Business ethics 88.
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A fresh scandal involving illegal profits by the former director of the cadaver donation program at UCLA has turned public attention to the realities of trading in cadavers.
This is an ancient branch of commerce, dating back thousands of years. In ancient times, cadavers were used for medical research and body parts for medicines. Hair was taken for wigs and teeth for dentures. After the invention of gold fillings, new incentives were, of course, created.
The value of cadavers has gone through the roof in recent years with the increased potential for using body parts for implants and transplants. The greatest value is for vital organs of otherwise healthy people who die suddenly. There are individuals willing to pay tens of thousands of dollars for hearts, livers, kidneys and the like.
But cadaver tissues are also used for more mundane, yet still lucrative, uses.
Here is a quote from an op-ed in the LA times, written by Kerry Howley: "Modern medicine has come to rely on a steady supply of products generated from the tissues of the dead. Organs are allocated to recipients by a medical bureaucracy, so there is no legal commercial market in them. But heart valves, tendons, ligaments and the like are all transplantable, and they all fetch a price. Osteotech Inc. .... grinds human bone into a putty used to patch small breaks. Skeletal grafts help cancer patients replace arm and leg bone lost because of illness. And it's not all borne of medical necessity. Ask your plastic surgeon for a pair of plumper lips, and you may get a shot of human-derived Alloderm."
Ethical questions surrounding this morbid market are probably as old as the market itself, but a bizarre legal anomaly creates a new wrinkle.
Again quoting Howley: "The National Organ Transplant Act of 1984 was enacted, in part, to prevent you and me from selling our body parts, which is seen as degrading and dangerous. [Similar laws apply in most countries - A.M.] Most medical ethicists continue to stand by that law, but they're ignoring the obvious: We can't sell ourselves, but others can." In other words, trading in cadavers is actually permitted, for anyone except for the original donor and his/her estate.
One is the concept of exploitation. The prominent 18th century ethicist Immanuel Kant believed that all ethics could be inferred from a single "practical imperative," that other human beings should always be considered as ends in themselves and never merely as means to an end. Among the ethical rules he derived from this principle is that prostitution is unethical since the prostitute is selling her body, and that organ sales are unethical since an organ is part of one's self. (Kant used the example of teeth.) The application to cadavers is not inescapable but is accepted by many. The second principle is respect for the dead, which extends to respect for the corpse. Jewish tradition is particularly strict on this point.
The problem is that the law actually realizes neither of these ideals.
The body parts are in fact sold on the open market. As Howell points out, only the donor is cut out of the deal. The exact boundaries would have to be drawn by a political process, but the current situation where commerce on the part of the donor is completely forbidden and commerce in the secondary market is completely unrestricted seems to me the worst of both worlds.
The issue of commodification (turning people into commodities) can be dealt with partially at the semantic level, as it already is in plasma donations. Technically, payment can be given for permission to use the tissues rather than for the tissues themselves. Another solution is to prescribe that the money be paid to some charity of the donor's choice. An additional possibility, which I proposed in a scholarly article, is to have a fixed statutory payment, which limits the impression of distasteful wheeling and dealing.
I think that if we are shocked or offended at certain uses of cadavers, these uses may be legitimately outlawed. Conversely, if we view other uses as vital needs, which sanctify rather than desecrate the body, we should provide some way for the donor's estate to share in the benefit.
The writer is research director at the Business Ethics Center of Jerusalem (www.besr.org), an independent institute in the Jerusalem College of Technology.