the evidence is here). Of course, trade liberalization may cause local economic shocks, and there can be distributional effects: some people will benefit more than others, and some may even be worse of after liberalization, especially in the short term. But it’s the aggregate medium term effect on a country or an economy that counts.

This is similar to the positive effect of economic growth on poverty reduction:

The vast majority of the world’s poor live in the rural areas of these two countries [China and India]. Both countries achieved significant reductions in poverty during 1980–2000 when they grew rapidly. According to World Bank estimates, real GDP grew at an annual average rate of 10 percent in China and 6 percent in India during these two decades. No country in the world had as rapid growth as China, and fewer than ten countries exceeded the Indian growth rate. The effect on reduction in poverty in both countries was dramatic, entirely in keeping with the “Bhagwati hypothesis” of the early 1960’s that growth is a principal driver of poverty reduction. (source)

Not all of the poor will be automatically better of as a result of economic growth, and growth may widen income inequality or relative poverty while reducing absolute poverty. But on average and on aggregate, economic growth – like trade liberalization – reduces poverty. That’s not just a story of “trickle down” or “all boats rising on a rising tide”; economic growth also means that the government has more resources to fund welfare and redistribution. (Obviously, none of this implies that growth is always beneficial or that there isn’t room to make growth even more “pro-poor” than it already is).

Arguments in favor of trade liberalization

The interesting part of the argument is that the positive effect of trade liberalization on poverty reduction passes through enhanced economic growth: liberalization reduces poverty because it enhances growth.

[P]ractically no country that has been close to autarkic has managed to sustain a high growth performance over a sustained period. Furthermore, … if one classifies countries into globalizers and nonglobalizers by reference to their relative performance in raising the trade share in GNP during 1977–1997, the former group has shown higher growth rates… [T]he outward-orientation of the Far Eastern strategy … led to the Asian miracle. (source)

Free trade is one of the determinants of economic growth. Growth requires increased productivity, and that’s what free trade delivers. Free trade means more productivity because it means

  • more specialization
  • more use of comparative advantage
  • better access to technology and knowledge
  • better and cheaper intermediate goods (raw products etc.) and capital goods (machines etc.)
  • benefits of scale
  • and increased competition.

All these consequences of free trade have a positive effect on productivity and hence on growth. And that’s not just theory; there’s empirical proof. Reductions in trade barriers were almost always followed by significant increases in productivity (source).

And it’s not just productivity; trade liberalization has other effects as well. The removal of tariffs can reduces prices for consumers and hence reduce poverty. It’s often the case that goods consumed by poor people have a higher tariff tax than goods consumed by rich people:

In his research, [Edward Gresser, senior fellow and director of trade policy at the Progressive Policy Institute] found that the tariff rate on a cashmere sweater is 4 percent; the rate for one made of much cheaper acrylic is 32 percent. A silk brassiere has a tariff rate of less than 3 percent, but the rate on a polyester one is slightly less than 17 percent. The tariff rate on a snakeskin handbag is just over 5 percent but climbs to 16 percent for one made of canvas. Similar variations occur when it comes to household goods. Drinking glasses that cost more than $5 each have a tariff of 3 percent, while those that cost less than 30 cents each have a rate of 28.5 percent. A silk pillowcase has a rate of 4.5 percent; this goes up to nearly 15 percent for one made of polyester.

Overall, clothes and shoes contributed nearly $10 billion in tariff revenue in 2009, while higher-cost items including audiovisual equipment, computers and even cars added less than $2 billion. Gresser contends that the $10 billion is disproportionately borne by people who can’t afford to buy luxury goods. What’s more, when customers pay sales tax on these products, that amount is also higher than it would otherwise be thanks to the tariff that drives up the retail price. (source)

Hence, not only does free trade alleviate poverty, trade restrictions and protectionism actually aggravate poverty. Take also the example of restrictions on rice exports in rice-producing countries:

At first glance, this seems understandable, because a country may not wish to send valuable foodstuffs abroad in a time of need. Nonetheless, the longer-run incentives are counterproductive. (source)

When farmers can’t export, there’s little incentive for them to farm rice. Result: the shortages that were meant to be avoided.

Arguments against trade liberalization

However, we shouldn’t lose sight of the undisputed downsides of trade liberalization. The removal of subsidies can hurt certain producers and it can, especially in the short run, depress employment and wages in certain sectors. It can therefore reduce some people’s incomes and push them into poverty. Trade liberalization can destroy entire markets: it can force a country to abandon tomato production for example, because nonsubsidized local producers are no longer able to compete with increased import competition coming from countries with a comparative advantage. The local producers will lose their jobs and income. However, these same people may benefit in other areas: products which they consume may become cheaper. So, when assessing the impact of trade liberalization on poverty, one has to aggregate all the losses and gains in different areas, and that’s ultimately an empirical question that has to be investigated country by country. Overall, the evidence is that, on aggregate, the effect is probably positive.

