VIEWS: 15 PAGES: 2 POSTED ON: 8/27/2011
2 ............................. Compulsory CME VOLUME 34 NO.7 J U LY 2 0 0 2 3 ............................. Paradigm Shifts in Organ Transplants M I TA ( P ) 2 0 9 / 0 2 / 2 0 0 2 4 ............................. Spare Parts for Humans SMA 6 ............................. Sharing Your Liver 8 ............................. Slim 10: Fat Hopes? 11 ............................. Thinking Aloud One Evening N E W S To Sell or Not To Sell? By A/Prof Goh Lee Gan EDITORIAL BOARD A ndy Ho’s solution about human in cases involving organ harvests from ANDY HO’S ARGUMENT FOR THE Editor organs in the 30 June 2002 issue the living that may carry substantial PRO-SELLING STAND Dr Wong Tien Yin of the Straits Times is “To save health risks. Andy’s points are: Deputy Editor lives, legalise organ markets.” Indeed, Finally, proponents of prohibition (1) Human biological materials (HBM) Dr Daniel Fung this is an evergreen proposal – push it often dwell on the social risks associated are already regarded as commodities Members down to the business level of buy and with the “commodification” of the body. so there is no difference between Dr Chan Kah Poon sell, and legalise it to make sure no They argue there is value in (a) setting flesh and flour; Prof Chee Yam Cheng one can take unfair advantage of the limits to what can be bought or sold (2) Basic necessities are subjected situation. So, why are we hesitating? in the market as a commodity, e.g. to market forces, so why should Dr Jon Goh The arguments in the debate over the treating flesh differently from flour; and flesh be any different from flour; Dr Lee Pheng Soon buying and selling (“commercialisation”) (b) supporting systems that rest on and (3) Everybody is paid in the transplant Dr Terence Lim of body parts have changed little over promote voluntary giving, especially work, so why not include the donor Dr Oh Jen Jen the years. The following is a summary where the gift is life itself. as well; and Dr Toh Han Chong of the pros and cons from the website (4) The market can be tweaked to take Ex-Officio http://www.debatabase.org. This is a PRO-SELLING out the transactional problems. Prof Low Cheng Hock useful website to visit on the subject of The points for a pro-selling stand are: Dr Tham Tat Yean selling body parts. There are writings Firstly, in the face of the shortage of Andy: “Patients are dying for want of Executive Secretary on the pros and cons and you can even organs and other tissues, with people transplants while we resolutely refuse to Ms Chua Gek Eng participate in the debate. on waiting lists dying every day, the acknowledge that human biological materials Editorial Assistant Broadly, the views of the pro-selling proponents argue that the safety (HBMs) are, in fact, already commodities.” Ms Krysania Tan and against-selling people have been risks associated with payment are Andy: “Invaluable necessities, like summarised on the “debatabase” website outweighed by the benefits of an food, shelter and medicine – basic human into the following points. increased supply. Improved screening necessities – are subject to market forces and testing would in any event ameliorate, every day...Yet no one clamours to remove AGAINST SELLING if not solve, the safety problem. such goods from the market. Instead, Firstly, those who call for prohibition Secondly, according to this theory, efforts are made to help the less fortunate point to the safety risks associated with it is immaterial that desperate financial pay for such goods.” commercialisation, and offer expanded circumstances drive people to do what Andy: “Everyone is benefiting so why The views and opinions expressed in all the articles educational efforts to encourage people they would not do otherwise. If people not the donor as well...So denying donor are those of the authors. to come forward and donate as an are not physically compelled or threatened compensation does not remove HBMs These are not the views of the Editorial Board nor alternative measure to increase supply. with harm as a consequence of not from the market domain – it merely the SMA Council unless Public health concerns clearly motivate selling tissue, then their choice to sell is postpones commercial gain in favour of specifically stated so in writing. The contents of a policy that bans selling of body parts voluntary and the government should healthcare providers down the chain...” the Newsletter are not to be printed in whole or in and even tissues like blood. not interfere. (After all, we permit Andy: “In effect, the donor gives away part without prior written Secondly, there is a fear that people to take life-threatening risks property rights to his organ, which then approval of the Editor. vulnerable populations will be exploited for money in other contexts, i.e. choosing confer significant economic benefits on Published by the Singapore (i.e. the poor and others whose social employment.) subsequent parties...Let us stop fooling Medical Association, Level 2, Alumni Medical circumstances give them few choices Finally, they argue that free markets donors: Legalise the sale of non-vital organs Centre, 2 College Road, Singapore 169850. and little medical sophistication, will are inherently good, promoting the by living persons, and all organs by near- Tel: 6223-1264 become “tissue factories” for the rich). freedom of individuals – and any limits death persons. These markets will improve Fax: 6224-7827 Email: firstname.lastname@example.org These concerns are usually most acute are arbitrary. the quantity and quality of organs available.” URL: http://www.sma.org.sg Page 10 10 Page 1 – To Sell or Not To Sell objections continue even beyond death to health care, selling kidneys would THE COUNTER-ARGUMENTS