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The increasing debate on financial incentives for organ donation raises concerns about a "commodification of the human body". Philosophical-ethical stances on this development depend on assumptions concerning the body and how people think about it. In our qualitative empirical study we analyze public attitudes towards organ donation in their specific relation to conceptions of the human body in four European countries Cyprus, Germany, the Netherlands and Sweden.
This approach aims at a more context-sensitive picture of what "commodification of the body" can mean in concrete clinical decisions concerning organ donation. We find that moral intuitions concerning organ donation are rooted in various conceptions of the human body and its relation to the self: The language of commodification is much too simple to capture what is at stake in everyday life intuitions about organ donation and organ sale.
We discuss how the plurality of underlying body-self conceptions can be taken into account in the ethical debate, pointing out consequences for an anthropologically informed approach and for a liberal perspective. In September , visitors to the internet auction website eBay were presented with an unconventional offer: A human kidney, praised as "fully functional" in the accompanying advertisement text.
Nevertheless, the case attracted broad media attention and aroused considerable public debate [ 1 - 3 ]. The incident could easily be dismissed as just another bizarre internet episode, and was in any case probably a hoax [ 4 ].
In two respects, however, it appears to be quite characteristic of certain tendencies in contemporary society [ 5 ]: First, it seems to represent a general trend of commercialization affecting more and more areas of personal life and social relationships, now even encroaching upon the human body and turning it into a commodity indeed, real offers of human kidneys are still easy to find on the internet [ 6 ].
And secondly, the crossing of this last, "physical" border obviously provokes a culturally deeply-rooted unease among the general public in most western countries. Subsumed under the catchphrase "commodification of the human body", the critical reflection of this development constitutes an important issue in current bioethics, most prominently in the debates about market models for blood, tissue and organ procurement [ 7 , 8 ].
However, while the commodification debate seems to touch upon very strong intuitions about the nature of the body and its moral implications, these intuitions are often not easy to explain and to translate into rational, intersubjectively convincing bioethical arguments [ 9 ].
In the spirit of empirically-informed ethics [ 10 ], one step in this direction could be to take into account the general public and explore their views and attitudes in order to achieve a more context-sensitive picture of the positions and arguments occurring. Against this background, we want to empirically investigate the conceptions of the human body involved in the public debate and their role in public attitudes towards organ transplantation: How are the body and its parts perceived and conceptualized and what are the implications for the evaluation of different modes of organ procurement from altruistic donation to profit-oriented sale?
We start with a theoretical overview of body conceptions in recent ethical and political discussions about the commercialization of organ donation.
In the methodological section, we give a short description of our own research methods. Our analysis is based on socio-empirical material from focus group discussions on transplantation medicine made up of lay people and patients in four European countries Cyprus, Germany, the Netherlands, and Sweden [ 11 ].
We examine three different body conceptions brought forward by the participants and their argumentative use, showing that the language of commodification is much too simple to capture what is at stake in everyday life intuitions about organ sale. In the discussion, we revisit the theoretical level in the light of our empirical findings and draw conclusions for the ethical and political debate on organ donation and its commercialization.
The commodification debate shows paradigmatically that an issue like organ donation and especially organ trade [ 12 ] not only concerns our explicit evaluative and normative standards, but also culturally deeply-rooted ideas concerning human nature and existence, personhood, personal identity and the body [ 13 , 14 ].
The concept of commodification [ 15 ] entails that an entity is viewed and treated as a commodity, that is, an instrumental object without subjectivity and intrinsic value which can be replaced by similar objects or money [ 16 ]. Therefore, commodification arguments for or against the commercialization of organ procurement obviously draw on some conception of the human body which specifies why it is or is not adequate to view and treat it this way.
In the Kantian tradition, for example, scholars usually assume that the body is an essential part of the person as such and that persons generally have dignity, that is, incomparable value, and represent an end in themselves. And especially in Marxist social philosophy, criticizing the adverse impacts of universal commodification in modern capitalistic society in terms of "commodity fetishism" and "alienation" has a long tradition. In analogy to Marx's considerations about the commodification of labor power, markets for body parts are deemed problematic because of their exploitative nature and dehumanizing effects on individuals and societies [ 19 ], p.