There can be individual losers from liberalization, and even individual countries can lose: countries that depend on mineral resources, for example, can take the fast lane towards the resource curse when trade is liberalized. But it’s the global balance of poverty alleviation that determines the desirability and success of trade liberalization.

The claim that liberalization negatively affects government revenues because of decreasing income from tariff taxes, and hence diminishes the generosity of the welfare state, is also not well founded. First of all, liberalization also means reduced subsidies, which should improve governments’ fiscal situation. Secondly, trade volumes increase as tariffs are reduced, and hence the net effect of reducing tariffs doesn’t have to be falling revenues. And finally, even if revenues fall, the poor don’t necessarily have to suffer: it’s ultimately a political decision where to spend which types of government revenues. Priorities can change when revenues change.

Another possible disadvantage of free trade is a cultural one. The claim is that free trade means cultural imperialism: small cultures don’t have the resources to export their cultural products and risk being overwhelmed by, in particular, American culture. Hence, there may be a case for cultural protectionism, but this case doesn’t extrapolate to protectionism writ large.

Conclusion

Liberalization isn’t a magic bullet, neither for economic growth nor for poverty alleviation. Sustained growth and substantial long term poverty reduction require more than free trade. Conflict resolution, good governance, education etc. need to accompany liberalization. It’s no secret that we don’t yet fully understand all the determinants of growth and poverty reduction. The advantage of trade liberalization, compared to other possible pro-growth or pro-poor policies, is that it’s relatively easy to implement: it is – or should be – easier to abolish tariffs and other trade restrictions (especially if there’s an element of reciprocity in global negotiations) than to create a solid education system or a non-corrupt judiciary able to enforce market rules and property rights.

The evidence in favor of the pro-poor effects of trade liberalization is compelling, but we shouldn’t underestimate some measurement difficulties: the measurement of poverty, of trade liberalization and of the effect of the latter on the former is by definition imprecise. The concept of trade liberalization may also be too broad or too vague. And the specific outcomes of liberalization policies depend not only on the precise reforms being undertaken, but also on the context in which they are undertaken. The same measures will have different results in different economic environments. The extent of multilaterality also determines the effects.

Read more on the topic here and here. More posts in this series are here.

Human Rights Promotion (2): Who Does Most Harm to Human Rights? The Left or the Right?

I can simplify this question a bit and focus on those rights violations that are caused by government action. Moreover, I’ll focus on governments in developed countries and say that those are generally democracies dominated either by left-wing or right-wing political movements, alternating. Now, if I want to judge whether it’s the left or the right that is most harmful to human rights, I need to define left and right. And that’s tricky. But let’s simplify some more and say that

  • the right is generally conservative, concerned about respect for religion and religious rules/morality, in favor of capitalism and free markets, against taxation and government intervention in markets, not very interested in equality or equal rights in some areas (as a consequence of religious morality for instance), suspicious of immigration, in favor of a strong national defense, and focused on law and order;
  • the left is worried about capitalism and free markets, in favor of government regulation and intervention in markets, suspicious of free trade, willing to tax and redistribute, and politically correct.

I know, highly simplistic, but I’ll try to make it useful. So bear with me. If we focus on present-day developed nations, which of these two political ideologies is most likely to lead to government policies and legislation that cause human rights violations?

If you look at national defense, you could claim that right-wing governments are most harmful. Although the left is often very supportive of the war on terror, especially in the US (but less elsewhere), it’s the right that is most enthusiastic and most eager to adopt extreme measures. In the name of this war, the US tortured, invaded, murdered civilians, eavesdropped, rendered, and arbitrarily arrested. After every new terror-scare, right-wing spokespeople are quick to demand more rights sacrifices (Miranda rights should be suspended, citizenship revoked etc.). On the other hand, it was a left-wing government in Britain that eagerly supported this war, and Obama seems to be continuing the work of Bush.

If we look at markets, the left is clearly more skeptical about it’s benefits. However, economists – also left leaning economists – generally agree that free trade is good and that many interventions in markets, such as trade restrictions, quotas, subsidies etc. aggravate poverty. And poverty is a human rights violation. Of course, right-wing governments also impose or maintain such restrictions, but arguably left-wing governments are more prone to such vices since they often depend on support of labor unions and other protectionist forces.