of the seller. put transplants out of reach for many, TO ANDY’S POINTS and allow the rich to outbid others and Limitations on flesh as commodities People doing transplantation work jump whatever queues might exist.” About flesh as commodities, a quotation are providing a service (Source: http://www.debatabase.org) in a paper from the University of Why deny the donor compensation when Houston Law Centre gives us some all the others connected with transplant MAKING SENSE OF THE perspective: “...Presently, many countries work are paid? The argument is that OPPOSING VIEWS have laws in place flatly prohibiting the the services involved in providing the Both the pro-selling and against-selling purchase or sale of body parts. U.S. law transplantation work come from people sides have a common end-point – namely, has tended to divide body parts into who can be deployed to do other have more organs available. The means categories. Payment for non-regenerative work and provide other services if to achieve that is of course different. The or non-renewable tissues used in there is no transplant work. Hence, the against-selling side achieves the numbers transplantation, such as hearts and kidneys, argument of benefiting these people is through encouraging people to donate. has been prohibited. However, payment not valid. Transplantation work and non- The pro-selling side achieves it through for renewable tissues such as blood, transplantation work are still services fiscal means. What stands in the way of hair and semen has been permitted. rendered and these should be paid. either side are the physical, social and The National Organ Transplant Act, moral risks. Finally, there is the question which applies to any transaction that Market imperfections of flesh being different from flour, affects interstate commerce, prohibits Can the market look after itself? The and should therefore not be treated payment for solid organs. These include market can look after itself if it is a perfect commercially in the same way. organs derived from a fetus as well as market. However, the buying and selling skin, bone and bone marrow. The federal of body parts, if allowed, will be conducted The Gift of the Magi law, like many state laws, includes in a market of imperfect information. At the end of the day, it is the question of imprisonment as a possible sanction. The quantity of organs for the poor may values we attach to the different risks The exception to the no payment rule, be made fewer and well beyond their to the individual and society. The best mirrored in many state laws, permits reach. The quality of organs may be poor way out of the difficulty may be to go reasonable payments associated with as sellers try to sell off what they can back to the big value of giving. Read the transplant process itself (e.g. organ exchange for money. Or, the organs may the “Gift of the Magi” by O Henry to retrieval and implantation) and payments have been procured by violent means. be moved. The message is there. to cover the expenses of the donor The laws can never deal with the such as travel and lost wages.” (Mary complexities of transactions. Hence, the The Nicholas Effect Anderlik, 1998.) oft-quoted saying that “the law is an ass”. To be more direct and specific, there is the It is safer to avoid the slippery slope Nicholas Effect coined by Reg Green, the Basic necessities and body parts rather than to try to stay upright on the father of a little boy of seven, Nicholas, who Is selling flesh the same as selling flour? slope. Imagine trying to stay upright died in a car hijack in Italy while on holiday The argument is that basic necessities on a mountainside covered with moss. from California. The parents decided to that keep us alive are different from flesh On the market perspective, Jeffrey donate his body parts to seven Italians. that come from human beings. The sale Kahn from the Center for Bioethics, This led to an outpouring of love by the of body parts renders the seller less University of Minnesota, has this view, people of Italy and a sharp increase in intact. The harvesting of such desired “We have made a decision not to allow organ donor rates. The father wrote the tissues for the buyer may leave the a market in human organs for a number experience in a book called “The Nicholas donor more vulnerable to disease or of reasons. For living donors, we have Effect”. You can buy it from Amazon.com. injury and sometimes the risk of death. focused on two main issues. First, we It is a touching and transcendent book. One may argue that all the risks are concerned about the exploitation of As one book reviewer puts it, “Here is will be removed if one were to give potential donors. Everybody has a price, a book that will make you cry, make orders to sell the desired body parts and it is unethical to create situations you glad you’re a human, and make after death and instruct the payment where people overlook the risks of you want to do something great.” to be made to individuals mentioned donation to themselves and their family in the will of such a seller. Well, it will (pain, disability, long term effects, BEYOND MONEY still have to counter the argument and even rarely death), for monetary It is good to know that there are some of human dignity, and the moral inducements. Second, we have decided things that are shared not by dollars hazard of being killed for the body as a society that it is unfair to base access and cents, but by love. So should we parts by unscrupulous individuals who to a scarce health care resource on not continue to ban the selling of body stand to gain from the killing. So, the one’s ability to pay. Even with access parts commercially? s S M A N e w s J u l y 2 0 0 2 Vo l 3 4 ( 7 )
"To Sell or Not To Sell "