Kidney Collectivism
[Originally published in the Front Range Voluntaryist, article by Noah Leed]
Every year, thousands of people die while waiting for kidney transplants. What could this fact possibly have to do with a debate over individualism and collectivism? Everything.
We hear the word "individualism" tossed around by some as if it means pursuing selfish interests without regard for anyone else. Of course, that's not at all what it means. When conceived correctly, it simply means that the rights and interests of each and every individual are of paramount importance and take precedence over group or government interests. So it's pretty easy to realize that if that's the case, we can't just go about pursuing interests without observing the fact that each person we encounter also has the right to pursue his own interests. By that reckoning, respecting his rights becomes my responsibility, just as respecting my rights becomes his responsibility.
So "individualism" does not mean every man for himself, come what may. It means every human life has intrinsic value (or in religious terms, that each life hold a spark of divinity). It means, in ideal form, that we act as individuals or as groups of individuals in ways that include the assumption of both individual responsibility and individual value for each. We have the right to act as self-interested individuals, but only so long as the action is "responsible" in the sense that our actions do not violate the rights of any other individuals. For one to pursue individual (or group) interests, ideals and happiness at the expense of others, without their willing participation, is not individualism; it is enslavement.
It is also nonsensical to refer to our own interests as merely "selfish." Certainly much of what we might pursue will be in the interest of furthering our own selves, since we need to eat and stay warm, and we desire to experience pleasure and to educate ourselves and realize our individual potentials. But where do we realize these potentials? Out in the world, a world crammed with other people, all trying to realize their own goals, too!
One of the things maturing children will (hopefully) learn about repeatedly getting what they need and want over the long term is that instead of demanding immediate one-time gratification at the expense of others, it is to their ultimate advantage to cooperate with other people, to play fair and to cultivate trust. To achieve our own objectives we discover it can be quite beneficial to help others achieve theirs, or at least to not interfere with their attempts in ways that might come back to hinder our own attempts.
To some degree, then, we all know that self-interest is best realized by allowing it to symbiotically coexist with the interests of others in mutual-interest. We also know that because we love, like and respect certain others (family, friends and community) that sometimes we go so far as to place what is in their best interests even above what seems to be in ours. We value our children more than we value ourselves. Self-interest almost always includes looking out for the interests of those close to us, and thus is not selfish at all.
So we might then realize that when we generously sacrifice for the benefit of others, such altruism and generosity might actually be considered just another form of self-interest, since we would feel we had betrayed our deepest values if we didn't act in such a manner. Self-interest can indeed be manifested in the form of what is commonly thought of as "selfless" behavior!
Another way of looking at this dynamic is that, since we each have a shared value system deeply rooted in our biological and cultural history, we are in a constant state of making exchanges on different levels: we are not only bargaining and negotiating with others, we are bargaining and negotiating with that person we might consider to be our "future self" to help ensure we maintain and develop our own moral standards and our continued well-being.
For example, I might willingly and happily sacrifice my last bite of ice cream now (a cost to me) to make you happy (a benefit to you) so that I will feel good about myself later (a benefit to future-me), and hopefully I will do it in a way that makes you feel more generous to others in the future (a benefit to future-you). In other words, the exchange really involves four people and not just two: there's you, me, future-you, and future-me. We see in this example that three people realized benefits at the cost of one person making a tiny sacrifice, yielding a net gain. Such a deal.
The benefits, though, go well beyond what is immediately apparent. Consider the possibility mentioned above, when receiving something shared makes you more generous and responsible in the future. If you manifest that generosity and responsibility with real action out in the real world, repeatedly, you then might also help other people to be more generous in the future (a benefit to them). And so the network of those who benefit from one small act expands much further than we could ever know.
We should also realize that the opposite is true: when we harm another, violate his rights or interfere with his pursuits, the negative outcomes of that transaction might be manifested in a series of corresponding negative outcomes that ripple outward. Violence begets violence. Rather than an extensive network of more and more people realizing benefits from a single action, we end up with untold numbers bearing the added weight of cumulative costs, perhaps degrading the morals and values that might have otherwise been reinforced.
As we act in the world, we might wonder: am I spreading virtue, or am I spreading pathology? This is why voluntary and un-coerced action, on the level of the individual, is so important. Someone could come along and force me to give you my last bite of ice cream, and in material terms the net outcome would be the same as if I had given it up voluntarily: a small benefit to you, and a small cost to me. But gone are the potential additional benefits created by outward ripples of good feelings and generosity and mutual benefit. In their place we might see an outward ripple of ill-feeling.
