Body Commerce

I can't say enough good things about The Red Market, by Scott Carney.  This is a short, readable, gripping book about the trade in human parts and wholes--bones, kidneys, blood, eggs, surrogate mothers, babies, hair, and human guinea pigs.  Carney exposes types of commerce you wouldn't have dreamed possible.  For example, a post-Tsunami refugee camp in India where almost all of the women have sold a kidney to support themselves.  Another place in India where poor women make money as surrogate gestators for infertile western couples, spending nine months in almost total confinement.  Another place--once again, in India--where an enterprising dairy farmer ran a live blood bank using kidnapped men who were locked up and drained nearly to death.  Then there's Cyprus, where desperate, light-skinned women are flown in from Russia to sell their eggs to infertile couples from other countries.  And even in the US, did you know there are people who make a living by traveling around from place to place, making a living by participating in clinical drug trials?

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.


Oscar said...

Although perhaps not super on-point, I wouldn't let Singer get away with saying that "the trade-off is that this [companies moving operations to so-called developing countries] helps the poor earn a living" either, any more than selling their body parts or wholes does. The main reason companies do this is so they can pay workers in developing countries significantly less than their developed-country counterparts, and certainly nothing close to even a bare subsistence wage. Not to forget the detestable working/living conditions -- no safety regulations; prohibition, almost always by violent and coercive means (often with the help of the state), of unionism; well below standard housing; and so on -- many of these workers face which are (in principle if not always in fact) not permissible in developed countries.

The only party this benefits is the company, who can keep up profits and minimise all other "expenses", worker or otherwise. Carney is correct to point out the unequal power dynamic at work here between rich and poor, with the latter giving for the former, and I think Singer naively glosses over this in both cases.

I'm reminded of the documentary Mine War on Blackberry Creek, a 1986 short which "reports on the long and bitter United Mine Workers of America strike in 1984 against A. T. Massey, America's fourth largest coal company with corporate ties to apartheid South Africa." The then-CEO of Massey, Don Blankenship, said as much as Singer about their treatment of South African workers in the coal mines they operated there.

Scott Carney said...

Thanks for the thoughtful comments on "The Red Market", Jean. I have a similar reaction to Singer's quote, body commerce is worse that simply trading labor. And yet, since people do buy and sell bodies, what is the proper solution?

Lately I've been contacted by a few people trying to push a bill through congress modifying NOTA to allow commerce in kidneys. I'm conflicted about whether to support it or not. MY feeling is that transparency is the critical issues. Slaughter houses should have glass walls. So too should operating theaters.

Jean Kazez said...

Hi Scott, Great book, and I also enjoyed hearing you on NPR. Your book does something I consider very useful as a starting point--it made me very perplexed. Whatever route you go (donation vs. selling, transparency vs. secrecy) there's a downside. I don't think I could have an opinion without thinking a lot more. Meanwhile, I just heard about a movie about kidney transplantation--


More to think about, though I think this sort of person-to-person altruistic donation is unproblematic, as you said.

By the way, the hair chapter was wonderfully weird. Is there really hair in our food?

Brett Hetherington said...

This is a really-thought provoking blogpost on a book (I think) I'd want to read.

I agree with most of what you wrote Jean, except I want to dispute your view that: "if you sell your labor, you really don't sell your self, unless you're a virtual slave, laboring endlessly or in captivity."

I think quite a lot of work involves a kind of prostitution of the self. Any job where you do things regularly and significantly against your will is a diminution of the self, a debasement of one’s identity.

This was never more apparent to me than when I worked as a supply/relief/substitute secondary school teacher. I remember one hour of my life where I was stuck in a classroom with a small group of 16 year-old English girls who were talking (amongst themselves) about sex and their periods in a way that was hugely insulting to womankind. I am about as tolerant, open-minded and progressive a person as you could find but being unable to block their sordid little banter from my mind (which they happily continued well after I asked them change the subject) was nothing short of the vilest experience.

That day I was convinced that even the most “professional” jobs can feel like being in a sewer. Against your better sense of self.

crystal said...

I once worked in a hospital surgery and remember a time when someone was near death and an orgn donor - people flew in from all over the country to harvest his many parts, including his corneas. I guess this was a good thing but there was something somehow creepy about it, as if he was disintigrating. I wonder where the line gets drawn between a person and their parts.

Jean Kazez said...

Crystal, Hmm, I have an organ donor card, and never thought about "what happens next"--and that quality of disintegrating. Officially I think the corpse is not the person, but it's certainly a very symbolically important remnant of the person.

Brett, When I wrote this I was thinking about my own many horrible jobs (a long time ago), and the fact that even the worst of them had some level of dignity. There's always some skill involved even if minimal--you an do the most mundane thing either well or badly. So the typical crappy job seems to me to have more dignity than making money by selling parts of oneself. I was also thinking about an interesting recent thread about dignity and work at Brian Leiter's blog. Lots of good stuff to read there--


Jean Kazez said...

About work again--I meant to give an example, not just repeat what I said in the post. My job at Burger King as a 16 year old. Dreadful, but I must say I'm very good at operating the milkshake machine. I don't think I'd be able to have any pride at all if I were making money by selling my parts. They're not under my control in the same way that my labor is, so there's no possibility of pride.

Brett Hetherington said...

Jean, I think what you say about finding dignity and pride in even mundane jobs is a good point. I'm not sure I could sustain that attitude if I was just repeating the same basic task day in and day out but i have a lot of respect for anyone who can.

It's easy to see how extreme poverty and/or desperation could drive someone to sell body parts. There's more ethical good in doing that though than in managing a hedge fund for some international criminal.