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New Cannibal Markets

 | 
Jean-Daniel Rainhorn
, 
Samira El Boudamoussi

Globalization and Misuses of Biotechnologies: Back to Cannibalism?

Jean-Daniel Rainhorn

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“It has become appallingly clear that our technology has surpassed our humanity.”—A. Einstein

“Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means.” —E. Kant

  • 1 Concept proposed by the World Health Organization, Geneva. See document EB136/CONF/3. January 2015
  • 2 Oxford Dictionaries define “natural resources” as: “Materials or substances occurring in nature wh (...)

1This book results from a multidisciplinary symposium held in February 2014 in Geneva. A group of international scientists from both medicine and the social sciences gathered with the goal to collectively explore how some misuses of new biotechnologies—that make it possible to provide consumers with “medical products of human origin”1—tend to consider the human body or parts of the body as reservoirs of “natural resources.”2 Advances in biomedicine have led to new, and particularly lucrative, health industries, and their rapid development has contributed to major behavioral changes that sometimes call into question certain well-established values that have until now been considered universal. Indeed, today, in a globalized neoliberal environment, there are markets for the human body that have little or no regulation and depend in part on the massive rise in inequalities worldwide. Such inequalities are at once social, economic and cultural and the created markets allow improved health for some people—those in privileged social classes—by exploiting the bodies of other human beings—the disadvantaged. These new markets result in a new way of looking at the integrity of the human body, which is no longer a sacred universal value.

Advances in biomedicine

2It is easy to understand the fascination the media, and therefore the general public, have for medicine as it contributes to improving the overall health of the population. Average life expectancy at birth has doubled in a century. Improved hygiene and vaccinations have reduced the spread of infections and diseases. Progress is being made in treating cancer, in pain management, in reducing the risks of pregnancy and birthing, in assisted reproduction technologies, in tissue and organ grafts. These are just a few of the spectacular advances made in the last few decades. Technological developments are by far not the only explanation for a decrease, or at least control, of some diseases, but they clearly play an important role in improving overall health.

3The realm of scientific advances is not one in which it is always easy to remain objective. The spectacular and the emotional often override fundamental questions linked to their use, when it is not monitored or regulated in some way. Medicine and science in general have the goal of making new biotechnologies available to as many patients as possible. We cannot however underestimate the fact that these same technologies can sometimes be used for other ends than those for which they were originally designed.

4We are living in a very particular era, in which we see easy-to-use technology marketed in areas as vastly different as biomedicine and genetics, computers and communication, the environment, energy and the food industry. Today, these technologies have a determining influence on whole sectors of the world economy, but many of them also impact the daily lives, and particularly the physical, mental and social well-being of individuals. Rarely in the history of humanity have human beings had to face and adapt to so many changes in such a short lapse of time. Concomitantly, the use of these technologies raises many cultural, socioeconomic, and political issues.

5Some of these technologies also raise non-negligible ethical questions, impacting areas or life and values that have until now been more or less untouchable, such as respect of privacy and individual freedom, confidentiality of correspondence, non-commercialization of living beings, parenting, food safety, and more. In addition, the globalized nature of their use, and the fact that they generate profits that can be very high, lead to new forms of criminality that are challenging both national and international legal systems.

6We are seeing the development of worldwide markets in which everything can be bought and sold—even the human body—under conditions that are farther and farther from a respectful vision of the human person. It is like a huge supermarket in which the consumers can find everything they think they need. We are experiencing a true cultural revolution, one that provides the immediate satisfaction of personal needs. Everyday, we have access to more and more commodities that come to us via new technologies and new means of production. Generally, we access them with little regard for the conditions in which they were produced (child labor, bonded labor, banned chemicals, products of human origin, etc.) as long as they respond to the need or to the desire of the person who has the means to pay for them. A new type of society seems to be developing insidiously, a profoundly unequal global society that is less respectful of human beings and, perhaps, in the long run, more totalitarian. It is a society in which we will be able to buy/rent human body parts or products based on our own needs, often regardless of the person from whom they come. This society operates under rules that more often than not escape all forms of public regulation, even when they impact the most basic human-rights. As Herbert Marcuse (1955) reminds us: “Concentration camps, mass exterminations, world wars, and atom bombs are no ‘relapse into barbarism,’ but the unrepressed implementation of the achievements of modern science, technology, and domination.”

The slow desubjectification3 of the human person

  • 3 See Wieviorka (2012).