When coerced into the transaction, there is a good chance that future-you will have some guilt for eating my last bite of ice cream, and future-me will feel some anger, resentment, or even betrayal. (You could have at least spit the damn ice cream out!) Being human, we may very well pass these emotional costs onto others, not wanting to bear them ourselves, without even being remotely conscious of that fact.
In terms of spreading virtue rather than pathology, every act can be considered to have an impact on the greater world.The creation of a human chain on a beach, to save swimmers caught in a rip current, is an amazing example of using spontaneous voluntary organization to create order and purpose out of a chaotic situation. Saving lives is a wonderful outcome in itself, but the value created in this act of determination and cooperation goes well beyond that. I have no doubt that the act was incredibly inspiring to all those dozens directly involved, but also no doubt inspiring to millions of others who read about it or watched it. The virtuous actions of a few rippled outward, conveying the spirit of heroic behavior to many others.
When individuals come together like this to perform heroic feats that can only be accomplished by group cooperation, it could be called collective action, but it is not an example of collectivism. Rather, it is an example of individualism. Those organizing and participating in the group activity recognized the value of the individual lives that were in danger and then acted accordingly, as voluntarily cooperating individuals. The same idea would apply, for example, if some within a group struggling through deep snow decided to carry an individual who was too weak to walk. The survival of the entire group is now at greater risk because its interests are subordinated to that of the weak individual.
Collectivism is really just the opposite. Participation becomes mandatory or coerced rather than voluntary. Here, it is the interests and values of the group that take precedence over the interests and values of any given individual within the group, and individuals may become expendable. To better ensure the group survives its journey through the snow, it might be decided that the weaker individual be left behind, and sacrificed for the "greater good." Some times this greater good is not actual survival, but is simply a value, concept or idea that is supposedly cherished by the collective. Today, for example, we collectively seem to cherish the idea that human organs are not to be bought and sold as mere commodities, and so we forbid such market activity under the law.
Now, without thinking too deeply about it, we might congratulate ourselves, as a culture, on the seeming nobility of deeming the human body as something sacred and not to be chopped into and pieced out for remuneration. In thinking that, however, we fail to acknowledge the annual death of those many thousands of individuals who cannot secure a kidney for transplant. Any individual who might wish to be compensated for the risk and hardship involved in donating a kidney finds that forbidden by law, just as it is legally forbidden for the potential recipient to offer such compensation. So even with millions of potential donors, many of those needing kidneys end up dying.
One might wonder: how did the collective arrive at this decision to interfere with the desire of one individual to save his own life by compensating another, through a voluntary and mutually beneficial exchange? Strictly speaking, the members of the collective never made such a decision. It was made for them, pretty much without their knowledge or input, by their elected representatives some thirty years ago (in 1984, appropriately enough).
That's not to say there are not valid reasons to oppose a free market for organs, and that there is not a widely shared emotional sentiment against "selling a kidney." It's only to question why there has never been any real public discussion or debate of these issues, or any real exploration of alternatives to this total restriction of individual freedom. Such an exploration might give us a system that falls between the extremes of total freedom and total restriction, one that allows life to be saved wherever possible while still taking into account any possible objections and conflicts.
The first step in such an exploration would be to discard the pejorative of "selling a kidney." That's not really what happens. What one would like to be compensated for is the pain and risk involved in undergoing major surgery, and the redirection of one's time and energy from other ends that surgery might interfere with. Such hardship and risk, as with other difficult and risky endeavors, justifies a potential for payment; the kidney itself is free.
The second step would be to formulate a program for compensation that responded to whatever objections currently exist. For example, to avoid the potential for "exploitation" of donors who were desperate addicts or were deeply indebted, a market could have multiple mechanisms to screen out both desperate addicts and those deeply indebted. Even the (rather absurd) objection that one should not directly benefit from donating a kidney could be addressed by insisting that benefit be directed to a loved one instead.
These steps are not being taken, however, because the supposed will of the collective gets bogged down in the machinery of government and in the inertia of the status quo. On top of that, existing policy of all types is often deeply based in emotion, and a small minority can hinder or effect change by virtue of being either very vocal or very powerful. The majority of individuals just go along for the ride, even if the collective-qua-government ends up moving in distressing directions (like backwards, or more commonly, nowhere at all).
By being so willing to have our "collective" choices arrived at by so few actual members of the collective, we could have theoretically ended up with a drastically worse policy on organ transplants with only a slight shift of emphasis on values. After all, if we value life so much, why not make kidney donors subject to conscription, so that healthy kidneys are transplanted into needy patients by mandate? For the utilitarian benefit of the collective, our government could use a lottery system to facilitate enforced donation and could completely eliminate the waiting list for kidney transplant, saving thousands of lives a year. Uncle Sam Wants You.