On the other hand, the trust in markets expressed by the right can result in a kind of blindness: the right often doesn’t notice market failures and the harm that a slap of the invisible hand can do. As a result, the poor are blamed for their poverty, which is why government assistance in the struggle against poverty is deemed unnecessary, unhelpful and even damaging. The right’s focus on private philanthropy is good but it’s naive to think that philanthropy alone will solve the problem of poverty.

Taxation is a difficult one. Very high levels of taxation are obviously economically inefficient and may lower living standards rather than equalize them. On the other hand, very low rates make it impossible to fund the welfare state, with the same result. Both right wing and left wing fiscal policy can be harmful from a human rights point of view. And there’s a problem of actions vs words here: it’s not obvious that right-wing governments impose low tax rates and left-wing governments high tax rates, despite the respective rhetoric.

If we accept that the right is more enamored of religion, then it’s clear where we should lay the blame for a host of rights violations, such as attempts to undo the separation of state and church, discrimination based on religion or sexual orientation and invasions of privacy. Take the example of 0gay marriage. A focus on religion can also lead to a lack of respect for the sexual privacy of consenting adults, not just homosexuals, but also adulterers, people consuming obscene or pornographic material, or engaging in sodomy. Laws against homosexuality, adultery, sodomy and obscenity usually come from the right. Moreover, the right can show a lack of respect for religious minorities, a result of the incompatibility of different religious claims (“there is only one God”). Opposition to Muslim headscarves for instance is often more prevalent among the right (although there’s also anti-Muslim sentiment in some parts of the feminist or atheist left).

Moving on to another topic. The right’s focus on law and order has led to high incarceration rates, especially in the U.S. These rates have also been inflated by a misguided war on drugs, apparently inspired by a puritan religious morality. Capital punishment is also more popular on the right.

Regarding the left, we can mention some of the harmful consequences of political correctness. PC can lead to exaggerated limits on free speech. Hate speech, for example, is in certain cases a justifiable reason for speech limits, but it seems like some of the limits go too far. An innocent use of a particular word can get you fired, for instance.

Of course, I did simplify. The left-right dichotomy as I have defined it here doesn’t accurately reflect all nuances of political ideology. Some on the left are more pro-free-market than some on the right. Moreover, the dichotomy doesn’t capture all ideologies (libertarianism in a sense is neither left nor right). Also, many governments are left-right coalitions. And, finally, many human rights violations are not caused by governments but by fellow citizens. And when they are caused by governments, they may not be caused by those parts of government that are made up of elected politicians of the left or the right. Bureaucracies or judges can also violate rights. Some violations are not based on left or right leaning ideologies, but on other things such as an extreme desire to regulate etc.

Still, I think that the overview given above is useful. It’s not useful in the sense that it allows us to quantify or compute the respective levels of (dis)respect and to conclude that either the right or the left is better for human rights. It doesn’t. In that sense the question in the title of this post is meaningless. However, the overview above highlights the fact that everyone can violate human rights and that human rights activists should be careful when affiliating themselves with a particular ideology. Neutrality, objectivity, fairness and a lack of double standards are crucial in the struggle for human rights.

The Causes of Poverty (37): Lack of Trade Liberalization

I’ve argued before that doing away with trade restrictions (especially in the agricultural sector) – such as subsidies (like the EU’s Common Agricultural Policy), import duties and other protectionist measures – would be a boost to the global struggle against poverty. Free and unsubsidized trade reduces poverty in at least three ways:

  • It brings down prices because of increased specialization, competition and comparative advantage. Although the removal of subsidies (only one element of trade liberalization) would initially raise prices and hence also poverty levels in importing countries, over time this would be compensated by the downward pressure created by specialization, increased competition and comparative advantage. However, these importing countries wouldn’t be the poorest ones: “three-quarters of the world’s poor live in rural areas, with the majority of them depending directly or indirectly on agriculture for their livelihoods” (source). The poorest countries would benefit from initial price rises caused by the removal of subsidies. (That doesn’t mean that everyone in the poorest countries would benefit: non-farm workers may suffer).
  • It opens up foreign markets for poor producers.
  • It eliminates distortions of competition between local producers and foreign, subsidized products, distortions which often force local producers out of business.

All this has a positive effect on the income of the poor. There’s a new paper here arguing that the net effect of trade liberalization is a reduction of the number of poor people worldwide by 3%:

the winners from trade reform would include poorer countries and the poorest individuals within countries. Nevertheless, it is also clear that even among the extreme poor, some would lose.

Of course, and again: beware of the silver-bullet fallacy. Domestic anti-poverty policies continue to be important as well.

