Why Not Harvest Kidneys to Save Lives?

Harvard economist Greg Mankiw recently wrote an essay titled "Defending the One Percent," in which he defends many conservative economic views. In it, he makes a key moral argument. Essentially, he says that any policy that redistributes goods based on the overall welfare of society is a violation of rights. One of Mankiw's criticisms of a consequentialist approach is that we could probably save many lives by forcing random people to give up one of their kidneys to those who need transplants (since people can live with just one kidney). Nevertheless, we don't do it, and the thought of it seems abhorrent. He moves from that point to the conclusion that making policy from a public welfare perspective is against our moral intuitions, and is not something we should be doing. Mankiw makes other arguments in the paper, and I think he has a lot of it rather wrong. However, I'm going to focus on addressing the kidney argument, since it is similar to many general critiques of utilitarianism.

Breaking it down, Mankiw's argument takes this form:

Premise 1: If utilitarianism is true, then forced kidney transplants are good public policy.

Premise 2: Kidney transports are not good public policy.

Conclusion: Utilitarianism is not true.

This is a basic modus tollens logical argument, also known as denying the consequent. If the two premises given are true, then the conclusion must also be true. However, I do not think the premises are true. Particularly, I take issue with the first premise for several reasons.

First off, there's an important distinction to make. Even under utilitarianism, the fact that an act is moral does not necessarily imply that compelling people to take that action is good public policy. The world would be a better place if everyone was willing to give up a kidney to save a stranger's life. People as they are today, however, would be unlikely to tolerate a state that would randomly decide to make them give up a kidney. The negative utility that resulted from people's decreased trust in the state could very well be more harmful than the utility gained from the lives saved by forced transplants.

Under utilitarian thinking, it is quite possible to consider freedom to be a public good. Freedom is something people want, and it is reasonable to think that granting people substantial control over themselves and their life is an effective way to increase overall utility. People tend to hold their own body as something uniquely special. If they have no freedom over their own body, then they can't really have freedom in any other areas of life (conservatives might want to consider this line of thinking next time they talk about abortion). When the state is given power to simply remove important organs from people's bodies for the public good, that strips away people's freedom over their own bodies.

As a utilitarian, I am not strictly speaking concerned over people's freedom as an end in itself. However, I think that people are often happier when they're free, and less happy when they are unfree. The really important thing here is not so much the freedom itself, but rather the perception of freedom. People want to feel free. Living in a state where a federal agent could come by and remove your kidney does not feel even remotely free. Even if the total number of forced transplants was small, the fear of it happening to you would loom large in the imagination. Once again, it is easy to see how the negative utility would more than offset whatever gains could be had from forced transplants.

Finally, it is difficult to come up with a system for determining who would have their kidney removed when someone needs a transplant. A truly random system wouldn't make any sense. Too many people are sick, elderly, or young to make a random system work. Once we start removing people from the pool, it becomes difficult to decide when to stop. Should beloved authors have a kidney removed, even though they do so much for the public good? Presumably it is possible to come up with a perfect solution to the problem, and find a way to maximize the public good from forced kidney transplants. It seems unlikely, though, that our institutions could do this job well. And the whole system would be dangerously open to abuse. The difficulties of establishing an effective forced transplant system might be enough to make such a program impractical.

My point here is that, unlike libertarian ideology, utilitarianism in itself does not recommend specific policies. Utilitarianism is a criterion for evaluating policy. The role of the state in society can itself be analyzed in utilitarian terms, and often such an analysis will find that there are legitimate constraints on state power even in a purely utilitarian context. Mankiw's criticism of utilitarianism is an attack on a very narrow and limited version of the philosophy, and really misses the broad scope of what utilitarianism brings to the table.