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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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Votes. Sex. Addictive drugs. Toxic waste. Life-saving medicine. Credit derivatives? Some things should not be for sale. The limits are moral, argues political philosopher Debra Satz. Even the staunchest proponents of market systems are revolted by the thought of a state-regulated exchange in, say, crystal meth or kidneys. But what exactly makes a market noxious? When, and for what reasons, is it appropriate to ban trade altogether?
Satz is guided by two major impulses in her work. First, an idea in classical economics: labour markets shape and change their participants. Second, she follows the egalitarian vision that individuals are moral equals in any just society. Against "general egalitarians," however, who argue that marketplace inequities should be corrected by the (re)distribution of resources (in a tax-and-transfer policy, e.g.), Satz contends that certain market choices ought simply to be disallowed. Markets have a role to play in advancing social equality, but they can also exacerbate asymmetries of power and cause suffering. Trying to assess "the" market in abstraction is not very illuminating.
This work is intended primarily for a scholarly audience. Satz spends two chapters dealing with "intramural issues," as she puts it, in political philosophy and economics. Yet her writing is not overly technical, or bogged down with jargon. Anyone who is interested in the role and scope of markets in broader society will gain from Satz' investigation.
She examines several particular markets in detail: women's reproductive labor and sexual labor, child labor, bonded labor and kidney transplants. These cases poke at our gag reflexes, so to speak. Satz uses them to identify four parameters of a "noxious", or morally objectionable, marketplace. (1) First, when an exchange relies on the "weak agency" of some participants or (2) their relative "vulnerability." Also, when an exchange produces (3) extreme harms to the individual or (4) extreme harms to society. "Scoring high" in any one of these categories makes for a noxious marketplace. However, the parameters admit of degrees, and there is no straightforward calculation of harms or benefits.
Consider the case of the kidney as commodity. In every nation in the world but one (Iran), it is illegal to sell your own kidney. In America alone, tens of thousands of people die annually waiting for a kidney transplant, and the rate of the disease is rising. One person is added to the waitlist every 13 minutes (Goodwin 2006, 6). Not surprisingly, international black markets in human organs are thriving. Some experts
propose that a regulated market in kidneys is preferable.
Satz evaluates trade in kidneys according to her four parameters. (1) Current sellers appear to have "weak agency." The supply of kidneys on the black market comes mainly from people who live in impoverished conditions and lack follow up medical care. They are not informed about how they are likely to fare with one kidney. Satz safely assumes these individuals incur significant risks by selling a vital organ. Indeed, in one study, nearly 80% of sellers in India regretted their decision (Satz 196). Why were they willing to sell a body part? Sellers are desperately poor, and therefore (2) relatively vulnerable participants in the exchange.
In theory, a properly regulated kidney market could guard against weak agency, vulnerability and harms to individual buyers and sellers. If parties were fully informed, received proper medical care, and sellers were not desperate, would an international trade in kidneys still be noxious? Let's look at Satz's fourth parameter: the harm a widespread kidney trade might do to society. Buying and selling kidneys affects the nature of the choices available to everyone. Where selling a kidney for money is seen as a feasible option, healthy kidneys start to look like collateral. People are pressured to turn their over their bodies; those who can't or won't do so pay the cost with creditors. In economics speak this phenomena is called a "pecuniary externality." Should people be penalized for an unwillingness to sell their organs?
Satz says no. She follows Ronald Dworkin in drawing a "prophylactic line" around the human body. The body is as if inviolate and "body parts [are] not part of social resources at all" (200). Kidneys are not commodities like apples. Is this a strong enough reason to block their sale/purchase? Satz herself is "a bit tentative" (200) to prohibit selling because the welfare of the many who are dying of kidney disease also has moral weight. However, she concludes that a competitive market in kidneys should not be legalized.
Throughout the book Satz pits moral considerations against black and grey markets. Her point of departure, that markets influence the kinds of people we are and the capacities we have for political action, deserves attention. In egalitarian societies, markets that render classes of individuals vulnerable or diminish their future freedoms are indeed problematic. In today's world of globalized marketplaces, assessing (potential) market exchanges in terms of the broad category of "society" is fraught, though. What is suboptimal for kidney sellers in the developing world is optimal for dying Western patients. Are the harms to individual sellers offset by the benefits to individual buyers? There is no one "society" within which these harms and benefits can be measured, let alone judged.
The condition of "weak agency" is also more complicated than Satz makes out. A bevy of literature about rational choosers reveals that a majority of us are "weak agents" when it comes to predicting the future consequences of our actions. Market exchanges commonly encourage people to act against their best interests and the best interests of future generations. (Hello fast food advertising, oil-based plastics manufacturing, subprime mortgage speculation...) It's not "weak agency" that distinguishes "noxious" markets from benign ones. As Satz herself admits, the real problem comes when "extremely harmful outcomes" befall sellers or buyers.
Extreme suffering or harm is a moral problem in any context. For too long modern economic theory has exempted market exchanges from moral and political analysis or, worse, presumed that trade tends inevitably to generate conditions of autonomy and equality. Satz's inquiry is valuable antidote. Deliberate, thought-provoking and admirably lucid.
Michele Goodwin, Black Markets: the supply and demand of body parts. (New York: Cambridge University Press), 2006.
© 2011 Karen Kachra
Karen Kachra holds a PhD in Philosophy from Northwestern University. She is a writer of fiction and nonfiction and an independent scholar who lives in Oakville, Ontario. To view her publications and sample her work, visit her author's website at www.karenkachra.com.