Organ Trading: A Christian Perspective
by Dr Roland Chia
The recent case of two Indonesian men, who were prosecuted for selling their kidneys, has sparked a robust debate on the question of whether Singapore should legalise the sale of human organs. In an article in The Straits Times (21 July 2008), Health Minister Khaw Boon Wan was quoted as saying: “Let’s push within the current regime … but at the same time, let’s not write off an idea just because it sounds radical or controversial … We may be able to find a compromise which is workable and yet does not offend people’s sensibilities’.
A spate of articles on this issue was subsequently published in The Straits Times, many of which argued in favour of the legalisation of the sales of human organs on the humanitarian basis that such a legislation will save many lives by increasing the supply of transplantable organs. In an article titled “S’pore can take lead in legalising organ trade” published in the 17 July issue of The Straits Times, Jennifer Yeo and Madan Mohan argued that organ trade is a “social relationship … which gives a new lease of life to both stakeholders”. For this reason, they maintained that the “law ought not to step in to criminalise and punish such relationships”.
What is the Christian perspective on the issue of the trading of human organs? Obviously, the Bible does not address this issue directly. A Christian response must therefore enquire into what the Bible has to say about what it means to be human, what is the moral status of the human body, and what are the implications of putting a price tag on the human body and its parts.
The moral status of the human body
In many discussions on the legalisation of human organ trading, the practical arguments that such a move would save the lives of many who would otherwise die is very compelling. This very pragmatic and pressing concern has meant that theological and philosophical questions are sometimes brushed aside. The Christian reflection on this issue, however, must take these theological and philosophical questions very seriously. We must at the outset recognise the fact whatever conclusions we may arrive at, and whatever policies we may propose, they are all undergirded and shaped by a philosophical position. This is true even if these philosophical presuppositions are not clearly thought through or articulated.
Modern medicine views the human body as possessing instrumental value in that it is a resource from which patients, physicians and researchers may benefit. This instrumental view of the human body is undergirded by Cartesian dualism that views the body merely as an extension of the “essential self”. This Cartesian metaphysics has in turn resulted in a materialistic view of human body, according to which the body is seen merely as a property at the disposal of its owner. Such a materialistic account of the human body has led some to conclude that its commodification and commercialisation does not pose any ethical problems.
The Christian understanding of the moral status of the human body is radically different from this. According to the Christian faith, the human being is a psychophysical being, made up of body and soul. The body, therefore, cannot be viewed merely as an extension of the essential self. Rather, the body is part of that self, because the human being is essentially an embodied being. The best of Christian tradition therefore places much significance to bodily existence. According to the Christian faith, it is not accurate to say that we possess bodies. Rather we must say we are our bodies. Embodiment therefore is a vocation, a way of being that expresses the original intention of God, our Creator.
The living body locates the person in time and space. I am not at home listening to Mozart because I am here talking to you. My presence in this place is a bodily presence: you know that I am here because I am physically i.e. bodily, present. The living body also differentiates a person from other persons. Thus, the body makes it possible for others to “find” this person, and also to identify him or her. But it is also pertinent to note that our bodies enable others to find us not merely as things or objects, but as persons who are unique and precious bearers of the image of God. The body is therefore inseparable from the individual “I”.
In many ways, this intuition regarding the status of the human body is not exclusive to the Christian faith. It is also found in modern medicine, even though modern medicine is so profoundly infused with secularism. In conventional medical practice, doctors are strictly prohibited from invading the bodily sanctuary without special authorisation and without good reason. In the literature of medical ethics such acts are often described as intrusions, trespasses and even pollutions. In addition, even those who have been authorised to make such access must conform to appropriate conduct governed by the common rituals of medical practise.
The identification of the body with the person has also influenced the way in which we view a corpse. Even though we understand that a corpse is the mortal remains of the person we once knew, we cannot look upon the corpse without thinking of the person with the network of relations associated with him or her. The human body is always the body of a person. It should never be treated as a merely physical or biological entity.