The Causes of Poverty (33): Agricultural Subsidies

After the United States and before Turkey, the world’s second largest producer of tomato concentrate is the EU. Its tomato farmers are paid a minimum price higher than the world market price, which stimulates production. The processors, in turn, are paid a subsidy to cover the difference between domestic and world prices.

Some of the effects of these subsidies on West African LDCs in the 1990s have been documented. The subsidy is reported to have reached about $300 million in 1997. The processors, then, need to find markets, and about 20 per cent of exports at that time went to West Africa. In the mid-1990s, about 80 per cent of demand in this region was covered by tomato products from the EU, which were cheaper than local supplies.

Stiff competition from EU industries led to the closure of tomato-processing plants in several West African countries. In Senegal, for instance, tomato cultivation was introduced in the 1970s, and progressively acquired an important position for farmers, for whom tomato production was synonymous with a key opportunity to diversify their farming systems and stabilize incomes. In 1990-1991, production of tomato concentrate was 73,000 tons, and Senegal exported concentrate to its neighbours. Over the past seven years, total production has fallen to less than 20,000 tons.

One of the main reasons for this dramatic fall was the liberalization of tomato concentrate imports in 1994. Despite the positive impetus provided by the devaluation of the CFA franc, the tomato-processing industry could not compete with EU exporters. Imports of concentrates jumped from 62 tons in 1994 (value: $0.1 million) to 5,130 tons in 1995 (value: $4.8 million) and 5,348 tons in 1996 (value: $3.8 million). SOCAS, the one Senegalese processing firm that has survived, buys imported triple concentrate and processes it into double concentrate.

Other West African LDCs – Burkina Faso and Mali – have had similar experience of enormous increases in imports of EU tomato concentrate. (source)

More on free trade and protectionism.

The Causes of Wealth Inequality (5): Globalization

Globalization is supposed to have lowered the earnings of less-educated workers by putting them in direct competition with low-wage workers around the world. This competition put pressure on wages through international trade in goods and services; through the relocation or threat of relocation of production facilities to overseas locations; through competition with immigrants in local labor markets; and through other channels. …

U.S. and European workers are told that … our societies can no longer afford a generous welfare state. …

Contrary to the standard framing, which presents globalization as something that no nation can escape or even attempt to shape, we can choose the terms under which we integrate capital, product, and labor markets across countries. Over the last 30 years we have indeed “chosen” a particular form of globalization in the United States – a form that benefits corporations and their owners at the expense of workers and their communities. If we had chosen globalization on different terms, however, economic integration would not have required rising inequality. Another globalization is possible. (source, source)

So globalization, as it has occurred and is occurring, causes higher inequality in the West in two ways:

  • The direct competition with overseas workers who can produce at lower wages puts downward pressure on wages in the West, especially for low-skilled workers at the wrong end of inequality.
  • Governments in developed countries react to this competition by restricting social safety nets because the taxes necessary for the funding of these safety nets hurts the competitiveness of local businesses, a competitiveness already under pressure from low-cost labor in the developing world. Less generous safety nets obviously also have a negative effect on inequality.

If these effects are real, perhaps they can explain the decline of manufacturing in many developed countries.

However, I’m not sure this pressure on wages is real and significant (I’ll try to find some data), and we also shouldn’t dismiss the benefits for low-wage workers in the West of cheaper products. This particular result of globalization can offset the possible negative wage effects of wage competition.

Also, I’m not sure governments in the West are actively attacking safety nets (here it says they haven’t during the last decades, but it seems that the recent economic crisis has convinced some to start cutting benefits). And finally, we should remember that inequality isn’t just a national problem. The inequality between countries is just as, if not more, important. And globalization has had a beneficial effect on inter-country inequality because it has redistributed wealth from rich countries to poor countries. For example, it’s hard to imagine how China could have had the same success in poverty reduction without globalization. The question is of course whether this redistribution had to come from low skilled workers in the West, rather than from their more wealthy fellow citizens. The fact that it did come, however, was undoubtedly beneficial to the poor in the receiving development countries.

