Kant on organ donation

Elisabeth asked:

What would Kant say if keeping a promise or fulfilling a duty, and using oneself as an end, conflicted? For example, someone selling their kidney in order to use the money to buy life-saving surgery for their child?

Answer by Paul Fagan

Here we are faced with a conundrum that pushes us into the world of contemporary medical ethics. However, by just concentrating upon Kant’s opinion, the fact that Kant was never faced with such a situation would mean that we would be foolish in assuming that we would know what he would ‘say’ with complete certainty.

Nevertheless, by applying a very reduced version of deontology, we may say that we should never be using others as a ‘means’ to an ‘end’. And in the example provided, voluntarily using oneself as a ‘means’, by selling a kidney would seem to be acceptable. Moreover its status as a dutiful and moral act would seem to be reinforced as it allows two others, the child and the recipient of a kidney, to be treated as ‘ends’. Hence, I cannot see any conflict here: of course, all of this rests on there being no risk in any surgery involved, the kidney’s donor retaining a working kidney, and the kidney’s recipient being easily able to afford her purchase.

That said, there may be other reasons why this situation would fall foul of Kantian reasoning, and this may be unveiled by focussing upon a famous line from Kant’s Grounding for the Metaphysics of Morals:

Act only according to that maxim whereby you can, at the same time, will that it should become a universal law.

Following this, we may ask, could the aforementioned organ-swapping scenario ever become a universal law by which we could all live? I am not sure that it could. Furthermore, I am immediately reminded of a thought experiment, referred to by some as ‘The Eyeball Lottery’, that may provide strong intuitive arguments against instituting such a law.

The thought experiment goes as follows. Imagine that a completely, safe operation is developed to transfer eyes from the sighted to the blind allowing the latter to see. A society that wished to give all of its blind citizens some sight may then institute a lottery whereby all two-eyed citizens donate an eye when their number comes up. Although, some persons would willingly donate eyes, others may recoil at being forced to donate an eye, and would consider any forced ‘donation’ to an assault (and at  least two interesting websites are available for further reading concerning this matter: https://www.theadvocates.org/2014/12/eyeball-lottery-powerful-argument-self-ownership/ and https://mises.org/library/self-ownership-freedom-and-equality-ga-cohen).

Hence, although benefitting two persons by a personal sacrifice may seem laudable, many may feel that attempting to engender widespread acceptance of such a sacrifice is distorting any duty we have to others. Even where medical procedures are totally safe, any theorising promoting the normalisation of organ transfers from living donors would have its detractors and could not possibly expect to gain unanimous agreement. At present, the provided scenario is one area where medical ethicists may hope to make progress and set tentative norms.

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