The body as property
This brings me to another important image of the human body that we find in modern medicine and culture: the body-as-property. This image is often supported by a metaphor that is used by doctors and the media when referring to the procurement of human organs, namely, salvaging. When the image of the body-as-property is wedded to the metaphor associated with machinery, the result is the view of the body as simply an entity from which different parts can be dismantled and used. The body-as-property can therefore be dis-organ-ised. But this view not only has the potential to mislead, it also has the potential to reduce the human body and its parts to mere commodities. Rejecting this metaphor taken from manufacturing, Alan Rubenstein, a member of the United States (US) President’s Council of Bioethics, asserts: “Human organs … cannot be ‘ordered from the factory’ like fuel injectors can”.
Here is where Paul’s description of the human body is instructive. Paul uses the profound metaphor of “temple” to speak of the human body. Writing to the Christians at Corinth, Paul asserts: “Your body, you know, is the temple of the Holy Spirit, who is in you since you received Him from God. You are not your own property; you have been bought and paid for. That is why you should use your body for the glory of God” (1 Corinthians 6:19, 20). Because the body is the temple of God’s Spirit, we must exercise proper Christian stewardship towards it. And although Paul does allude to the body as property, he emphasises that its owner is God. We do not own our own bodies. God does. We therefore do not have the right to dispose of our bodies, and its parts according to our wishes. Thus, Paul’s reference to the human body as the “temple of the Spirit of God” urges us to view the body in a particular way, to acknowledge its sacredness. It also invites us to reflect on the responsibilities we have for our bodies and for the bodies of others. As Courtney S. Campbell puts it in her article for The Hastings Centre Report:
The temple imagery sought to establish a middle path between these alternatives by calling forth a fundamental disposition of reverential awe toward the “sacred space” of the body, and a sense of both restrictions and responsibilities regarding what may be done with, by, or to that temple by oneself or others.
A close reading of the 1 Corinthians passage therefore suggests that it is theologically legitimate to use the metaphor “property” to describe the human body, so long as we qualify this in the way that the passage does. Thus, although the Christian faith accepts the view that we human beings experience our bodies as what we are as well as what we possess or have, it insists that the body is a distinctive kind of property or possession. According to the Christian faith, to say that bodies are our possessions does not imply that we “own” our bodies. Possession alone is an insufficient criterion for ownership. Similarly, although we may see the human body as property, we must also make an important qualification. Based on the Bible, Christians must say that although we possess our bodies, we do not own them. “You are not your own property”, Paul says, “you have been bought and paid for. That is why you should use your body for the glory of God”.
The problem of commodification
We now come to the heart of the objection to the trading of human organs. To allow the sale and purchase of human organs is to reduce these human body parts into mere commodities, like other commodities transacted commercially. Based on what I have said about the profound relationship between the person and his or her body, the trading of human organs would result in the commodification of human beings. To commodify human beings is to fail to accord him or her with proper respect and dignity. To commodify something is to exchange it for money, to treat it as a property that can be bought or sold. To commodify a human being is to treat a being of profound dignity and worth as a mere object to which a price tag can be arbitrarily attached. Donna Dickenson explains the implications of this clearly in her book, Body Shopping: The Economy Fuelled by Flesh and Blood:
What is wrong is making a saleable object out of something that should be treated as having value in itself, irrespective of what use might be made of it. Because people have value in themselves, parts of people, you might think, would be particularly problematic. If it’s wrong to make people into objects or things – as slavery does – and if the body is the person, then is it wrong to trade in bodies and their parts?
The answer, of course, is “Yes”. According to this view, to pay a person for his kidney is already to violate his dignity and exploit his personhood, regardless of how handsomely he is paid for the organ. Thus, exploitation does not only occur when the poor are poorly paid for their organs because of unscrupulous middlemen in the black market for human organs. It occurs whenever money is offered – however large or small the amount – as payment for a human organ. As Leon Kass, the former Chairman of the US President’s Council on Bioethics has put it so provocatively:
We surpass all defensible limits of such conventional commodification when we contemplate making the convention-maker – the human being – just another one of the commensurable. The end comes to be treated merely as a means. Selling our bodies, we come perilously close to selling out our souls. There is even a danger in contemplating such a prospect – for if we come to think about ourselves like pork bellies, pork bellies we will become.