On the other hand, many proponents of a commercialization of organ procurement [ 20 ] state that there is nothing wrong with commodification. Premising Locke's idea that everyone is the rightful owner of his person and faculties, especially some liberals derive a specific conception of "self-ownership" which entails that "each person is free to do with his body whatever he chooses so long as he does not cause or threaten any harm to non-consenting others" [ 21 ], p.
Since most people tend to associate ownership with the right to alienation, this conception also encompasses the freedom to sell parts of one's body [ 22 ]. This line of thought seems to presuppose that the self can act as an autonomous authority disposing over its body like over some kind of property [ 23 ]. Thus, on both sides of the debate, addressing the question as to whether commodification of the body and its parts is justifiable apparently entails certain basic assumptions regarding what the body means for the self and the person as such [ 24 ].
In order to give an overview of these assumptions and systematize their role in the debate, Joralemon and Cox [ 25 ], p. According to them, the spectrum of possible standpoints can be roughly structured along two axes: According to this scheme, for example, donation on the basis of a narrow consent solution is the result of a voluntary and purely altruistic that is: On the other side of the spectrum are inter-vivos sale of organs. Clearly, these interrelations between body conceptions, conceptions of commodity and the human being are in need of further investigation — not only from a philosophical point of view, but also on the level of empirically informed ethics.
Otherwise, the dynamics of individual and social decisions taking place in concrete situations cannot be adequately addressed [ 26 ]. In the light of the academic commodification debate, our research is interested in the conceptions of the human body which actually underlie public attitudes towards organ donation in Europe. This research interest aims at a deeper understanding of public opinions by exploring their ideational and motivational backgrounds, that is, the subjective meanings they express and the cultural web of ideas and values they are embedded in.
Given the specific direction of this interest and the lack of precedent research, methodological standards and systematic knowledge in this field, we used qualitative methods to gain access to this symbolic dimension.
In qualitative socio-empirical research, focus groups, moderated group discussions with usually not more than 8—10 participants [ 27 ], are an established tool for investigating common sense beliefs and public topoi on a general level [ 28 ]. Our analysis is based on the transcripts of eight focus groups which were conducted in four European countries: Cyprus, Germany, the Netherlands and Sweden. The selection of countries was guided by an attempt to obtain a rough cross-section of the variety of national regulatory and organizational frameworks of organ transplantation in Europe.
Of course the findings of qualitative studies are not representative for a country or even Europe as a whole. But an inter-European comparison allows for building hypotheses about public moralities by abstracting from specific national or religious backgrounds. Two focus groups with 8—10 participants per group were set up in each country. One consisted of lay people and one of affected persons. The latter were patients who had had a transplant, were waiting for a transplant or had refused transplantation, along with relatives of such patients.
In total, 66 European citizens took part, 34 men and 32 women. The participants were recruited using different strategies such as the distribution of flyers, online and print advertisements or the snowball method. The affected people were approached more directly with the support of medical centers, self-help groups and patients' organizations.
The overall number of responses was in Germany 85, in the Netherlands 71 and in Sweden 34 for Cyprus, no figures on overall response are available. The composition of the groups was intended to achieve a gender balance and to be as heterogeneous as possible in regard to age and educational level.
In regard to religion, however, the composition often mirrored the respective national situation; thus, in the Cypriot groups, all participants were of the Christian Orthodox faith, whereas the Swedish groups showed a dominance of Protestants.
A degree of religiosity could not be given. In all countries, the group discussions were moderated by two facilitators and followed the same semi-structured questionnaire. The questionnaire contained a a future scenario of unlimited organ replacement, b questions about a hypothetical case of a proxy decision for a brain-dead relative and open questions about c attitudes towards post-mortem and living donation, and d public policy.
It was designed to initiate discussion and kick-off a discursive dynamic through which participants would be incited to bring in their positions and explicate underlying world views and value systems.
All discussions lasting for 1. The speaker codes used only provide information about gender Mr. The coding was compared and differences were adjusted. This approach reduced subjective bias. Since we were mainly interested in moral positions and cultural values, we followed a hermeneutic-analytical procedure common in social science based on a combination of qualitative content analysis [ 29 ] and Grounded Theory [ 30 ]: Interpretive concepts were applied to structure the material along our general research questions, but they were also developed inductively to identify main lines of argument.
