Ambivalence, Autonomy, and Organ Sales

Recent philosophical arguments in favor of legal markets in human organs such as kidneys claim that respect for autonomy justifies such markets. I argue that these arguments fail to establish the moral permissibility of commercialized organ sales because they do not show that those most likely to serve as vendors would choose to sell autonomously. Pro‐market views utilize hierarchical theories of autonomy to demonstrate that potential organ vendors may autonomously consent to selling their organs even in the absence of any practical alternative to doing so. But central to hierarchical accounts of autonomy is the idea that persons my experience volitional ambivalence, a condition in which the will is irreconcilably conflicted. Because commercialized organ sales would create volitional ambivalence in many of those who opt to sell an organ, the choice to sell an organ would not be an autonomous one.