The book continually probes the question what's wrong with all of this--at least if you subtract the criminal elements. One problem, stressed throughout, is the direction of commerce--
Inevitably red markets have the nasty social side effect of moving flesh upward--never downward--through social classes. Even without a criminal element, unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.That's the image, over and over again--people who are absolutely desperate, so give up a body part, or their whole bodies over some time period, to an affluent person with a health or fertility problem. In many cases there are prohibitions on selling babies and body parts, but middlemen who facilitate the transaction are allowed to profit. They then have a huge incentive to find more "donors" and pay them, but under the table, and not a fair price. So lots of money is made--by fertility doctors in Cyprus, and by companies that procure and extract eggs, for example. The infertile couple winds up with a child. But the desperate woman who gives up an egg is left with a token payment.
Carney's proposal is total transparency. Every body part or baby should come labeled, so all can see how the donor was treated, what she was given or not given, whether she was kidnapped or confined, whether the transaction was wholly voluntary, etc. This reminds me of what Michael Pollan says about how slaughterhouses ought to have glass walls. We should know what we're doing when we engage in body commerce, or not do it.
You get the sense, though, that Carney would really like to see no commerce in body parts. He doesn't explicitly say so, but he paints a picture of the Indian kidney donors and surrogate mothers, the Russian women flown in to give up their eggs, the itinerant human guinea pigs, that's repulsive. The whole thing is in some fundamental way illicit--and that's the ethical puzzle that runs through the whole book. Is there something just basically bad about body commerce?
This would make a great book for an ethics class, because it would be awfully interesting to look at that question from a many different moral perspectives. You'd understand the perspectives better and make headway with the question.
Half-way through the book, Carney says he emailed Peter Singer to find out what he thinks about selling eggs, and Singer responds--
I don't think that trading replaceable body parts is in principle worse than trading human labor, which we do all the time, of course. There are similar problems of exploitation when companies go offshore, but the trade-off is that this helps the poor earn a living. This is not to say there are no problems at all--obviously there can be--and that is why doing it openly in a regulated and supervised manner would be better than a black market.I'm inclined to disagree that trading body parts is no worse than trading labor. First, precious as it may sound, there's a certain amount of dignity in labor, even of the lowliest kind. By which I mean: you can do a job well or badly, even if it's the worst possible shit work. There's pride in doing well, even if you're doing well at something you'd rather not be doing. There isn't this sort of dignity in letting a surgeon extract some part from your body.
Second, if you sell your labor, you really don't sell your self, unless you're a virtual slave, laboring endlessly or in captivity. But your parts are you in some basic way. I think that's what's so creepy about the image of (for example) the Indian village where all the women have given away a kidney. They have nothing else, so they've (sort of) started selling their own selves off, bit by bit.
But OK--Singer was talking about eggs, not kidneys, and though they're not actually replaceable, they're both surplus and tiny. Do you really sell yourself by selling an egg? Not in quite the way selling a kidney or another major organ is selling yourself. But eggs turn into children, if they're sold, fertilized, and gestated. My child, myself? There's something to that.
So it seems to me selling body parts really is more troubling than selling one's labor. It is experienced as degrading, and for good reason. (Giving away a part to a friend or family member, for completely altruistic reasons, is another matter.) But what should be done about it, considering that a black market develops, and middlemen exploit donors, if selling body parts if legally prohibited?
Hard question. Good book.