The eight FGs' transcripts were treated as one broad sample in which we compared inter-individual arguments to justify or reject specific positions. The final step of our analysis was the identification of main lines of argument by working out a qualitative typology of ideas and values lying behind them.
Although a full commercialization of organ procurement is rejected throughout all focus groups, the language of commodification, instrumentalization and exploitation seems to be densely interwoven with many argumentative threads of the discussion. Several participants refer to organ extraction as "harvesting" [Mr. This imagery hints at the relevance which background conceptions of self and body already have for attitudes towards organ transplantation in general and not only for the commercialization of organ procurement in particular.
Thus, the agricultural image of a field which is harvested might tend to elicit different answers to the question as to what should be permitted than the mechanistic imagery of the body as some piece of machinery with replaceable parts might suggest [ 31 ].
In the following section, the main types of images and conceptions of self and body which appeared in our focus groups will be described and explored with respect to their interdependence with attitudes towards organ donation as such and the commercialization of organ procurement in particular.
Many participants in all focus groups attach great importance to the idea of personal autonomy. For most of them, this idea also comprises bodily self-determination in the sense that one has the right to freely dispose of one's own body. In the context of organ transplantation, this right plays a crucial role when it comes to decision-making processes. And a speaker from Cyprus declares: On closer examination, two different conceptions of bodily self-determination seem to present themselves.
The first one is premised on the idea that no other person may make any claims with respect to one's own body or is allowed to interfere with one's decisions concerning it. In the group discussions, this "defensive" aspect of bodily self-determination is stressed when it comes to the question as to whether individuals have any responsibility or obligation to donate, be it towards the family or society at large.
In these contexts, bodily self-determination is widely and vehemently postulated as "the right to refuse" [Ms. However, the mere absence of third parties' claims to my body or its parts does not necessarily imply that I myself am entitled to freely dispose of it as I wish. After all, there may still be limits to my bodily self-determination based on religious or "philosophical" considerations see below. Thus, a German speaker who vehemently stresses the right to refuse donation also states: In this respect, the second conception of bodily self-determination goes much farther, the postulate being that one has an unrestricted right to actively do with one's body whatever one likes.
In the focus groups, this "empowering" aspect of free choice and self-development in view of one's body primarily comes into play when future technological scenarios such as enhancement or infinite organ replacement are discussed and assessed:.
When at a certain point you say: In the group discussions, the idea of bodily self-determination is frequently addressed in terms of ownership. The notion "that [ This idea of bodily self-determination in terms of ownership seems to bring the human body in line with other pieces of private property.
On closer inspection, however, the application of this ownership paradigm does not necessarily imply approval of commercialization in the sense of making money with one's body or its parts.
On the contrary, money often seems to be perceived as a factor which has the potential to impede self-determination by corrupting persons and distorting their own proper will, that way inducing them to do things they would not do otherwise.
Thus, the autonomy and authenticity of decisions concerning the body can be called into doubt when financial motives are involved since this is seen as "something different than voluntary registration" [Ms. Against the background of similar considerations, German participants discussing the obligatory psychological test in the case of living donation even compare financial incentives with other constraints on the freedom of decision such as psychological pressure in the family context.
On the other hand, arguments for bodily self-determination do show a certain affinity to a particular kind of body conception. Thus, especially when discussing the pros and cons of a future scenario in which self-preservation through infinite organ replacement becomes technically feasible, the participants frequently employ images from the sphere of handicraft or engineering which suggest analogies with the reparation of machinery in order to address and articulate their position:
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5oo - * 1 oo - T n I n I Fig 5 1 2 • - - - I t I #: # plg Cd/l Zn-, Zn/Cd- and Zn/Pb- contamination 1 o 2O 3o 4o 5o lug Pb/l in Radix peregra (soft body parts) 1. Amy Randall hat diesen Pin entdeckt. Entdecke (und sammle) deine eigenen Pins bei Pinterest. Full-Text Paper (PDF): «Torn to pieces»: The fragmented body. the human body is perceived and represented by means of individual body parts and fragments. 15+ million members; + million publications; k+ research projects.