the-lancet---culture-and-health.pdf

Advance supply will neverand by definition can

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advance, supply will never—and by definition can never—meet demand. As science increases its ability to give new life to those with failing tissues and organs through transplantation, genetic modification, and tissue preservation and regeneration, the ethical ambiguities grow exponentially as practices outstrip the moral capacity to adjust. At stake is not only emergence of new international cultures of commerce, but also the highly unequal and unfair availability and distribution of appropriate matches for both poor people who cannot afford commercially driven treatments and for ethnic minorities for whom appropriate organ matches might be unavailable. 144 In a study in the British West Midlands, 145 for instance, more than 1500 British Asians awaited kidneys while that same subpopulation donated just more than 100. Under such conditions, many go abroad. However, of those who do go abroad, one in three will either die or have their new organ fail, making this cohort four times as likely to die from the procedure as those who stayed on dialysis. But these people seek organs anyway—an issue exacerbated by the fact that some countries use promotion of such services as a form of economic development. 146 Again, the capitalisation of organ buying leads to moral conundrums that societies seem ill-equipped to address. Because of capitalisation (removal of an exchange from a reciprocal moral economy), an important question exists that few policy makers will face or know how to face: how do we regulate trade in medical services that so disadvantage and abuse some socioeconomic and cultural groups, and that develop markets for those who can and will pay for body parts of others? Policy makers have historically avoided issues that they are incapable of controlling, resulting in an explosion of minimally regulated or unregulated off-shore health services that only activists and rights advocates seem willing to question. Ignoring these issues has meant that when governments fail to act, individuals and charities need to step in to make a moral commitment to help the disadvantaged—both clinicians becoming social scientists and social scientists becoming clinically informed, if not also clinically trained. Anthropologist Nancy Scheper-Hughes has been one of those leading the call for social scientists to redefine their professional identities and directly help disadvantaged people worldwide whose poverty leaves them little choice but to sell organs to wealthy purchasers. Libertarians claim that one has the right to sell one’s body in free and open markets. But how free is such a decision if brute poverty motivates an irreversible sale, if many die on the surgeon’s table, and if people and organs are traffi cked to often-unregulated places to serve health tourists with money to spend?
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