Reader Austin Donisan has a long comment worth reading in response to my post on why kidney markets might offend me. I’m not going to engage with every single point Donisan makes, because in doing so I would be repeating myself (please read the post which started this discussion). But let me make a few responses in any case.
First, Donisan suggests I have “an a priori opinion on the matter of paid organ donation.” Well, yes, I do. As I stated in my last post, I have a strong, instinctive revulsion to the possibility of poor folks in this country, in these times, selling their kidneys for pittances; my revulsion is not directed toward paid organ donations per se. Call it a preference if you like; no worries. But do indicate what my preference is for in more specific terms.
Second, Donisan is too keen to convince me in economic terms; that is not going to work in this situation. You are asking me to make commensurate two scales: one, which measures markets in terms of efficiency; the second, which reacts to markets in less tangible terms like distaste. We might be talking past each other.
Third, Donisan says:
The ability to donate a kidney may be poor’s biggest comparative advantage, and comparative advantage is the only way to get ahead in the world.
So, presumably, the best way to help the poor would be to encourage them to sell their kidneys. This doesn’t sound right to me; I can think of many other strategies that would enhance the “comparative advantage” of the poor, which do not require them to sell their vital organs.
I’d like to evaluate kidney markets in a broader context and Donisan wants to make the context narrower; it will enable a market-based argument to go through, but it does so at the cost of making the argument uninteresting to me. A poor man selling a kidney in the US today is just an abstract agent seeking comparative advantage for Donisan; not so for me.
Anyway, I’d like to stop repeating myself and let Oscar Wilde have the last word. So, from Lady Windermere’s Fan, Act 3:
CECIL GRAHAM. What is a cynic?
LORD DARLINGTON. A man who knows the price of everything and the value of nothing.
CECIL GRAHAM. And a sentimentalist, my dear Darlington, is a man who sees an absurd value in everything, and doesn’t know the market price of any single thing.
Samir Chopra 
That’s fine to have an instinctive revulsion to something, we’re human after all. But opinions on what’s acceptable or not changes over time. Charging interest on loans used to be morally unacceptable, while slavery was just fine. In “The Wealth of Nations” Adam Smith included a list of things it was disgraceful to pay someone to do: acting, singing, and dancing.
With an economic argument, it’s hard to get someone past their repulsion to something. If the idea of selling an organs in order to pay for necessities is repulsive for you, that’s likely not to change. But laws based on repulsion are almost always terrible laws.
For example, I find the idea of eating insects repulsive (I can’t even look at the Wikipedia article on it), and most Americans probably agree with this irrational, learned preference. It doesn’t matter that they’re cheap protein, I think they’re disgusting and so I won’t eat them; that’s part of my indifference curve. I find the idea of having to eat insects far more repulsive than selling a kidney to buy “real” food. Even some people who don’t think selling kidneys should be legal probably agree with that.
But should our repulsion to this practice stop other people who have different indifference curves? It’s easy to claim such a law would be helping them, after all, it’s repulsive to even think about other people eating insects, while at the same time it’s obvious that a ban would hurt these very people. But isn’t that what a ban on selling kidneys is? You are trying to impose your utility function on someone else, which in your opinion makes them better off, but in their opinion makes them worse off. There may be times for this (minors, bad parents, etc.), but at some point people need to be able to make their own decisions.
This concept of “utility” is maybe the greatest crime perpetrated on the world by economists. It’s nothing more than an acceptable way of washing your hands of responsibility to discuss substantive questions by claiming that every human action is the result of some unknowable but all-powerful governing self-interest. “He performed the action, therefore the action was beneficial to him.”
BULLSHIT.
This is not about indifference curves. This is not about someone deriving more pleasure from grilled cheese sandwiches than from beans, and someone else preferring the opposite. The issue here is the injustice inherent in the system that creates a world in which indifference curves about selling one of your vital organs for a measly $2500 can be different.
YES, some people would derive greater “utility” from $2500 than I would. And yes, some people are in dire enough straits that that $2500 could, for a moment, appear to be a lifesaver. And that is part of the problem with allowing organ markets. Doing so creates a situation where we (people who do not live in a situation that shifts our indifference curve to consider $2500 for a kidney to be a good deal) wash our hands of responsibility for changing underlying inequities in the system by creating so-called “opportunities” for the poverty-stricken to “help themselves.” That should be criminal, frankly.
And then the free-marketers come around with their bullshit utility arguments AGAIN on the other side, and tut-tut about the behavior of the poor, whose indifference curves are just so different from ours. Oh well, nothing can be done about that – it’s just the mystery of rational self-interest. Who knew people could be so different from each other?
All of this so-called logic does little other than whitewash the fact that it’s not a question of individual preference, or otherness, or fucking indifference curves. These issues are situational, not personal. They are understandable, discussable, actionable – not cordoned off behind some unassailable wall of personal preference.
What I can’t separate from the kidney market question is the issue of scarcity. Is selling sperm a problem? Nope. Selling eggs? Seems ok, although the procedures are more invasive – it also pays more. Hair? Pfft, totally fine. If someone could make a buck selling their fingernails, I’d be down with that, too. But selling a kidney? Not only is its function more vital than any other example (although I would also be against the sale of fingers for money, or ears, or teeth), it’s more scarce. You only get two. To me, that has a significant impact on the question of whether or not it’s ok to sell a body part.
Should selling your appendix be legal? (Pretend there’s an eccentric rich guy who likes to collect them. Or some lab needs to lots of experiments. I don’t think the reason matters.) It’s a completely useless body part, but you only have 1.
I think most people’s gut reaction is that it would be fine. This is because giving up your appendix doesn’t affect your life. But here’s the thing, neither does giving up a kidney, or half your liver, or your wisdom teeth.
That you mentioned ears and fingers (let’s throw in eyes while we’re at it), yes giving up these would affect your quality of life. This opens a whole bag of worms that I avoid with the kidney argument. I mean all sorts of crazy scenarios. I don’t think think a free market approach here is the way to go, but I really don’t know/haven’t thought about it.