Consequentialist Bioethicist Is Proud of Efforts to Restrict Organ Donations

Much thanks to Virginia Postrel for her continued blogging on the need for a free market in organ donations (kidneys, etc.). A recent posting -- with the awesome title And How Many People Did That Kill, Art? -- links to an interview of bioethicist Art Caplan of Penn. Although Caplan's views seem to be a mixed bag -- for instance, he rightly was against government intervention in the Terri Schiavo case. But when asked what debates he has most influenced, he leads off with "I was involved in the National Organ Transplant Act. I single-­handedly held up the movement toward creating markets in organs." Hence the superb blog title from Postrel.

Later in the interview Caplan states that: "I'm a consequentialist: I'm looking at outcomes. I'm trying to decide if a particular policy--such as allowing surgeons to do face transplants--would do more harm than good."

So apparently he thinks that opening up the current organ donation regime will do more harm than good. He is against more people donating organs that save lives and save people from pain and misery (e.g., kidney dialysis), because that is exactly what a free-market in organ donation would lead to. If you let people gain value from their donations of part of their body (which more than anything else is their property, remember), far more people will do so -- living people would be more willing to donate a kidney, and far more people would sign up for organ donation upon their death if they knew that their family would receive some financial payment in return. And such a free-market system would also remove the stigma associated with people selectively giving to particular individuals (friends, relatives, etc.) instead of giving through the regulated system to a complete stranger. Caplan is against all that it seems, because his analysis is that somehow it would do more harm than good.

But, as with all consequentialists, the important question to ask is: more harm or good, for whom? Certainly the people who will get organs that they wouldn't otherwise get (many of whom will die much sooner as a result) will experience only massive good from a free-market in organ donations.

Actions and events are good or harmful to individuals, and there is no "ethical value" common denominator that a consequenialist can use to compare "good/harmful for me" vs. "good/harmful for you". There are no numbers to add up, no comparisons that can even be made. To use a cliche, it is apples and oranges here. And that is all the more obvious in a case like organ donation, where lives are directly at stake. How does Caplan add up evaluations, what he calls the good and the harm, across millions of people? How does he rate Person X's life being saved by an organ donation that wouldn't otherwise have been made, or person Y's life being significantly improved in similar fashion... how does he compare those, and to what? What is the harm on the other side of the ledger that he thinks outweighs the good for persons X and Y? And even if some other person is somehow harmed (?), what is the evaluative common denominator by which he can legitimately compare it with the good for persons X and Y?

That is a rhetorical question of course. It simply can't be done -- this is the critical, fundamental flaw in consequentialist schemes in ethics (other than agent-centered consequentialism, such as ethical egoism). There is no way to add up the good/harm for two or more people, or otherwise compare the consequences for each, because all such good/harm is always "good/harm for the particular person". This is simply a fact about the nature of value: the very concept of value presupposes answers to the questions "For whom?" and/or "For what?". (Note: I'm not advocating ethical subjectivism, in the sense of whatever a person chooses to do is therefore "good" for them. Rather, I'm saying that whatever is objectively good for a person can only be said to be "good" in the context of that person, and you can't compare goods and harms -- consequences -- across persons.)

Perhaps it is too much to try and nail down Mr. Caplan on an answer anyway, as in the interview he also states: "In general, I'm not looking for fundamental truths when I discuss ethics. What matters is what is most practical at a given time. I ask, "What are the bene­fits and costs?" And I understand that the answer will change over time."

So his consequentialist answers are not only incoherent at any point in time, but will also change over time, based on pragmatism. Wow.