The commodification of the object in object relations theory.
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Commodifying the polyvalent good of health care.
This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy on commodification and health care. The essay attempts to sharpen the articulation of generally expressed worries about the commodification of health care. It does so by defining commodification, analyzing three components of the good of health care, and attempting to assess how commodification might distort the shape of each of those components. Next, it explores how the good of health care might be distorted by the market-based principle of distributive justice, "to each according to ability to pay." Finally, it identifies two basic questions about the relationship of medicine and the market that merit further exploration. (1) How does the market-based language of "incentives" so pervasive in the world of managed care distort the complex patterns of virtue and vice that motivate actors in the health care arena? (2) If we recognize that we cannot eliminate the influence of money from the health care system, how can we insure that the good of health care remains, in Radin's terms, "incompletely commodified"?
Commerce↗
Common ethical issues in regenerative medicine.
One of the common ethical issues in regenerative medicine is progress in 'componentation' (= being treated as parts) of the human body, and the enhancement of the view of such "human body parts." 'Componentation' of the human body represents a preliminary step toward commodification of the human body. The process of commodification of the human body follows the steps of 'materialization' (= being treated as a material object) [first step] -- 'componentation' [second step] -- 'resourcialization' (= being treated as resources) [third step] -- commodification [fourth step]. Transplantation medicine and artificial organ developments have dramatically exposed the potential of organs and tissues as parts, and regenerative medicine has a role in advancing 'componentation' of the human body and further enhancing the view of human body parts. The 'componentation' of the human body, regardless of the degree of regenerative medicine's contribution to it, is considered as a challenge to the traditional view of human bodies and the abstract value of "Human Dignity" in the same way or alongside the 'resourcialization' and commodification. However, in the future, a new perspective of human bodies that means "a perspective whereby human bodies, organs, tissues, and even the bodies themselves are perceived as disposable tools like disposable cameras, syringes, or contact lens" and therefore a new ethical view, suitable for a new reality, may emerge.
Biomedical Research↗
What does it mean to use someone as "a means only": rereading Kant.
Debates about commodification in bioethics frequently appeal to Kant's famous second formulation of the categorical imperative, the formula requiring us to treat the rational (human) being as "an end in itself" and "never as a means only." In the course of her own treatment of commodification, Margaret Jane Radin observes that Kant's application of this formula "does not generate noncontroversial particular consequences." This is so, I argue, because Kant offers three different--and largely incompatible--interpretations of the formula. One focuses on the obligation to preserve rational willing; the second stresses respect for human (physical) dignity and integrity; the third views respect for others as "ends in themselves" as primarily involving a willingness to govern one's conduct by a procedure of impartial co-legislation. Only the third of these interpretations, I conclude, offers a reasonable and coherent approach to moral judgment about the limits of commodification.
Bioethics↗
Contested commodities at both ends of life: buying and selling gametes, embryos, and body tissues.
This essay examines the increasing commodification of the body with respect to tissues, games, and embryos. Such commodifcation contributes to a diminishing sense of human personhood on an individual level, even as it erodes commitments to human flourishing at the societal level. After the case for social harm resulting from the increasing commodification of the body is made, the question becomes whether that harm is best remedied by following any of three approaches by which government traditionally seeks to promote the flourishing of its citizens. The author concludes that it is not, and that what is needed is a pragmatic and somewhat casuistic approach to the regulation of contested commodities--that which legal scholar Margaret Jane Radin calls "incomplete commodification."
Altruism↗
The special case of property rights in umbilical cord blood for transplantation.
In this Article, Professor Stephen R. Munzer makes a case for limited property rights in umbilical cord blood. Professor Munzer proposes that the unique nature of cord blood distinguishes it from body wastes and qualifies it as a body part in which property rights vest. Employing a theory of property, based in part on the articulation of the principles of utility and efficiency, justice and equality, and "labor-desert," he explores legal and philosophical arguments that justify the acknowledgment of such rights. He also discusses concerns over alleged generous granting of patents in the area of cord blood stem cells in light of these principles. Significant aspects of health policy are explored with particular focus on the potential value of using cord blood to treat various diseases and disorders. Professor Munzer discusses various difficult cases involving the exercise of property rights in umbilical cord blood with respect to the interests and/or motives of newborns, parents, and other parties. He argues that some of the concerns associated with the commercialization and commodification of cord blood are not serious enough to warrant significant barriers to market exchanges of property rights in cord blood. In addition, he concludes that the particular nature and harvesting of cord blood do not make its commodification morally problematic. Finally, Professor Munzer reinforces his treatment of property rights in cord blood by addressing objections that view property as "propriety," as a pragmatic institution, or as social relations.
Blood Banks↗
Testing the limits of freedom of contract: the commercialization of reproductive materials and services.