The Ethics of Human Rights (25): Free Organ Trade and the Commodification of the Body

The case for allowing free organ trade seems like a no-brainer. Many countries, including the U.S., now forbid the sale and purchase of most organs, and, as a consequence, sick people die because of organ shortages, and poor people stay poor because they can’t “monetize” their organs. Poor people suffer a “double injustice”:

[We say] to a poor person: “You can’t have what most other people have and we are not going to let you do what you want to have those things”. (source, source)

However, when organs are freely tradable, many extremely poor people, especially those struggling to survive, will be tempted and even forced to sells parts of their bodies. Moreover, the rich will be able to benefit disproportionately from the market because prices will be high, given that demand will outstrip supply in an ageing society. The most obvious means to balance supply and demand, and to force down prices and allow the less than wealthy patients to participate in and benefit from the market, is to create a global market without trade restrictions, an organ-GATT if you want. This will bring in the masses of poor people from Africa and Asia, pushing up supply of organs and hence bringing down prices. This will supposedly benefit both the less than wealthy patients and the very poor donors. The latter will benefit even with prices for organs falling because of increased supply, because they start at extremely low levels of income. Even the sale of a cheap kidney can mean years of income for them.

The problem with this global market is that organ extraction will take place in sub-optimal medical conditions, creating risks for donors (if you can still call them that), also in the case of renewable tissue donation. Paradoxically, the poor are driven to risk their lives in the process of saving their lives. Even in the best healthcare systems in the world, organ extraction is often very risky. In the U.S., the extraction of a section of the liver, for example, carries a risk to the donor’s life of almost 1 percent (source). That’s not negligible. I doubt anyone would cross a street if that were the odds of getting hit by a car.

I’m convinced that an opt-out regulation for cadaveric donors (meaning that everyone’s a donor after death unless an explicit opt-out), combined with non-financial encouragement of voluntary pre-death donation, is the best way to solve the organ shortage problem. A free organ market will obviously also solve the organ shortage problem, but will create new problems instead.

The distinction between renewable tissue such as bone marrow, and non-renewable organs such as kidneys, eyes, etc. is a relevant one. If the donation of renewable tissue can take place in medically safe conditions, I can’t see a problem with being allowed to trade, on the condition that poor patients have the same opportunity and power to buy as rich ones (and that’s a pretty big “if”). The needs of the sick or disabled who risk dying or suffering because of a lack of available organ, clearly outweigh any remaining concerns.

One of those remaining concerns is the problem of the commodification of the body. Organ trade is obviously commodification, and commodification is dehumanization. I don’t want to imply that organ trade liberalization necessarily results in “organ farms”, dystopian places where people are “cultivated” solely for the harvesting of their organs – although the Chinese criminal justice and capital punishment system for instance comes awfully close. (I sometimes wonder if deterrent and punishment is the real goal of executions in China). But people can commodify and dehumanize themselves. And although we should normally respect people’s self-regarding choices, what looks like a choice may not always be a true choices.

The logic of economics tends to overtake all other domains of life, even those where it doesn’t belong and can do serious harm. Why is it so evident to so many that body parts are something that it supposed to be tradable? Even the most outspoken proponents of organ trade draw the line somewhere: they won’t allow people to sell parts of their brains, I guess, or their children and wives, or the parts of aborted fetuses (perhaps fetuses specially conceived and “harvested” for their parts), not even if this would fill a great social need. And yet they accept as natural that non-vital body parts should be tradable and seem to forget that irreplaceable body parts form our body and that we can hardly exist without our body. If we allow total freedom of organ trade, we will have to accept the case in which a poor father decides to sell off every single one of his organs for the survival of his family. After all, he is the master of his own body, he has a right to self-determination, and the government has no right to limit what masters of their own bodies should be allowed to do with it. If you don’t accept the legitimacy of this extreme case, you accept limitations on the freedom to trade organs. Since most opponents of organ trade also accept certain types of trade – e.g. renewable organs such as bone marrow and skin – the disagreement isn’t a principled one but one about degree.

Underlying the argument in favor of organ trade is the fiction of a market populated by free, equal and self-determining individuals who make free and rational economic decisions and agreements on what to sell and buy, free from government interference. The reality is of course that organ trade isn’t an expression of self-determination or autonomy but rather of the absence of it. And that organ trade, just like a lot of other trade, is radically asymmetrical: some are forced to sell in order to survive, especially if the price and hence the reward is very high, as it will be relatively speaking for the poor. And others will sell without rationally examining the benefits for or risks to their interests (absence of informed consent). It’s beyond my powers of comprehension that all this can be denied:

It’s true that I don’t find any of the arguments about the coercive effects of money on peoples’ decisions particularly compelling.  Megan McArdle (source)

Any potential paid organ donor is always free to decline the transaction, and is left no worse off than before. What next, will you tell me that I “coerced” Apple into sending me a Macbook? (source)

This seems to me to be more correct, or at least less outrageous:

Talk of individual rights and autonomy is hollow if those with no options must “choose” to sell their organs to purchase life’s basic necessities. … Choice requires information, options and some degree of freedom. (source)

Of course, some would say: if someone is forced by poverty to sell her organs, would you stop her and make her worse off by imposing legal restrictions on her autonomy and “reducing her resources”? That’s again the myth that markets always make things better. What if she does get some money, has a better life in the short run, but gets sick because of the operation (or do we also assume the myth of perfect healthcare for the world’s poor?) or because of the lack of an organ? Who would make her worse off? The one allowing her to sell, or the one stopping her? And anyway, there are better ways to protect the poor than to allow them to harvest their organs.

