by: Rabbi Jeremy Rosen - Last updated: 2004-01-23
Rabbi Jeremy Rosen
This past week the issue of human organs has returned to the news. Parents are suing the National Health for removing organs from their dead children without consent and then trying to hide the evidence. Yet at the same time there is a very serious shortage of human organs and a new organisation run by orthodox Jews is campaigning for more organs.
The shortage has led to a growing world trade in human organs. The most common are kidneys, taken mainly willingly from the very poor to furnish the needs of the wealthy or at least the wealthier. In the early 1990's most of the buyers were from Gulf States who travelled to India to buy kidneys. Now buyers come from India, the Middle East, Britain, Canada and the United States. Commerce in human organs is forbidden by most Western countries and also by the World Medical Association. In 2002 the British Medical Council for the first time banned an individual who had participated in commercial organ transplants. But there is no effective International regulation. Sadly in recent months a series of scandals involving Israelis, Brazilians and South African has highlighted illegal transactions. But l'm certainly not going to justify or even discuss the criminal side of things.
The trade is often justified on the grounds that there is a severe shortage of donated organs (for all sorts of different reasons) and many very poor people are only too willing to sacrifice a kidney for sums ranging from $1,000 to $10,000 that will either clear debts or set up their families for the future. Opinion amongst doctors and philosophers is varied. Some approve of a free and open trade with market forces applying.
At least if it is in the open there is a chance of proper medical treatment rather than butchery, reminiscent of the old back street abortions. Proponents argue that this trade actually helps those less well off because the rich, jumping the queue by buying organs, enable more organs when they do become available to go to the poorer. Some object to the monetary incentives as crass materialism and argue for donors receiving no more than medical expenses and insurance policies. Others advocate only 'ethical incentives.'
A recent article in the New York Review of Books argues that it is the fault of hypocritical Jews, Asians and Muslims whose culture is biased against donating organs who are mainly responsible for encouraging this trade that takes advantage of the hopelessness of the poor.
I have written before that Judaism is not opposed to organ donation to help other human lives. Sadly the terrible toll of homicide bombers in Israel has led to several well-publicized examples of organs from victims helping others live. It is true there is a reluctance to become general donors because very often hospitals and doctors do not take appropriate care nor do they always ensure the rest of the body is treated with respect. And recently publicity about hospitals in Britain simply adds to concern.
But it seems to me that there are two issues here. There is the right of a person to dispose of his or her own body and the much more troubling issue of rich versus poor. I believe as a citizen of a liberal democracy that people should be allowed to do whatever they want with their bodies provided they do not harm others. And if they take such action as to burden the community with having to clean up their mess or take care of them, then they should be taxed or fined for their selfishness. If they can destroy their organs by ingesting poisons then, I would argue, if a person willingly gives up an organ to help another, this can be regarded as very praiseworthy.
Of course as a hallachically bound Jew I believe we have other standards and responsibilities but these are options we are free to adopt or reject.
We must take good care of our bodies, officially. Though I am amazed that any religious Jew is allowed to smoke anywhere that bills itself as a place of religious worship or study. We are supposed to take care of our diet and fitness but you wouldn't know it from observing what many religious people do. There is a very huge gap in the religious world between what ought to be done and what is done.
But there is one area where the religious seem to win hands down. They tend to try very hard to ameliorate the plight of the poor. And this means not just giving money but valuing them as human beings and trying very hard to make them feel valued and respected despite their lack of resources. Sadly the way the rich are treated in religious societies propagates distorted values. Hence the old Yiddish proverb that 'Baal Hameah Hu Baal HaDeah' The guy with a hundred is the one whose view counts. This sadly goes for too many Jewish societies and needs to be squashed. But I just don't hear enough pious rabbis speaking out against it. Instead they are encouraging it!
What worries me about the trade in organs is that poor people are taken advantage of because they are so separate and halachically one may not take advantage of another's distress. I can well imagine a scenario in which a desperate man might offer his lungs or his heart. There is a huge difference between a sane, rich man deciding to end his life and a desperate poor man offering up his heart so that his children might have food.
This is not a new problem. One of the realities of Eastern Europe that is forgotten in the nostalgic yearning for the Good Old Days of the Shtetl is that there was an enormous white slave trade in young poor Jewish girls. Bertha Pappenheim campaigned relentlessly and although some rabbis supported her, most were indifferent.
The issue is one of sensitivity to the plight of the desperate. I do not see how one can legislate for this. Any more than one can legislate for the rich being able to afford better treatment, life prolonging luxury treatment, better education and better after care than the poor. But the very notion is ethically disturbing. It was to avoid this that the dreamers who founded the Welfare State hoped to institute one health system for all. And in the slow decline of State Welfare we are also going to see the erosion of the ethical values that assert that all human life is equal.
The most common exhortation of the Torah is not a law as such, it is to remember the poor and the disadvantaged, for if their cry goes up to heaven, says the Talmud, God will surely hear it. We need to be sensitive to the circumstances that create both the need and the supply. Desperation is never a fair basis for ethical decisions.