Back to Basics: Self-Ownership and Organ Donations

Ronald Bailey, over at Hit & Run, asks, “Should a person who is dying of an incurable illness be allowed to donate his organs before the disease kills him?” This strikes me as a very odd question to ask, especially given who is doing the asking. Hit & Run is the blog for Reason Magazine, a publication I have been led to believe has some libertarian bent. Yet, oddly, it seems they are still mulling over the most fundamental principle of libertarianism: self-ownership.

Once it is recognized that the fellow from the story, Gary Phebus, is a self-owner, the answer to Bailey’s initial question becomes blindingly obvious – a resounding yes. What would it mean to be a self-owner but be unable to use one’s body and its parts as one wished? Surely, any libertarian must recognize the right to commit suicide and the right to donate one’s organs after death, which is all this amounts to. Why the struggle?

But maybe what Bailey meant to ask is “should a person who is dying of an incurable illness donate his organs before the disease kills him?” Note the difference between these two questions: the former asks whether we should restrain someone by force from donating their organs, while the latter asks whether someone should choose to donate their organs.

On this question, I must part ways again with Bailey who says,

On the one hand, it is certainly wrong to take a vital organ, even if given voluntarily, from a healthy person. On the other hand, Phebus is not healthy. In any case, harvesting organs from Phebus would violate the medical ethical principle: “First, do no harm.” Phebus’ generous impulse moves me, but I fear that honoring it would create dangerous precedents.

First, I am not sure it is certainly wrong to take a vital organ, if given voluntarily, from a healthy person. What if a healthy, 60 year old grandmother has a 10 year old granddaughter who needs a new heart to survive, but the line to get a new heart is so long (thanks to government prohibition of organ markets, of course) that she has only a slim chance of surviving? Would it be certainly wrong for the doctors to take the grandmother’s donation to her ailing granddaughter? I cannot see why. Indeed, I would think that the grandmother is not only acting in a permissible manner, but in an admirable manner, and a doctor who refused to allow this would seem to be cold and cruel.

But this case seems even more in favor of the donation going through given the point that Bailey himself acknowledges: the donor is not healthy. He suffers from an incurable disease that will cause him to painfully waste away for the remainder of his shortened life. This is a case where even mainstream thinkers can often justify euthanasia, yet Bailey is balking at someone throwing in that he will also donate his organs? What’s going on here? How can adding beneficence and charity to the act harm the case in favor of euthanasia?

The last two sentences seem to take a swing at answering that, with an appeal to the principle of nonmaleficence and the “dangerous precedents” involved in breaking it. I think, however, even on his own terms, this should be permissible. I do not see what harm is done by the doctors in accepting the donated organs; this seems beyond question. What Bailey is really referring to is the ethics of euthanasia, a topic far too in-depth and complex for a full treatment in this blogpost. I will make one point on this though: it does not follow that by shortening someone’s life, you do them harm. Few people believe that we should extend our life at any cost and I doubt very much that Bailey is one of them. If one can live a shorter, more virtuous and happy life, that is preferable to living a longer, more vile and miserable life. So it cannot be said that a doctor who gives his patient the ability to choose the former over the latter does him harm, indeed, it would seem that a doctor who prevents his patient from taking that course is the one who does harm.

Finally, it would seem to me that the most dangerous precedent of all that can be set in this case is to prevent Mr. Phebus from doing with his body what he pleases and thereby denying the essential right of self-ownership.