Should we allow competent adults to sell their organs and tissues? The libertarian view, with its doctrine that freedom is the highest value, constrained only by the prohibition against harm to others (the "harm principle") but not to self, would allow the sale of body parts. Even on this view, proponents stop short of condoing the sale of vital organs, for this would result in death, although the logic of libertarianism would seem to allow even this. Libertarians would not be justifying the potential sale of spare body parts if there were no demand. As biomedical science advances in areas such as reproductive technology, fetal tissue transplant and organ transplantation, market incentives appear to be one way in which supply might meet escalating demands.
There has been resistance to the commercialization of body parts. For example, the National Institutes of Health now funds research in fetal transplants for Parkinson's disease patients. The NIH is clear, however, that no pregnant woman can sell her fetus. NIH ethics guidelines assume that if financial incentives were allowed, poor women surely would become pregant in order to make money through aborting the fetus, optimally at the beginning of the second trimester when the fetus has developed sufficiently but still contains undifferentiated brain cells, and selling the fetus to physicians or to patients with neurodegenerative diseases.
The utility of fetal tissue transplant still is debated, particularly in light of other possible medical therapies under development. But imagine what could happen if fetal tissue transplants were to work effectively as a cure or partial cure for the diseases of Alzheimer's and diabetes. The demand quickly would reach into the tens of millions. Four million people in the United States have Alzheimer's disease, and the number will triple as the baby boomers become elderly. For the Parkinson's operation, at least three to four fetuses are needed per transplant (a dime-size hole is drilled into the top of the skull, and fetal brain cells are implanted on the outer brain surface.) The libertarian proclaims "long live freedom," and in the meantime, the problems of poverty and of children having children are finally solved -- a welfare conservative's dream. Caregivers for people with various dementing diseases might be liberated from a sea of diapers and nursing home payments.
The critics of commercialization of the fetus quickly point to the injustice of it all: The poor become pregnant to earn money that ultimately comes from the wealthier classes. Surely a wealthy woman who is financially comfortable will not need to sell fetuses. A poor woman might be able to sell four fetuses a year, perhaps at several thousand dollars each. Perhaps the moral ambiguity of abortion will entirely disappear in a culture that establishes a new profession in fetal sales. While this is all rather futuristic, it should be remembered that in India, where a huge black market in nonvital body parts provides kidneys for the wealthy, it is the poor who sell. Is this truly freedom, as the libertarian proclaims? Or is it a forced choice made in destitution and contrary to the seller's true human nature? I see such a market as the most demeaning form of human oppression, as unworthy of any valid human freedom, and as reducing the unborn child to mere grist in the medical mill.
The NIH rightly forbids the sale of fetuses, as well as the designation of particular fetal-tissue recipients such as a father or some other loved one, for fear of emotional pressure on the donor. Of course, even on the current basis of voluntary donation, many are disturbed by the very idea of encouraging the "harvesting" of fetuses as an act of beneficence, akin to donating blood. Will signs on buses read, "Be a giver of life. Donate your fetus today"?
Writing in 1971, Richard Titmuss lamented the commercialization of the blood supply in the United States. He wrote that "proportionately more blood is being supplied by the poor, the unskilled, the unemployed, Negroes and other low-income groups. …