Conventional wisdom tells us that some things are simply not for sale. There is, of course, nothing wrong with commerce. In fact, commerce has brought about human flourishing. But this is true only when human life itself is not turned into a commodity. As the Lutheran ethicist, Gilbert Meilaender has so perceptively pointed out, “if we allow ourselves to suppose that [money] is a universal medium of exchange, we are bound to lose our moral bearings”. Society recognises this very well. That is why most societies respond to slavery and prostitution with revulsion. And that is why society recognises that the public offices, the criminal justice system and human beings are not for sale. To this list, we must add the human body and its parts. The French National Ethics Committee makes this point emphatically when it states that it categorically “does not accept that the human body should be used for commercial purposes”.
Selling and donating
Selling our organs for financial gain is profoundly different from giving or donating our organs for the good of the recipients without expecting any rewards. The relationship that we foster in a business transaction is very different from other relationships. The business transaction is based on demand and supply, but it is not just a matter of supplying something in order to meet a demand. When I sell something that you need to you, my motivation is not merely to enable you to meet that need. My motivation is also to meet my need. Thus, I am only willing to meet your need if in return, my need will be met. If my need is not met, I will not take steps to meet your need. Although a commercial transaction may be many things, it is always a quid pro quo relationship. A business transaction, strictly speaking, can never be seen as an expression of unconditional or self-sacrificial love.
Giving or donating one’s organ is very different. In donating his or her organ, the donor is performing an act of profound nobility. Donating one’s organ without reward in order to help a fellow human being – whether related to the donor or a stranger – is an act of genuine love and sacrifice on the part of the donor. It is an act of self-giving because, as we have seen, the organ is part of the human body, and the human body cannot be separated from the human self. Giving therefore is a beautiful expression of the donor’s response to the divine call to love another as we love ourselves. In this way, the donor who gives away his or her organ sacrifices himself or herself for another. He or she is willing to put himself or herself at risk in order to save the life of another human being, without expecting any rewards.
Through this act of self-giving, the donor emulates Jesus Christ Himself, who poured out His life for others. But such acts also have profound impact on society. Our society is often characterised by selfishness and violence. The act of sacrificial giving without reward therefore serves as a tremendous witness to the grace of God. It serves also as a powerful repudiation of the materialism, commercialism, individualism and pragmatism that are so pervasive in our society. As Thomas Murray of the Hastings Centre has put it:
Gifts to strangers affirm the solidarity of the community over and above the depersonalising, alienating forces of mass society and market relations. They signal that self-interest is not the only significant human motivation. And they express the moral belief that it is good to minister to fundamental human needs, needs for food, health and knowledge. These universal needs irrevocably tie us together in a community of needs, with a shared desire to satisfy them, and we see them satisfied in others.
In conclusion, let me say something about reimbursements. The latest news is that the government will introduce a reimbursement scheme next year to Human Organ Transplant Act (HOTA). In a recent article in The Straits Times, health correspondent Salma Khalik delineates some aspects of the scheme. Frankly, when I read the article, I was disappointed. The amount of course is not disclosed. But from the report, it will not be a small sum. It will be a five-figure sum, maybe even six figures. But what I find most disappointing is that apart from arbitrarily suggesting the amount of reimbursement, it seems, from what I could gather from the report, that the government will not be doing anything more. The recipient is expected to come up with the money. And if the recipient is too poor, he or she must go to organisations like National Kidney Foundation for help.
The National Council of Churches of Singapore (NCCS) has issued a statement on organ trading. In that statement, it maintains that it is supportive of reasonable compensation for organ donors. But it insists that monetary compensation or reimbursements are always ethically problematic. The NCCS therefore recommends compensation in terms of the provision of essential services to donors in government-funded hospitals. These include:
• Pre-transplant medical screening for all potential donors;
• Hospitalisation, tests, treatments and all medical procedures related to the transplant, including the surgery;
• Post-transplant medical consultation, tests and treatment for life;
• Advantage in the organ allocation process, if donors later need a transplant;
• Special medical insurance.
The NCCS maintains further that ‘compensations should not provide incentives for donors out to make a financial gain from their donation’. In other words, compensations or reimbursements should not be payments in disguise. These compensations are meant to “help willing donors ally fears of incurring high medical costs, before, during and after the donation”. But most importantly, compensations of this nature will not result in the commodification of human beings created in the image and likeness of God.
(This talk was given at the GCF’s Contemporary Issues Ministry Forum on Human Organ Trading held on 12 November 2008 at the GCF-FES Centre).