You've Gotta Be Kidney Me!
Excuse the horrific pun, but this week’s blog post calls for it. Weeks ago, I stayed up all night starting and finishing a wonderful book. It is not wonderful because I agree with it. To the contrary, it is wonderful because it has challenged me so much. The book is entitled Whose Body is it Anyway? by an academic who is coming to be one of my favorites: Cécile Fabre. I recommend it to everyone. It is extremely accessible, adequately contentious, and insufferably thoughtful.
In this post, I will summarize the argument that Fabre puts forward in the fifth chapter of her book, entitled “Confiscating Live Body Parts.” I will then summarize criticisms of Fabre’s position, as advanced by Nir Eyal. After, I will discuss Fabre’s response and why I feel, despite my disagreement with her conclusion that her argument should be accepted by all liberal egalitarians. Furthermore, this should serve as reason for liberal egalitarians to abandon liberal egalitarianism.
To put it bluntly: Fabre argues that justice requires individuals who are “medically rich” give their organs to the “medically poor.”
You’ve got to be kidney me.
Before completely writing off this argument, let me represent it as best I can. A core commitment of liberal egalitarianism is that social primary goods be distributed such that they are to the benefit of those least well-off in society. Social primary goods include things like rights, liberties, income and wealth, the social bases for self-respect, and health. Fabre contends that “body parts can be regarded as resources to be redistributed” (Fabre 2006, p. 100). That is, some body parts can be regarded as such.
Blood and nonvital organs, in particular, are the types of body parts which the sick have a right to according to Fabre. If it comes at little cost to us to transfuse a pint of blood or to have a kidney removed and it furthermore makes all the difference to a “medically poor” person who, without the blood or kidney, would be hindered from living a minimally flourishing life…then that medically poor person has a right against a medically rich person who would be able to provide them with what would give them the opportunity to lead a minimally flourishing life.
Think of it this way: if one believes that somebody is obligated to jump into a shallow pool to save a drowning child (rather than this being considered some kind of supererogatory act), then you also believe that somebody is obligated to transfuse a pint of blood, donate some bone marrow, or give up a liver lobe at little cost to them to save a seriously ill person in need of that blood, marrow, or lobe. Fabre goes so far as to say: “I submit that losing those particular body parts constitutes much less of a restriction on the projects the able-bodied want to pursue than losing, say, between 25 per cent and 40 per cent of their income through taxes” (Fabre 2006, p. 104).
If you’re bothered by this, so is Nir Eyal, who reviewed Fabre’s book in 2009. He argued in “Is the Body Special? Review of Cecile Fabre, ‘Whose Body is it Anyway? Justice and the Integrity of the Person’” that it makes no sense for Fabre to treat body parts as disposable in the way she does for 2 reasons:
Bodies and body parts differ from other kinds of property in that people take trespass into the body to be a sign of disrespect that undermines one’s autonomy.
Even if it doesn’t in fact undermine one’s autonomy, the disrespect it poses strikes at the social bases for self-respect in those individuals who have their body parts confiscated for the common good.
These criticisms seem compelling. They are to me, anyways.
Fabre rejoinders convincingly. Not all instances of interference with the body constitute the kind of trespass which Eyal alludes to. Rape is certainly this kind of interference. We are psychologically connected to our bodies when we experience sex in a way that makes this kind of interference absolutely impermissible. Missing a pint of blood, though? We are not connected to our blood or bone marrow or liver lobes in the way that we are connected to our genitals or our extremities and the things which we take to constitute our person as such. Thus, we ought not mistake the confiscation of the live organs which Fabre advocates for as the kind of integrity-striking bodily interference that we cannot stand for in liberal society. In fact, to not confiscate these organs leaves the medically poor in a most vulnerable position that seems far more illiberal.
As crazy as it sounds, I think Fabre is exactly right. Not that her conclusion is correct, but that she is correct in suggesting that her conclusion necessarily falls out of the liberal egalitarian commitment to ensuring that the least well-off are most advantaged by political institutions. Unless one is willing to acknowledge that the things which we have property claims in, whether it is something as intimately connected to my understanding of myself as is my right hand or something as distantly connected to my understanding of myself as is my blood (or perhaps, my paycheck? Maybe this is more intimately connected to my understanding of myself than is my blood!) are uncompromisingly and dogmatically ours, then I don’t see how someone can evade the force of Fabre’s argument.
I hope that the success of Fabre’s argument serves as a reductio of liberal egalitarian commitments as I suggest it does. Perhaps it will make people more sympathetic to libertarian commitments. What do you think?