Jacob M. Appel is a bioethicist and fiction writer. He holds a B.A. and an M.A. from Brown University, an M.A. and an M.Phil. from Columbia University, an M.D. from Columbia University's College of Physicians and Surgeons, an M.F.A. in creative writing from New York University, and a J.D. from Harvard Law School. He has most recently taught at Brown University in Providence, Rhode Island, and at the Gotham Writers Workshop in New York City. He publishes in the field of bioethics and contributes to such publications as the Journal of Clinical Ethics, the Journal of Law, Medicine & Ethics, and the Bulletin of the History of Medicine. His essays have appeared in The New York Times, The New York Daily News, The Chicago Tribune, and other publications.
Appel has also published short fiction in more than one hundred literary journals. His short story, Shell Game With Organs, won the Boston Review Short Fiction Contest in 1998. His story about two census takers, "Counting," was shortlisted for the O. Henry Award in 2001. Other stories received "special mention" for the Pushcart Prize in 2006 and 2007.
He is admitted to the practice of law in New York State and Rhode Island, and is a licensed New York City sightseeing guide.
Appel contributed a Dangerous Idea to Big Think's "Month of Thinking Dangerously," advocating that we add trace amounts of lithium to our drinking water to help reduce the suicide rate.
Appel is a Big Think Delphi Fellow.
Question: Should buying and selling human organs be legal?
Jacob Appel: Sure. I've actually written about a legal market in fetal organs, which I think is somewhat different from a legal market in organs of post-born adults. And I would strongly favor legalizing the market in fetal organs because I don't feel that fetuses are people and therefore the risk of exploiting them is minimal and I feel that women are capable of making reproductive choices in relation to their fetuses particularly people who abort may want to save the lives of other individuals by making their organs available. And I think they should be able to profit from this.
In contrast, for adult organs, I think there should be a financial mechanism for allowing people to sell their organs. But I don't necessarily think there should be a market. I think a market opens itself up to abuse and will likely have the organs go to the highest bidder and make it most available to the wealthy.
In contrast, you want to create financial incentives so there are enough organs available for all 70,000 people who need kidneys, for example, in the United States. But then you don't want to distribute them based on economic opportunity, or economic -- based on assets, you want to distribute them based on need. So, I would have a system where the government bought up organs for people, let's say $10,000 for a kidney and then distributed them using the same system we have now, on a first-come, first-served, or need based approach. I think to tell people they can make other economic decisions in their lives, they can choose to be a laborer at $7.00 an hour for 40 hours a week, but they can't choose to avoid three months of work by selling a kidney is an unnecessary involvement, or an unnecessary intervention in the individual decision-making of people.
I will add, and I think this is often lost in the debate over organs. We focus excessively on the risk of exploitation of people who would sell their organs. We don't focus on the passion of people who die every year because they don't get organs. And if you are one of those individuals, or one of their relatives, you may see the question from a very different light.
Question: How difficult is it to obtain a life-saving organ in America today?
Jacob Appel: Oh, it's extraordinary difficult. I don't have the numbers in front of me, but there are approximately 115,000, 120,000 people on the waiting list for different life-saving organs in the country and with kidneys, we do have dialysis, so we can prolong the lives of these people a number of years. But the people who need heart transplants, or liver transplants, the majority of them, I believe die while waiting. Certainly a good plurality of them dies while waiting. Unlike kidneys where you can have a live donor make a donation, these people have to wait for cadavers. So the question arises, why not pay people who know they're going to die, or people to make their organs available in a pool if they are going to die to harvest their organs as soon as they do die, which would also reduce the risk of exploitation. These people are at death's door and are dying anyway.
As for kidneys, while dialysis is life prolonging, dialysis is not always life saving. It also substantially reduces the quality of life of individuals involved. In contrast, not having a kidney has no impact if you have one kidney of your own on the life quality or life expectancy of the individuals that give a kidney, on a virtually zero risk. Extremely low risk procedure. The real question that arises is, do we have an ethical obligation as healthy individual with two kidneys to give one to a stranger? And it's a challenging question. Maybe we do. We don't have the mechanism in place to make that happen. In fact, in the rare cases where people have tried to do that in this country, hospital ethics committees have often stepped in and questioned the capacity, or sanity of the individual who is seeking to. Which to my way of thinking is somewhat perverse. If someone is willing to, not sacrifice their life, or quality of life, but make a great altruistic **** for a stranger and we say this person must be crazy.
Recorded on March 1, 2010
Interviewed by Austin Allen