This article concerns the morality of establishing regulated kidney markets in an effort to reduce the chronic shortage of kidneys for transplant. The article tries to rebut the view, recently defended by James Taylor, that if we hold autonomy to be intrinsically valuable, then we should be in favor of such markets. The article then argues that, under current conditions, the buying and selling of organs in regulated markets would sometimes violate two Kantian principles that are seen as moral constraints. (...) One principle forbids expressing disrespect for the dignity of humanity; the other forbids treating others merely as means. In light of the moral danger posed by regulated markets, the article advocates an alternative way of diminishing the current organ shortage, namely opt-out systems of cadaveric organ donation. (shrink)

Much of the literature devoted to the topics of agent autonomy and agent responsibility suggests strong conceptual overlaps between the two, although few explore these overlaps explicitly. Beliefs of this sort are commonplace, but they mistakenly conflate the global state of being autonomous with the local condition of acting autonomously or exhibiting autonomy in respect to some act or decision. Because the latter, local phenomenon of autonomy seems closely tied to the condition of being responsible for an act, we tend (...) to think of the former, global phenomenon as a condition of responsibility as well. But one can act autonomously, or manifest autonomy with respect to some occurrent state, without satisfying the conditions for autonomous agency. Autonomous agency and responsible agency are logically distinct in part due to the varient conceptions of rationality each calls for. Both agent responsibility and holding a person responsible imply a fairly ``thick'''' form of rationality, where rationality embodies a normative component and is a matter of satisfying criteria that are objective in the sense that they are independent of what a person happens to want or to value. But autonomous agency calls for a quite different, ``thin'''' conception of instrumental rationality. (shrink)

James Stacy Taylor advances a thorough argument for the legalization of markets in current (live) human kidneys. The market is seemly the most abhorrent type of market, a market where the least well-off sell part of their body to the most well off. Though rigorously defended overall, his arguments concerning exploitation are thin. I examine a number of prominent bioethicists’ account of exploitation: most importantly, Ruth Sample’s exploitation as degradation. I do so in the context of Taylor’s argument, with the (...) aim of buttressing Taylor’s position that a regulated kidney market is morally allowable. I argue that Sample fails to provide normative grounds consistent with her claim that exploitation is wrong. I then reformulate her account for consistency and plausibility. Still, this seemingly more plausible view does not show that Taylor’s regulated kidney market is prohibitively exploitative of impoverished persons. I tack into place one more piece of support for Taylor’s conclusion. (shrink)

An applicant to our graduate program in philosophy, accepted as well by one (but only one) other graduate program, wrestles with his decision. Finally he decides to attend the other program, but he thanks me for our offer, telling me, "I'm glad that at least I had a choice." I want to focus a bit on these two stories, for while the central conclusion in each -- something turning on the importance of choice -- is initially compelling, it is also, (...) on reflection, philosophically puzzling. It is compelling, because many of us in similar positions would share this response; phenomenologically, it feels right to us. We want to believe that the central facts of our lives -- whether or not we have children, where we are educated, what career we follow, with 1 whom we join as partners -- contain in them some fundamental element of our own selection and decision. We will be exploring below exactly what will turn out to be important here, and why, but for now, in our pre-reflective grasp of this phenomenon, we can say that it seems to have something to do with the value we place on autonomy, self-governance, self-authorship. We want, metaphorically speaking, to write the story of our own lives. But let me now begin to draw out why I find this insistence on the importance of choice, which so many of us would share, to be so puzzling. Both individuals, in both stories, want to be offered a certain additional option in order to have -- or at least to feel that they have? -- a choice about what they are going to do next. But, on the one hand, we could argue that, even with this added option, they still don't have a "real" choice -- they don't have the choice of doing what they most want to do; and on the other hand, one could argue that even without the added option, they always had some choice. Let me explain. In the first story, my friend certainly doesn't have open to her the option that would have been her first choice (and, in our society, what we might call the standard choice, the most frequently chosen option): to produce a biological child with her partner in a happy marriage.. (shrink)