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The organ draft

February 2, 2015

[Or, the perpetual war on death]

Imagine, (as a student of mine led me to do during our discussion of Aristotle), a society in which all citizens–perhaps on the eighteenth birthday–are required to register for compulsory organ and tissue donation. Kidneys, livers, and lungs; blood and bone marrow; anything that you can donate to another person while still alive, the government can compel you to donate. Not everyone will end up donating–the world doesn’t need millions of unused kidneys sitting in organ banks–but if you get selected (at random), then the government sends you a letter saying that you’ve been called upon to give John Smith [or whoever] your kidney [liver, etc]; and then, either you show up at the hospital (and either donate or demonstrate your inability to do so), or you’re punished (somehow or another).

Let’s not worry about whether our society could be made to accept such a system. It may seem unlikely–most of my students, for example, recoiled in horror from the prospect–but then, lots of things make people recoil, then end up happening. Organ markets, for example, strike people as dehumanizing–bodies made into commodities–but they’re nevertheless emerging around the world. So let’s worry instead about whether such a society, however it came about, would be desirable.

*

How would a society with such a system understand itself?

My student compared this system to a tax, but it’s really more comparable to jury duty, or, even better, to a military draft. The burden is not distributed evenly, nor quite randomly (e.g. people with certain blood types will be more likely to end up actually having to donate); and the burden is quite high, costing a great deal of physical distress and, in some cases, death (organ donation may be safe, but it will probably never be as safe as not donating at all). It seems likely, then, that the society would think about the system, not the way we think of taxes: as a rule we follow because there are consequences to not doing so; but the way we thought of the draft, back when we had it: as a call it was honorable to answer.

An organ-drafting society would probably not look kindly on one like our own, in which organs are only donated voluntarily, and (so) in which people tend to receive organs only if someone loves them enough to volunteer. Being willing to donate organs only to loved ones, but not for the common good, would seem like being willing to die for one’s family, but not for one’s country. It would seem barbaric, akin to a society without the rule of law, in which you were protected from wrongs only to the extent that you were friends with someone powerful enough to protect you. And organ markets would seem akin to a society ruled by those able to hire the largest army.

*

We no longer have a military draft in this country, and most arguments leveled against the draft could also be leveled against organ conscription. But these arguments aren’t so powerful as to make military conscription untenable–we had it for a long time, and most European countries still have it–and neither, I suspect, would they be enough to make an organ-drafting society immediately fall to pieces.

The most obvious objection to either kind of draft is to equate it with slavery: what right does the state have to tell me what I must do? In its simplest form, however, this objection is too strong. It would render unethical any form of taxation whatsoever, at which point the modern state as we know it becomes impossible. If we’re not willing to go this far, we might try to make a distinction between my property and my body, and say that the state has a right to the one, but not to the other, presumably because your body is the seat of your personhood. But if the state were to take away all your transferable property, you would be unable to go on living. And, conversely, you can go on living while donating part of your body: that’s what makes this thought experiment possible. So the distinction doesn’t seem perfectly clear.

*

This is highly speculative, but I think the real force of this objection is that an organ draft doesn’t seem compatible with our own society’s sense of the boundaries of the person, which is to say, the boundaries surrounding the “pursuit of happiness” (that formulation, when understood in Aristotelian fashion, being more clear than Locke’s “property”). Slavery is objectionable because it makes the slave’s life not his own, and (so) makes it impossible for his life to be a good one. A society with an organ draft would have to see a person’s organs as in some sense not (only) his own, which disturbs us.

Would this really be so invasive as to put obstacles in the way of living a good life? The boundaries we put around our selves are flexible. There is a growing sense in our society, for example, that there is no acceptable level of externally imposed risk: that any risk whatsoever should be seen as a violation of one’s person, of one’s personal pursuit of happiness, for which one is entitled to seek reparations. The abolition of the military draft seems to me a related development: the draft implied, in a way that became intolerable, that a risk to one’s society could always be validly transformed into a risk to oneself. Is this world of atomized individualism really better than one in which the body of the people was a little less metaphorical? I’m not sure it is. After all, the state must itself be a good one in order for true happiness to be possible.

Whatever answer we want to give here, it seems clear that the issue is not so clear that another society could not arrive at a different one.

*

Other objections to either kind of draft invoke possible difficulties the draft would face, problems which supposedly make it impossible to enact fairly. For example, people worry that others will game the system: You have to grant exemptions to e.g. sick people, whom it would be useless to draft anyway; but then won’t people pretend to be sick? And you “have to” grant exemptions to conscientious objectors; but then won’t people adopt “conscientious” objections for pragmatic reasons? With an organ draft, there would also be problems on the receiving end: Are there limits on how many organs people can receive? If not, won’t some people stop taking their health seriously, knowing they can always get another liver if their own fails? If so, won’t that be unfair to people who through sheer bad luck end up needing multiple donations?

But none of these need to be given a definitive answer, but only a “good enough” solution. Yes, draft-dodging and other forms of system-gaming will happen here and there, but if the society as a whole views the draft as a good thing, there will be social pressure against dodging, and the system will basically work, despite failing occasionally. These edge cases only become real problems when (as in the Vietnam War in this country) the very purpose of the draft was called into question. In the case of the organ draft, why would it be? Surely saving people’s lives through organ donation is a more noble cause than going to war….

*

Perhaps the best objection to an organ draft would focus on this difference between its purpose and the purpose of a military draft: a military draft, while perhaps causing discomfort if it’s enforced in peacetime, will only entail any real risk, or any serious imposition on one’s body, in time of war, which is–or ought to be–the exception. In a society that does not go to war habitually, the military conscript knows that he is risking his life because his country needs him now, and he will understand his behavior in wartime as oriented towards making that behavior no longer necessary, at which point he will resume the business of trying to live a good life. (As Aristotle says, “We make war that we may live in peace.”) The organ conscript cannot see it this way: his donating a kidney today does nothing to reduce the need for his neighbor to donate a kidney tomorrow. Not only does it not make his life happier, but it also does not contribute to making his society more conducive to happiness. This lack of an end goal may make the imposition somehow less tolerable. Compare the military draft’s unpopularity during the Vietnam War, and how it stemmed, in part, from the sense that the war was not going anywhere, and was not going away.

And yet–

First, though we now believe that war is, or ought to be, the exception, this was not always so. The paradigmatic happy life noawadays may not involve warfare (and this is part of what we mean when we say warfare ought to be the exception), but in a traditional warrior culture (the Greece of Homer, not of Aristotle), it did. So there is nothing inherent in how the organ draft imposes on one’s body that makes it incompatible with a happy life; and, thus, nothing that makes it inherently objectionable for it to be normal, rather than exceptional.

Second, though the organ draft in general appears endless–a perpetual war on death–in the specific case the end is very clear: you’re helping whomever you’ve been drafted to help. When the process is over, someone who was sick is now well. This makes the organ draft even more like the traditional warrior culture. In such a culture, war (like the Vietnam war) does not go away, but (unlike the Vietnam war) each individual battle has very clear stakes: if you’re defending your home and lose, your home gets destroyed; if you’re going on a raid and win, you bring home your enemy’s possessions; and these clear stakes make the perpetuity of war less of an issue.

This might save the organ draft as well–so long as the conscripts can be brought to feel they’ve accomplished something when they sacrifice their bodies to benefit a random John Smith. Can this be done? I think people have more doubts on this matter than they should; emotions are easy to manipulate. Should it be done? That’s a more difficult question.

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