So, if we’re afraid that free organ trade might be exploitative for the poor, why not allow free trade but exclude the poor from selling? Because the poor will be, in general, the only ones tempted to sell. A wealthy person has no incentive to sell organs. Hence a free trade system restricted in this way will not solve the shortage problem, the main concern of proponents of free trade.

I’ve stated before that government interference can promote rather than restrict freedom. In the case of organ trade and donation, two specific types of interference can help:

  • Restricting the freedom to trade non-renewable organs, as well as renewable organs in circumstances in which extraction poses a health risk to donors, will protect the freedom of the poor. Not their freedom to sell organs obviously – which isn’t freedom for them anyway but compulsion – but the freedom to live a healthy live.
  • Imposing default cadaveric donation with an opt-out clause will protect the freedom to live a healthy live of patients in need of replacement organs. Of course, if it’s the case that for some organs cadaveric donation isn’t possible medically, I’m willing to accept an exception.

How about allowing people to sell their organs after death? This would evidently remove the health risks for donors. It could be considered a kind of life insurance for the deceased’s family. That would indeed remove all the concerns from the donor side. (The counter-argument that such a system would encourage families to kill their members for the “insurance money” seems a bit weak, and just as weak as the similar counter-argument against generalized organ trade liberalization, namely that people would murder in order to sell organs; I guess they already do).

But assume that we would allow free post-mortem trade: what would happen with the organs? They would be sold of course, but to whom? The most wealthy first, and hence we still have our problem on the beneficiary side: wealth yields better health. Of course, that’s already the case in healthcare in general: rich people also have better dental care etc. But do we want to add to the existing injustice by allowing wealth to determine who gets an organ?

If we allow limited organ trade of deceased’s organs, we’ll have to do something on the beneficiary side in order to neutralize the effects of wealth. A lottery system could be an option. Or subsidies for the poor, or price caps etc.

The Causes of Poverty (7c): Globalization

Does globalization erode social safety nets? Economic theory and intuition suggest that as economies become more globalized, the ability of governments to undertake redistributive policies and to engage in social spending erodes. After all, a large part of the tax base – corporations, financial intermediaries, and skilled workers in particular – become internationally mobile and can evade taxes needed to finance those public expenditures.

… the lack of an obvious decline in the overall tax take in major advanced economies, has led many observers to think that the hypothesized decline of the welfare state has not in fact taken place. [However], as technological progress and multilateral trade liberalization have made borders less of a barrier to economic activity, the scope of redistribution policies has become smaller. Dani Rodrik (source)

This doesn’t mean that globalization necessarily leads to more poverty. Redistribution on the basis of taxation is only one way to fight poverty. In this post I discussed some of the ways in which more free trade and hence more globalization can reduce poverty.

The Causes of Poverty (12): Protectionism

Few propositions command as much consensus among professional economists as that open world trade increases economic growth and raises living standards. N. Gregory Mankiw

Types and justifications of protectionism

Most governments in the world apply restrictions on the international trade of goods. They limit the imports into their countries by way of different measures:

  • Import tariffs (or taxes – “duties” ’96 on imported goods)
  • Regulatory legislation (e.g. public health legislation or sanitation legislation, “purity” legislation etc.)
  • Quotas (limits on quantities of certain goods that can be imported)
  • Anti-dumping laws (laws against selling below production cost)
  • Government-imposed monopolies on the sale of certain goods
  • And other measures.

They do so in order to protect local producers and farmers against foreign competition. That is where the word “protectionism” comes from. The reasons they state for introducing these measures are usually the following:

  • Someone else did it first.
  • Labor in other countries is cheaper, and therefore the products are cheaper.
  • Labor in other countries may be forced labor, e.g. in prison camps.
  • Labor in other countries may be child labor.
  • Governments’ first duties are towards their own citizens.
  • Countries should be self-sufficient and should protect certain important industries such as the food and energy industries, so as not to depend on foreign countries, even if the local products are more expensive than their foreign equivalents.
  • It may take some time for industries to become fully operative. Before that, countries can protect these industries by shielding them from foreign competition.
  • It is more environmentally responsible to consume local goods than products that have to be transported over thousands of miles.
  • Free trade favors the stronger party in a deal, and hence is neocolonial. The outcome of a free deal between unequal partners means more inequality.
  • Free trade encourages off-shoring and outsourcing, and hence job losses in the unprotected markets.
  • Etc.

