Sunday, May 23, 2010

Gifts of kidneys and gifts of gratitude

The ethics column in today's NY Times Sunday Magazine begins with this query:
"Last fall, a stranger donated a kidney to my husband. We offered her a gift after the operation, which she declined. Recently she wrote us that her house is in foreclosure, and she needs money. We obviously have no legal responsibility to respond, but what is our ethical responsibility? I wish it were legal to sell organs; it would be much cleaner in many ways. NAME WITHHELD "

The column's author and resident ethics guru, Randy Cohen, offers this response:
"You’ve no moral obligation to send money to the organ donor. She admirably — heroically — provided her kidney as a gift. An essential quality of a gift is that it comes with no strings, with no reciprocal obligations. Otherwise, it would be a sort of disguised sale. United States law prohibits the sale of organs, wisely, in my view. To permit such transactions is to allow those with money to harvest the organs of those without. Even if you prefer that system of organ allocation — many honorable people do — it was not what you and the donor agreed to.

That said, it is a fine thing to echo generosity, to respond to the subsequent and unanticipated travails of someone who has done so much for you. You need not put yourself in dire financial peril to send this woman money, but if you choose to help her, that would be estimable.

Perhaps it is my suspicious nature, an occupational hazard, but I see at least the possibility that she might have known about her money trouble for some time, and the hope of alleviating it may have been part of her motivation to donate a kidney, a desperate and pitiable measure. If you believe that she planned to psychologically pressure you into, in effect, paying for a kidney, you should decline to collaborate in cloaking an organ sale as a gift."

Update: my colleague Greg Mankiw, reflecting on his favorite textbook, summarizes the article this way.

Do two rights make a wrong?

via Greg Mankiw's Blog by Greg Mankiw on 23/05/10

Users of my favorite textbook know that it includes, in Chapter 7, a case study on whether kidneys should be traded in a market. Today's NY Times has a related article.

The paper's so-called "Ethicist" is dealing with this situation:

1. Person A receives a kidney transplant as a donation from person B.
2. A short time later, person B is having financial troubles and her home may go into foreclosure. Person A is considering her giving some money to help out.

So what does the "Ethicist" say about all this? Apparently, both of these gifts are noble acts, worthy of the highest praise and admiration. Unless, that is, there is some reason to think they are linked together. In that case, the reallocation of resources (kidney, cash) would be a despicable market transaction.

I suspect that few economists would concur. Indeed, the essence of market transactions is a kind of reciprocal altruism, enforced by contract. It might be nice if the world could work using pure altruism alone, but that seems highly unrealistic. The sad truth is that under the Ethicist's code of conduct, we have more deaths and more foreclosures than necessary, all in the name of fairness.

1 comment:

Stephen Weinberg said...

The columnist's claim that "An essential quality of a gift is that it comes with no strings, with no reciprocal obligations. Otherwise, it would be a sort of disguised sale" shows a remarkable lack of cultural understanding.

In our culture--and in pretty much any culture--gift giving DOES create ties of reciprocity. This is why it's incredibly awkward when somebody gives you too nice a gift, or when you get a Christmas card from somebody to whom you didn't send one.

Or look at the massive experimental economics literature on gift exchange and "reciprocal altruism." Or read Marcel Mauss's classic text, The Gift (required reading in the economic anthropology course I took in college, and in the behavioral economics course I teach).

I don't see the point of trying to create an ethic that is so far removed from actual human culture.