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Monday, May 9, 2016

Should Bad People Be Allowed to Save Lives?

Kidneys, Markets, and Altruistic Motivation

Many  people believe for-profit kidney sales are wrong because they think people who save lives ought not be motivated by self-interest.*

There are lots of problems with this thought. Does it imply that competent and skilled surgeons (firefighters, nurses, police officers, EMTs, etc.) who are just in it for the money, or who are significantly motivated by personal gain, ought not take the job?

Suppose Helen is a sociopath who doesn’t care about others. She would all things equal prefer to be a fighter pilot, because that’s the job she most intrinsically enjoys. She thinks the life of a surgeon sucks. But suppose she would be an excellent surgeon. She decides to become a surgeon just because it pays better. As a result, she saves many lives. By hypothesis, Helen has bad character, but it seems weird to say that she’s done anything wrong, or that she should not become a surgeon for the money.

Consider a variation of Singer’s drowning child thought experiment:

Three toddlers are drowning in three different pools.

In the first case, a person says, “I value the toddler’s life for its own sake, and I am willing to save the child without getting a reward.”

In the second case, a person says, “I am willing to save the child only if I make a small profit. $10 will do it.”

In the third case, a person says, “I am not willing to save the child myself — I can’t be bothered to do so, because I don’t care enough about other people. However, I think the idea of saving a child for profit is evil. So, in addition to not saving the child myself, I’m also going to make sure that person 2 doesn’t save the child for $10 either.”

The first person is the most noble. The second person isn’t noble, but at least he’s willing to help people for money. The third person, it seems to me, is vile and rotten. He uses moral language, but he is himself a morally contemptible figure. He refuses to help a child himself, and also, at the same time, stops less than fully virtuous people like person 2 from saving children.

Many opponents of kidney sales strike me as being like person three. I’ve given the Markets without Limits talk in front of about 3,000 total people at this point. I’ve always ask if anyone has voluntarily given another person a kidney. So far, no one has, even though it’s reasonable to estimate that at least 2,700 of the audience members I’ve encountered were healthy enough to do so, with little to no long-term health costs. So, one thing I know about the audience members I’ve encountered (including those at left-wing places like Boulder or Hanover) is that they don’t care enough about strangers to save their lives by donating a kidney.

But many of them do not simply fail to save lives themselves. They also express moral outrage at the idea that a person might donate a kidney in order to make a profit, rather than out of a desire to help.

Perhaps donating a kidney out of altruistic motivation is nobler than selling a kidney for profit. But, even if we grant that, it still seems that a person who is willing to save a life for money is (all other things equal) better than a person who is not willing to save a life, either for money or out of the goodness of her heart.

“I won’t save a life that way, and no amount of money could get me to do it” seems to me an admission of deep moral depravity. “I won’t help, even for money,” is a badge of dishonor.

Of course, there are other objections to kidney sales besides the one I’m considering here. People think kidney sales involve exploitation, the misallocation of resources, coercion, etc. But, as Peter and I show in our book, these are at worst contingent problems that could easily be regulated away in a legalized kidney market.

* One of the first things you learn in moral theory is that the moral status of an action and of the motivation behind that action can come apart. A person can do the right thing for the wrong reason or the wrong thing for the right reason. For instance, suppose I rescue a drowning toddler, but only because I mistakenly believe the toddler is the next Hitler. My motives are bad, but my action was still right. Or, suppose a parent gives her autistic child a bleach enema because she falsely believes that will cure the disease. Here, her motives might be good, but her action is wrong.

 I always ask people if they would be willing to sell a kidney for various amounts of money. Two trends I’ve noticed: Young people seem more willing to sell than middle-aged people at any given price. That’s not surprising. The other: people at very left-wing universities are far less willing to sell than people at more moderate universities (or, to be precise, less willing to admit they are willing to sell).

  • Jason Brennan is the Robert J. and Elizabeth Flanagan Family Chair at Georgetown University. He blogs regularly at Bleeding Heart Libertarians.