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Your Organs for Your Liberty?

South Carolina state legislators are considering a bill that would allow prisoners in the state to have their sentences reduced in return for organ donations. Short of outright physical coercion, it is hard to imagine a more blatant violation of the principle of altruism and free choice behind the nation’s organ donation system.

The federal law governing organ donation seeks to prevent exactly this kind of pressure on potential donors. It prohibits any “valuable consideration” in return for organs, and advocates of the new South Carolina bill are trying to figure out how to word their legislation in a way that doesn’t violate that provision.

What they have in mind is profoundly unethical. Offering a reward for organs to a vulnerable population under the control of the state is an appalling violation of the dignity of these prisoners. Even proponents of voluntary markets in organs must see that this extension of their idea makes a mockery of the principle of uncoerced choice.

And yet none of the legislators interviewed by the Associated Press seem to see a problem. The only thing holding them back is concern about violating federal law. One Republican state senator told the AP, “We want to make this work, we really do, but I want to make sure no one goes to jail for good intentions.”

The story offers a revealing glimpse into the attitudes that underlie a lot of our public-policy debates about medical research and medical practice. The fact that potential therapies are involved—that people could be healed—turns the argument into an emergency situation, where the rules of triage govern rather than the rules of sensible and ethical public policy. This is sometimes appropriate, but too often it causes a total loss of perspective and limits. The bill’s chief sponsor, Democratic state senator Ralph Anderson said, “I would like to see us get enough donors that people are no longer dying.”

This is an unusually terse and blunt expression of the utopianism behind our highest hopes for modern science, and of the dark side of letting that utopianism overtake our good sense. The rules of ethical policy making can be suspended, it seems, until people are no longer dying. But of course the tragic fact of human life is that people will always be dying. And for too many people in too many instances in our politics that seems to mean that when it comes to biomedical research and practice, the rules of ethics should therefore always be suspended, so that in effect there are no rules at all. This is no way to march into the age of biotechnology.


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