This article examines the cases for and against commercializing, or "commodifying," reproductive materials and services. Using a supply/demand third-party framework, three basic scenarios in which commercial-exchange relationships may be possible--exchange of gametes and zygotes, exchange of gestational services, and exchange of fetal material--and the major parties of interest, or stakeholders, are identified. The study sketches the liberal, essentialist, and radical contingency theories that shape the debate over the commercialization of reproductive materials and services. The article then attempts to derive some basic governing principles that reflect as much common ground as possible amongst these various normative perspectives, while recognizing that complete reconciliation is impossible. Taken together, these principles are designed to reflect a strategy of "constrained commodification," where commercialization or commodification, that is, financial remuneration, plays a relatively neutral role in the utilization of reproductive materials and services. In light of these principles, the article concludes by sketching legal and regulatory regimes with respect to the exchange of gametes and zygotes, gestational services, and fetal tissue.
Aborted Fetus↗
Feminists on the inalienability of human embryos.
The feminist literature against the commodification of embryos in human embryo research includes an argument to the effect that embryos are "intimately connected" to persons, or morally inalienable from them. We explore why embryos might be inalienable to persons and why feminists might find this view appealing. But, ultimately, as feminists, we reject this view because it is inconsistent with full respect for women's reproductive autonomy and with a feminist conception of persons as relational, embodied beings. Overall, feminists should avoid claims about embryos' being inalienable to persons in arguments for or against the commodification of human embryos.
Commodification↗
For your first born child: an ethical defense of the exploitation argument against commercial surrogacy.
In this essay I explore two arguments against commercial surrogacy, based on commodification and exploitation respectively. I adopt a consequentialist framework and argue that commodification arguments must be grounded in a resultant harm to either child or surrogate, and that a priori arguments which condemn the practice for puritanical reasons cannot form a basis for public law. Furthermore there is no overwhelming evidence of harm caused to either party involved in commercial surrogacy, and hence Canadian law (which forbids the practice) must (and can) be justified on exploitative grounds. Objections raised by Wilkinson based on an 'isolated case' approach are addressed when one takes into account the political implications of public policy. I argue that is precisely these implications that justify laws forbidding commercial surrogacy on the grounds of preventing systematic exploitation.
Canada↗
Advances in oocyte cryopreservation technology will eventually blur the ethical and moral boundaries between compensated egg sharing and commercialized oocyte donation.
Compensated egg sharing was originally conceived as a patient self-help co-operative scheme to avoid overt 'commodification' of donor oocytes and prevent doctors and medical institutions from acting as 'brokers' of donated human material. As such, egg sharing is an ethically justifiable and much-preferred alternative to commercialized oocyte donation. However, recent advances in oocyte cryopreservation technology are likely to blur the ethical and moral boundaries between compensated egg sharing and commercialized oocyte donation. The banking of cryopreserved oocytes would negate the requirement for donors and recipients in egg sharing to have co-ordinated and synchronized treatment cycles. Instead, fertility doctors and medical institutions can now offer subsidized fertility treatment upfront to any patient willing to donate a portion of her retrieved cohort of oocytes for banking and subsequent donation. Thus, more opportunity is now open for them to act as 'middle-man' to broker the transaction of oocytes between donor and recipient, which would inevitably result in overt 'commodification' of donated human material. Administrative and processing fees will de finitely be billed to prospective recipients, for banking and storage of the cryopreserved oocytes, which would mean that a direct profit can now be made from the transaction of oocytes between donor and recipient.
Cryopreservation↗
Environmental economics reality check: a case study of the Abanico Medicinal Plant and Organic Agriculture Microenterprise Project.
This paper presents a case study of the Abanico Medicinal Plant and Organic Agriculture Microenterprise Project in the Arenal Conservation Area, Costa Rica. Microenterprise is the Sustainable Development and the Women in Development model for gender equity and environment of the World Bank, International Monetary Fund and large non-government organizations, like the World Wildlife Fund-Canada. The authors of this paper argue that debt-for-nature investment in microenterprise and ecological economic models are not distinct from neoclassical economic and development models that created the environmental, social and cultural crises in the first place. This case study shows that the world market accommodates only one model of development: unsustainable export-oriented production based on flexible labour markets, low wages, indebtedness and low cost production. Working standards in those micro-enterprises are eroded due to many factors,including indebtedness. What happened at a national level in non-industrial countries with the international debt crisis is now mirrored in individual indebtedness through microenterprise. Is current development policy creating a new form of indentured servitude? Medicinal plants, prior to commodification, were a source of women's power and upon commodification in international development projects, are the source of their exploitation.
Agriculture↗
A nova vida: the commoditization of reproduction in Central Mozambique.
