DOI: 10.25549/usctheses-c3-302562
title: Morals, markets, and the public sphere: a study of the human organ procurement debate, 1984-2012

description: Recent estimates claim that one in three of the 115,000-plus people waiting for an organ transplant will die due to the current shortage. The question is simple – and urgent: how does the U.S. get more organs? This study is not concerned directly with that practical question but rather with the rhetoric of advocates. The focus is on two very distinct strategies, one based on furthering the current altruistic-based system and the other based on incentivizing organ donors through financial compensation and/or through an outright market for human organs. Until the altruism-based status quo can satisfy need, market alternatives will be present and need to be evaluated. ❧ The organ donation system in the U.S. is built on and maintained by the public moral values of civic republicanism, and economic neoliberal monetization, largely in conflict with those values, tends to be successfully transgressive in the current era. Analysis focuses on the normative dimensions – specifically the interplay of, and the rhetorically constructed limits between, morality and markets in terms of the logic of justification for the two strategies. This study also develops the context within which the two strategies appear in the public sphere, considers the broader political-economic relations at work in U.S. society during the era (namely, increasing neoliberalism), and draws implications for public deliberation and civic community. The dissertation lays out the civic republican rationale, market alternatives, the increasing fragmented moral positions and neoliberalization in the current era, and then engages in reconstruction of public moral argumentation as a substantive space of resistance to the unlimited commercialization of forms of life. Despite limits to civic republican appeals, neoliberal dominance can be resisted through a logic of good reasons and the process of public moral argumentation only if these latter are rethought through from the standpoint of (meta)ethics. This resistance is not absolute and the study visits ambiguous cases and aporias, with a look toward future considerations, as science continues to provide options to commercialize life. The study sits at the intersection of rhetoric, philosophy, ethics, and policy. ❧ What has normative force in this debate is the question of human dignity. Market advocates’ case turns most sharply on the fact that markets do not violate human dignity, but altruistic advocates respond that a good society would be one that actually promotes attitudes that enhance human dignity through communicative patterns and policies. While, in a sense, the telic orientation toward human dignity is shared, the corresponding justifications for (differing) actions hinge on differing telic views of society: whether it is a society’s job to promote and enhance human dignity, or whether the aim is one of negative liberty. ❧ Overall, moral disagreements like those over human organ procurement strategies, though uncomfortable, are expected in a pluralistic society like the U.S. Human organ procurement is a problem symbolically at the heart of contemporary moral and sociopolitical disagreements in the U.S., a metaphor for the economization of everyday life under the continued expansion and rhetorical resonance of neoliberalism. Deciding together about the limits of markets is about organ policy in particular but, more significantly, it is also about the very kind of society in which citizens exist, deliberate, and thrive.