7Examples of unrepressed implementation of biomedical achievements and the resulting behavioral changes are legion. One of the most recent is certainly the double scandal that broke out in Thailand in the summer of 2014.

8“Baby Gammy,” a child conceived through in vitro fertilization by an Australian couple and born with a twin sister to a Thai surrogate mother, was abandoned by his genetic parents because he had Down’s syndrome. This example sheds light on a movement toward desubjectification—of both the surrogate mother and the child—that can be found in the words chosen by people using surrogates. When the biological parents returned to Australia with the apparently healthy little sister, abandoning the little brother, who was also genetically their child, because he was handicapped, they more or less consciously considered that paying a large sum of money to the surrogate mother guaranteed them a “good quality” product. To them, Gammy—the purchased object—did not correspond to what they had imagined when they began the process of assisted reproduction. So, they did what they would have done with any other consumer good, they went as far as demanding some of their money back.

9The minimal consideration they demonstrated for the surrogate mother—who did accept to raise the child as her own—also raises the more general questions about the nature of the relations between intended parents and those that carry the children for nine months. This relationship is particularly unequal, because it reduces the surrogate mother to a function—reproduction—while imposing an obligation of results: a “perfect child.” This is a form of servitude that is certainly not fully compensated by the payment received, no matter what some say.

10The second scandal is that of a young, rich Japanese man. DNA tests showed him to be the biological father of fifteen or so children via surrogate mothers. He declared that he really did want a large family and didn’t do anything illegal. Indeed, nothing can keep someone with the financial means to pay as many surrogate mothers and he wants, in as many countries as he wants, to make as many children as he wants. The extent of megalomaniac desire is no longer limited by morality, respect of human beings or the law. Money is the only limit. If I am rich, I can buy as many cars, trips or babies that I want. I therefore can reduce the women who carry the children and the children themselves to simple commodities.

11It is understandable that, despite its tradition of tolerance, Thai society was particularly shocked by these two events. In November 2014, the Thai Parliament gave initial approval to a bill—on the first reading and nearly unanimously—that outlaws commercial surrogacy. Will this put an end to this new form of slavery? Perhaps in Thailand it will, although the law has not yet been voted by Parliament. But, the increasing worldwide demand and the absence of international regulation respected by all countries suggests that the assisted reproduction industry, and therefore use of others to carry babies to term, will continue to grow.

Healing that exploits bodies of others

12Taking some distance from some ethically questionable uses of assisted reproductive technology, it becomes clear that the same types of questions also come up in other areas of medicine and public health in which products of human origin are used for therapeutic reasons. Today, whole industries are developing, industries with asymmetric socioeconomics based on exploiting bodies and products of bodies from some people for the health needs of others. Trade in organs, blood, tissues, and human reproduction have become globalized markets that—beyond the legal practices generally offered in the public sector—have spread across the planet with impunity. Furthermore, the transplantation of an organ, the supply of a tissue or a gamete, or the use of a surrogate mother often occurs in a country that is not home to the “buyer,” and this cross-border nature makes it more difficult to establish a consistent legal framework applicable to all. Strengthening local legislation by forbidding these practices for foreigners and/or formulating or adopting an international legal framework like the World Health Organization has done in other areas are approaches currently being explored. This book sets out to contribute to this reflection.

13In the end, isn’t exploiting another person’s body to improve the “performance” of one’s own body or mind the same as ritual cannibalism, that is, eating an enemy’s body to appropriate his courage and intelligence? Can we apply the metaphor of cannibalism to these new health markets that use living or dead body parts to produce means to treat disease, to replace organs or simply to respond to a desire to have a child—which is sometimes considered to be a right?

14If we push the metaphor further, can’t we consider the pillaging of essential human resources in the form of doctors and nurses from poor countries as another form of cannibalism? Brain drain does consist of appropriating qualified human resources from countries with considerable health-care needs to transfer them to rich countries where the aging population—and with it the desire for immortality—is increasing the need for health-care professionals. Already weak countries are being emptied of their most qualified professionals, or symbolically of part of their life blood. Couldn’t that be considered a form of vampirism? These are strong, and even provocative, images touching myths that run very deep in the human unconscious. Perhaps not everyone will agree that they describe what many consider to be a market norm. Perhaps such words seem far from reality. But isn’t it also a myth to imagine a world in which the “invisible hand of the market” alone frames human relationships, a world that does not take into account the profound inequalities that exist?