Many of these justifications are also commonly used in the debate on globalization. (I will not examine the merits of these arguments here ’96 although I believe that some have some merit – because this post deals with the rationale of trade liberalization, not protectionism.)

Both developed and developing countries uses these measures to protect their own producers.

Another distortion of free international trade comes in the form of subsidies for the production of goods to be exported. This is also a protectionist measure because the aim is to protect industries in difficulties, industries which would have problems selling their goods abroad at normal prices.

Origins of protectionism

As is apparent from the quote above, these measures are usually not inspired by economic thought, but emanate from political concerns. Pressure groups in different industries lobby the government and try to have specific protections put in place. At the same time, however, the international community of states has been involved in trade liberalization negotiations (GATT, WTO etc.) that have been going on for decades already and that should result in the scaling down of the different protection measures. Some success has been achieved so far but the talks are still going on.

Trade liberalization and poverty

One of the aims of these negotiations is the reduction of poverty around the world. But does liberalization of farm trade help the poor? I think it does. Free trade brings down the cost of some products, because it may be cheaper to buy these products elsewhere than to produce them yourself. The cost of producing them yourself may be higher than the cost to produce them elsewhere (e.g. because of the climate in your country, or the available knowledge etc.), even if you include the profit margin of the seller in this cost.

Also, international trade’a0allows countries to specialize in certain products only, and specialization increases productivity and diminishes prices (see also the concept of comparative advantage).

There’s yet another reason why free trade may bring down the price of goods. Normally, if trade is free and restrictions on international trade are abolished, then competition will increase. And when competition increases, prices tend to go down.

So there are several reasons why free trade brings down prices. And when prices go down, consumers pay less. And when people pay less, they are generally less poor.

Import tariffs

Also, when import tariffs are cut in trade liberalization measures, prices for the consumers in importing countries go down, and exports in relatively poor export countries go up. So this would help the poor everywhere, the poor consumers in importing countries, and the poor producers in exporting countries.

However, when import tariffs are cut, local production in some countries will go down because local companies will have to compete with lower priced goods from abroad, lower priced because of the absence of tariffs, but often also because of cheaper foreign labor. With job losses as a consequence and hence more poverty for the people working in certain sectors of the economy. Consumers in general may be better off, but not those working in the industries that were protected by tariffs. For them, the benefits of cheaper products may be outweighed by the financial loss of losing their employment.

Furthermore, the government loses tax revenues when tariffs are cut, and therefore may be less able to provide a social safety net to cushion the adverse effects of competition.

However, most economists believe that removing tariffs and having free trade would be a net gain for society (for some evidence of this see here and here).

Import quotas

Import quotas limit the number of foreign goods that can enter a country and be sold there. This increases the prices of the goods because the supply is limited, and also because many of the foreign goods are cheaper than the local equivalents (mostly because of cheaper labor costs abroad). Restrictions on competition push up prices as well. Eliminating quotas therefore lowers prices and benefits the poor.

However, similarly to import tariffs, quotas protect local producers because they suffer less competition from foreign producers. Quotas can save jobs and therefore diminish poverty. But the people in these saved jobs are less numerous than the total population of consumers who benefit from lower prices (and they are also consumers themselves).

Quotas, contrary to tariffs, do not generate tax revenue, so there abolition would not cut into government benefits.

Export subsidies

Export subsidies depress prices and make it harder for non-subsidized producers, often in the poorer countries, to compete. Many local producers and workers will go bankrupted when the same products that they produce, are freely imported from countries where their production is heavily subsidized, sometimes to the extent that they can be sold below production price.

However, the initial effect of slashing export subsidies is an increase in prices of goods. Take the important example of food prices or prices for farm products. Even in rural societies, most people buy more food than they sell. Slashing subsidies would therefore hurt the poor because it makes it more expensive for them to buy food. The World Bank has estimated that slashing all farm subsidies would lead to a 5% increase in average prices. However, net food buyers are generally richer than net sellers; higher prices therefore transfer income from the rich to the poor, on average. Moreover, even the poor who buy more food than they sell (and those who do not sell at all), may benefit from higher prices for farm products because these higher prices boost demand for rural labor and push up wages for farm workers. The farm sector as a whole grows because of an increase in profitability, and this creates employment.