Of course, the fact that most of us view that Orwellian extreme of collectivism as a nightmare seems to show that we really still do lean towards individualism, in that none of us can conceive of letting our government remove one of his kidneys against his will, by force. But wait: why do we so easily concede to government the power to forbid that same individual from voluntarily having a kidney removed and being compensated for the risk involved?
We seem perfectly content to embrace that lesser form of collectivism that restricts freedom to own our bodies (even as we reject an outright invasion of our bodies). We, the collective, dictate to the dying individual that he has no right to save himself. And to the individual offering a kidney, we the collective dictate the terms under which he will save the life of another; he must either do it for free, or not do it at all. Once those terms are set by law, we see that very few people indeed are willing to endure the risk and hardship of donating a kidney unless the recipient is a loved one. Why are we making it against the law to get compensated for saving lives?
That question could be hypothetically posed by an individual in desperate need of a kidney, as an inquiry to all of us: why did you, the collective, sentence me to death? Why is your legal concept of "the good" of greater value than my own peaceful pursuit of merely staying alive? Why am I, the individual, being made a human sacrifice by the collective, on a mere whim of emotion?
To the kidney patients who claims he should have the right to pursue staying alive by peaceful means, we as a society respond, "No, your life is in OUR hands." To the prospective organ donor who claims a right to his own body, we as a society respond, "No, your life is in OUR hands." That, dear comrades, is a collectivist society.
In considering the allowance of some sort of exchange for a kidney donation, we should consider the costs and benefits of the donor and recipient, and of future-donor and future-recipient, and consider the ripple-effect on others when such an exchange is either allowed or forbidden. I think perhaps we are afraid that the willing donor, even though he is not being coerced, is somehow being exploited and that he is violating his own body out of either desperation or greed. We fear that negativity will ripple through society, and diminish us.
Yet we seem to have no fear that just letting people die, at a rate approaching fifteen a day, has no ill effect. How is that possible? Because we simply ignore that it is happening. In our ignorance and neglect, by passively denying dying people an opportunity to save themselves, are we spreading virtue or spreading pathology?
Remember, the reason we sacrifice for the benefit of loved ones is that we would feel we had betrayed our deepest values if we didn't act in that manner. If we could make a difference yet did nothing, how could we live with ourselves? But to apply that same standard to all complete strangers in all situations is not only unusual, it borders on pathological. There is so much need in the world, we could spread ourselves too thin in an instant. We just can't do it, physically or emotionally.
So there naturally are limits to what we willingly give for free. To best serve our loved ones, we generally demand compensation from others for our labor, our hardship, our risk and our sacrifice, no matter what we pursue in life. This applies equally to those who labor heroically to save lives, like nurses and doctors and firefighters, and to those who risk their lives in the hidden heroism of dangerously laboring to feed their families, like loggers and fishers and roofers. Heroes... get... paid.
Yet we refuse to apply the same (otherwise universal) standard to a life-saving exchange that might occur between kidney donor and recipient, even as we allow donors of blood, plasma, sperm, eggs, hair and bone marrow to be compensated for their time, effort or risk. Why the double standard?
To suppose ours is an individualistic society, where every single life is precious, is hard to reconcile with the mass death that we allow by restricting access to live kidney donation. Some 5,000 people continue to die every year because it is illegal to make the individual choice to offer or pursue compensation. A system of legal compensation could of course be regulated, and payments made only through third parties like charities, insures and governments (and in fact by doing so our federal government would save huge amounts of taxpayer money, since the Medicare costs of dialysis now run in the tens of billions of dollars annually).
Instead, we insist on letting patients die needlessly. Avoidable mass death is unfortunately a common result of giving in to collectivist tendencies, where individual lives become expendable in the service of some ideal.
The good news is that our own little version of collectivism is only sacrificing individual lives by the tens of thousands instead of by the tens of millions, as did the more virulent forms of collectivism practiced in twentieth century China and the USSR. The bad news is... our own little version of collectivism is sacrificing individual lives by the tens of thousands.
Maybe we can find a way to expand liberty such that people have more freedom to save themselves, and to save others. Perhaps we should explore ways to give individualism a chance when it comes to kidney transplant, since the waiting list (and the body count) continues to grow every year under the current system. We can do better. We have to, if we really wish more benefits of mutual-interest to ripple outward and to create a better world by heroic example. The rights of these dying patients are our responsibility, and we are ignoring that responsibility.