In Central Mozambique economic austerity and shifts in domestic organization have transformed kinship and gender relations in ways that reinforce reproductive demands on women. Against this backdrop of economic and social restructuring, commodification of long-standing reproductive practices has intensified. This paper examines the influence of commodification and female economic marginalization on virginity reviews, seduction fees, bride wealth payments, and childbirth assistance. Constructions of reproductive risk as human or spirit-induced threats of witchcraft, sorcery, or spirit possession resonate in this atmosphere of competition and instability. Rather than disappearing, occult practices may be increasing in response to the new inequalities associated with "modernity." This pressure contributes to women's reproductive vulnerability and informs new strategies to manage risk during pregnancy. Life history and pregnancy case study data reveal how women facing growing inequality and increasing danger to reproductive health mobilize cultural resources in ways that, paradoxically, both reinforce and contest dominant relations of reproduction.
Adolescent↗
The products of conception: the social context of reproductive choices.
This paper addresses the changing ideology regarding reproduction, an evolving American, and potentially worldwide, value system regarding children and parenthood. Children are increasingly being seen as products, and the new technology of reproduction, including the sale of reproductive material and services and especially prenatal diagnosis and selective abortion, encourage this commodification of the fetus. While the new technology does indeed offer new choices, it also creates new structures and new limitations on choice. In the contemporary American social structure, these choices are inevitably couched in terms of production and commodification, and thus do not offer individuals genuine choice or control.
Abortion, Induced↗
Prostitutes, workers and kidneys: Brecher on the kidney trade.
Brecher argues that the practices of selling blood and kidneys are akin to the practices of prostitution and wage-labour since they all involve commodification and, by implication, should be subject to legal prohibition. I suggest that these practices need not involve commodification and that they should only be condemned if people are forced into them because of their lack of power. Rather than these practices being prohibited, I suggest that it would be preferable if they were subject to state regulation in order to protect the weak from exploitation.
Commerce↗
Spectacular reproduction: Ron's Angels and mechanical reproduction in the age of ART (assisted reproductive technology).
Ron Harris captured the popular imagination in October 1999 with a website where he auctioned off the ova of fashion models to the highest bidder. This article treats the controversy surrounding Harris' site within a dual frame of critical theory's approach to reproduction and a folkloristic approach to discourse. The website fuses traditional narrative motifs and structures with the logic of advertising, seventies television, family-values rhetoric, and the fertility industry. I argue that the great attraction of ronsangels.com is that it put into relief the intervention of mechanical reproduction in human fertility together with the state of genetics at the turn of the 21st century. The result is not only a disconcerting aestheticization and commodification of biological reproduction, but also the biological reproduction of a particular aesthetic and moral code--a generation of reality by model.
Advertising↗
The social life of genes: privacy, property and the new genetics.
With the advent of the Human Genome Project and widespread fears over human cloning and medical privacy, a number of states have moved to protect genetic privacy. Oregon's unique Genetic Privacy Act of 1995, which declared that an individual had property rights to their DNA, has provoked national and international interest and controversy. This paper critically reviews the literature on genetic privacy and gene patenting from law, philosophy, science and anthropology. The debate in Oregon, from 1995 to 2001, illustrates many of the key issues in this emerging area. Both sides of the debate invoke the property metaphor, reinforcing deterministic assumptions and avoiding more fundamental questions about the integrity of the body and self-identity. The anthropological critique of the commodification of the body, and the concept of 'embodiment' are useful in analyzing the debate over DNA as property.
Anthropology↗
Social and ethical aspects of in vitro fertilization.
In vitro fertilization (IVF) stands out as one of the contemporary period's most extraordinary technologies, and its social and ethical consequences among the most far reaching. Despite its uncertain effectiveness and medical consequences, IVF has contributed significantly to the medicalization of infertility and the increasingly imperative character of reproductive technology. New developments in IVF, particularly oocyte donation, have created new definitions of treatable infertility and new social needs for IVF; when the technology does not result in pregnancy or healthy babies, these developments have created profound new disappointments. IVF and the commodification of the extracorporeal embryo have also confused the social meaning and legal definition of parenthood. Ultimately the relationship between prospective parents, infertility specialists, and the embryos that they create is a highly ambiguous one. This ambiguity is likely to be a long-term characteristic of efforts to develop, use, and assess assisted reproductive technologies.
Commodification↗
Selling bits and pieces of humans to make babies: The gift of the magi revisited.
Reproductive medicine, a sector of a health care system increasingly captured by the demands of the marketplace, is enmeshed in a drive to sell certain human bits and pieces, such as gametes, cells, fetal eggs, and fetal ovaries, for reproductive purposes. The ethical objection raised by Kant and Radin to the sale of human organs - that this is incompatible with human dignity and worth - also applies to these sales. Moreover, such sales nullify the reproductive paradigm, irretrievably replacing it with a manufacturing paradigm. This represents a change in kind, not just of degree, in the way that we view our capacity to generate children and destroys our concept of reproduction as an essentially human activity. In the face of a struggle to retain those common ethical values at the foundation of reproductive medicine, this form of commodification of the human body should be viewed as ethically unacceptable.
Aborted Fetus↗