The World Bank has argued that the net effect of all these elements (price increases because of slashing subsidies, higher wages in farm jobs etc.) is positive for the poor.

Conclusion

Free trade helps the poor, and the ongoing trade liberalization talks in the framework of the WTO should be pursued. But at the same time it should be made clear that free trade is not a miracle solution. Poverty has many causes and many solutions and should be attacked from many fronts at the same time.

The Causes of Poverty (8): Lack of Economic Freedom

Open markets offer the only realistic hope of pulling billions of people in developing countries out of abject poverty, while sustaining prosperity in the industrialized world. Kofi Annan

Africa must be allowed to trade itself out of poverty. Bob Geldof

Human rights do not include a right to have economic freedom or to have a free market. But one can argue that economic freedom is a necessary consequence of human rights and that the absence of economic freedom is an indication of a country’s disrespect for human rights. The right to do with your property as you like, to move freely and to associate freely are all human rights and are prerequisites and causes of economic freedom.

There’s also a strong case in favor of the theory that economic freedom promotes prosperity and hence also respect for economic rights.

Economic freedom consists of personal choice, the ability to make voluntary transactions, the freedom to compete, and security of privately owned property. This is the definition of the Fraser Institute. This institute tries to measure the degree to which the policies and institutions of countries support economic freedom. Their index measures:

  • size of government
  • legal structure and security of property rights
  • access to sound money
  • freedom to trade internationally and
  • regulation of credit, labor and business.

They conclude that economic freedom has grown considerably in recent decades and that economic freedom is correlated with income.

 

The complete list of countries is here. I don’t want to suggest that economic freedom should be absolute. There has to be regulation of markets (for health reasons, safety reasons, reasons of fair competition etc.) as well as political corrections of the effects of markets on issues of social justice, poverty and equality.

Moreover, when discussing economic freedom we shouldn’t only think of the internal structure of states but also their interaction: import tariffs, quota, subsidies and other protectionist measures also inhibit free trade, often at the expense of poor traders and farmers in developing countries.

The Causes of Poverty (6): Foreign Debt

Much of the foreign or external debt of developing countries is unpayable, and exacts a heavy toll. Cancellation of debt can free resources because poor countries have to pay a lot servicing their debt (not so much repaying their debt but paying interest rates on the money they owe). If they don’t have to pay this servicing anymore, the same money can then be used to expand health and education services, improve infrastructure etc.

“Can”, because there is no guarantee that the often corrupt governments of these countries will do so. They can use the money available because of debt write-offs for other purposes. That is why debt cancellation is often conditional. The main lenders of money, the international institutions such as the World Bank and the IMF (“multilateral creditors” which lend money at relatively low commercial rates), and the Paris Club, an informal group of rich lender nations (“bilateral creditors”), impose conditions such as good governance before agreeing to cancellation. They argue that only countries which have met these conditions can guarantee that the money will be spent on development. They also worry that debt relief might be seen as a perverse reward for countries that lack financial discipline.

Others charge that conditionality violates the sovereignty of borrower countries and imposes programs that may create problems for the local economies and for the legitimacy of the governments. They also claim that countries can only establish good governance and fight corruption when they have the money to do so. Any relief must therefore be unconditional. The truth is probably in the middle somewhere, which means that some conditions should be imposed but not too strictly.

The Heavily Indebted Poor Countries (HIPC) initiative was launched in 1996 by the World Bank and IMF to provide relief to poor countries from excessive debt burdens. HIPC identified about 40 countries, most of them in sub-Saharan Africa, as potentially eligible to receive debt relief. Countries deemed eligible have to meet HIPC targets for good governance, curb corruption and fraud, open up their economies and liberalize their international trade. Although it has provided debt relief which is worth billions of $ to many countries, it has still not produced a lasting solution to the debt crisis. Even HIPC countries are still spending more on debt than healthcare, for example.

Although today all parties agree on the necessity of debt cancellation (but not on the method of cancellation), it’s not useless to recall the origins of much of this debt. Poor countries suffer from so-called “odious debt”, the consequence of past or current regimes borrowing money not for the development of their country but for the conduct of wars for example.

In international law, odious debt is a legal theory which holds that debt incurred by a regime for purposes that do not serve the interest of the nation should not be enforceable. Such debts are thus considered by this doctrine to be personal debts of the regime that incurred them and not debts of the state. (Wikipedia)

And even the debt that was initially incurred for beneficial purposes was often diverted by corrupt and undemocratic regimes, institutions and individuals. So, these two facts put together makes it very difficult to maintain that this debt should be serviced.