This past week, I was on a panel for a Senate Hill Briefing entitled “Should compensation for bone marrow donors be legal?” The panel included myself, Robert McNamara (Institute for Justice), Mario Macis (Associate Professor of Economics, Johns Hopkins Carey School of Business), Samuel Hammond (Poverty and Welfare Policy Analyst, Niskanen Center), and Doug Grant (founder and CEO of Hemeos).
The event was co-sponsored by the Niskanen Center and the Georgetown Institute for the Study of Markets and Ethics. The Niskanen Center’s Samuel Hammond released a report entitled “Bone Marrow Mismatch” that same day, wherein he argued that the Department of Health and Human Services should not intervene to prohibit compensation for bone marrow donors (which is currently legal).
My comments were about the ethics of compensating people for their bone marrow. Here is what I said (video of my comments is at the end, if you prefer watching to reading):
Recently, Congressperson Nanci Pelosi said the following:
“We have a little time to save lives. What more important thing does any of us have to do than to stay here and pass a law to save lives? Somebody said to you, you could save 90 lives by passing a bill today, wouldn’t you do that? Or why wouldn’t you do that? Why wouldn’t you do that?”
Here we have an opportunity to save much more than 90 lives. We have the opportunity to save hundreds, if not thousands of lives.
All that the Department of Health and Human Services (HHS) has to do is nothing.
The question is, why wouldn’t they do that?
There is one company, Hemeos, that stands ready to help save more than 90 lives. All they require is the continued legal permission to operate.
I. Why Not?
So why would HHS not permit companies like this to operate?
I looked at the Department’s arguments in favor of passing a new rule that would prevent companies like Hemeos from saving more than 90 lives.
I also had a look at all of the public submissions to the Department of Health and Human Services when they opened this question for public comment. (Of 527 submissions, only 20 were in favor of the new rule. 507 submissions were opposed.)
II. Wrongful Exploitation
The first and most frequent response has to do with wrongful exploitation. The worry is that offering payment for bone marrow donations will unduly incentivize at-risk populations to make a health-related decision that may not be in their own best, long-term health interest.
There is no question that wrongful exploitation is a legitimate worry. If it were true that compensating bone marrow donors were wrongfully exploitative, that would be a significant objection. However, the compensatory model would not be wrongfully exploitative.
Unlike aspiration, apheresis is a non-invasive procedure. While there are risks, the procedure is not dangerous. In most cases, recovery, which is generally minimal or non-debilitating, lasts one week.
In addition, hematopoietic stem cells quickly regenerate. Donors do not permanently “lose” a part of themselves.
Given that the burdens are not significant, they provide no grounds for concern about wrongful exploitation.
There is also no evidence that compensation for bone marrow donations would be low, or that only poor or desperate people would be willing to donate for compensation. For example, Hemeos is offering $2,000 per completed donation. That is a sum that is sufficient to persuade middle- and upper-income individuals to donate, just as they now donate eggs or sperm for compensation.
Finally, donors would not be compensated on the day that they sign up to be placed on the registry. Instead, they are paid only after a match is found, and they complete the donation, which can take a long time, possibly years. Worries about wrongful exploitation are about people making desperate decisions in moments of desperation. A waiting period of months or possibly years gives people an opportunity to reconsider.
The second objection to the compensatory model is that it would promote the view that human beings, their bodies, or subparts thereof, are appropriately viewed as “commodities.”
We should mark a distinction between paying for something, and thinking of that thing as a mere commodity. It is trivially true that anything that is paid for or compensated is a “commodity,” but this is ethically irrelevant. What is ethically relevant is that the compensatory model would promote the view that bone marrow is a “mere commodity,” meriting no more ethical regard than other mere commodities, such as cars or clothing or widgets.
However, there is no evidence that the compensatory model would promote this view.
For example, there is no evidence that compensation for blood or blood plasma donations, nor for sperm and egg donations, has promoted the view that people or their blood, sperm, or eggs are mere commodities.
We also compensate Presidents, Senators, Congresspersons, members of the military, police officers, actors, artists, and so on. Mario and I are compensated as professors, mostly from the tuition our students pay. But there is simply no evidence that a paycheck for our labor promotes the view that we are mere commodities, nor that the services we provide — protection, education, artistic expression, representation, and so on — are regarded as mere commodities.
There is simply no evidence that a compensatory model would promote the view that donors or their bone marrow are mere commodities.
IV. Space for Altruism
The third, frequently cited, objection to compensating donors for bone marrow donations is that it would take away an opportunity for altruism. Of course altruism is desirable, and we should be careful to preserve and promote altruistic and benevolent motives and actions. But this is an unpersuasive argument.
The compensatory model leaves open the possibility for donors to reject the compensation. It also leaves open the possibility for a parallel non-compensatory model. Some blood drives, for example, are uncompensated, while, in other cases, blood donors are offered compensation. Both operate successfully side by side.
It is also true that compensation and altruism are not mutually exclusive. In many cases, people who are compensated are motivated either simultaneously or primarily by altruistic impulses. This is true of many teachers, of many doctors and nurses, of members of the military, and so on. Blood donors who are compensated are often moved by altruistic motives. There is no reason to think that compensation for bone marrow donations would completely, or even significantly, crowd-out altruism.
V. Open Letter
None of the three most frequently-cited objections to the compensatory model withstand ethical scrutiny.
This is not my view alone.
39 professional ethicists from across the political spectrum signed on to an open letter addressed to the Department of Health and Human Services presenting the arguments I have offered. They include well-known and well-regarded ethicists like Peter Singer, Gerald Dworkin, and David Schmidtz. The letter is hosted on donationethics.com.
In that letter, we also argued that given the ethical importance of avoiding preventable death, the proposed Rule by the Department of Health and Human Services is itself unethical.
When people stand ready, willing, and able to save lives, we need very good reasons to prevent them. In this case, we do not have sufficient reason to prevent them. Hemeos, and companies like Hemeos, would like to save lives. Because we do not have sufficient reason to prevent them, the proposed new rule is not merely “a bad idea,” it is morally wrong.
Passing this new rule is unethical. What is being proposed is morally wrong. We have the opportunity to save more than 90 lives. Why wouldn’t we do that?