15The association of scientific progress with neoliberal globalization has led to new realities and new behavior in the health sector, such as cannibal markets, new forms of servitude and slavery, medical tourism, and unequal treatment in the face of illness and death. The result is a slow migration away from the Hippocratic principles that have served as an ethical framework for medicine for the past two thousand years. Of course, many would argue that health-care is not like other fields, that it is about suffering, illness and death, and in addition that “health has no price.” But is that a reason to go as far as dehumanizing the other—the other who is also a human being—to the point of reducing his or her body to an object you can pay for to benefit from?

16Unfortunately, there is no lack of examples today to convince us that the misuse of certain biotechnologies can lead to an objectification of the human body and to the industrialization of their use. One would have to be blind, or unrealistic, not to see how close we are coming to the world described by A. Huxley in Brave New World (1932) or K. Ishiguro in Never Let Me Go (2005).

Sensational headlines or real facts?

17The international news is constantly covering stories that provide insight into the scope of these new markets that exploit the bodies of some to satisfy the health needs or well-being of others. These are no longer isolated events, whose illegal and sometimes sensational nature could make for tabloid headlines, but the inevitable consequences of the development of veritable globalized industries. Four examples taken from recent news are food for thought.

18In 2011, The Guardian and then later other newspapers (Gupta 2011; Bhalla and Thipliyal 2013; Rudrappa 2014) reminded us that India has more than 300 clinics in which medical teams and women are available to provide pregnancies for others, that rental of wombs of Indian surrogate mothers by foreign couples represents several thousands of births a year and that according to a report by the Confederation of Indian Industry, this type of practice brings in $2.3 billion a year. The growth of this market continues despite efforts by the Indian government to limit it. Although quantitatively lower, the situation is comparable in countries like the United States, Ukraine, Thailand and Israel.

19Surrogacy has all of the elements needed for the structuring and growth of an international market. On one hand, there is solvable demand represented by consumers whose desire for a child is limited by the legislation of their own country, to which can be added a new type of demand represented by homosexual couples wanting children. On the other hand, a nearly unlimited supply is developing in the form of surrogate mothers, based on a desire to overcome situations of great social vulnerability. In between the two, there are intermediaries—generally private profit-driven agencies looking for quick earnings through more or less honest means. This is a very asymmetric market, in which the body of some serves to satisfy the desires of others. Is the enslavement of surrogate mothers any different from that of prostitutes?

20In a second example, the serious German newspaper Der Spiegel (Putz 2013) carried a story about Syrian refugees selling their organs in Lebanon in order to survive. It added that, because of this new supply, the price of organs had dropped significantly. So, to survive, some of the three million Syrian refugees (UNHCR 2014), who now live without any income, depend on humanitarian aid and have no hope of returning to their home country in the near future, have nothing but their organs to sell. That gives an idea of the degree of despair in which they find themselves. A similar situation occurred in India after the December 2004 tsunami. It led to the arrest of a network that recruited refugees to supply grafts to hospitals (Schmitt 2007).

21So, when it comes to harvesting and transplanting organs, all the elements needed for the development of an international market exist. On one hand, there is a constant demand from consumers who suffer kidney or liver failure and who urgently need organ transplants. On the other, there is an unlimited supply represented by the planet’s socially excluded—be they refugees or just simply living in poverty—who are looking for any possible means to get out of a situation of great social vulnerability. Between the two, most countries have restrictive legislation that pushes individual or institutional intermediaries to look for—often in more or less licit ways—organs to graft. This very lucrative activity takes place more often than not through the purchase of organs from living donors under ethical and medical conditions that are more than questionable (Goyal et al. 2002; Mendoza 2010).

22A third example dates from the summer of 2012, when numerous serious newspapers published the results of an international survey on human tissue trade carried out by the International Consortium of Investigative Journalists (ICIJ) (Willson et al. 2012). This investigation, conducted in eleven countries, explored supply chains of human products used routinely to treat patients throughout the world and that are dominated by publicly traded Western companies (Le Monde 2012). According to this investigation, this market has been experiencing exponential growth, with revenue doubling in ten years. Once again and although the origin of these products are unclear, there is no doubt that such a market has a growing demand and a nearly unlimited supply.

23Finally, a fourth example is related to brain theft as another form of cannibalism, even if it does not directly concern a product of the human body. In the Daily Mail: “Out of around 13,000 new doctors registered by the General Medical Council every year, just 7,000 come from British medical schools” (Levy and Osborne 2013) and that two-thirds of them were trained in poor or emerging countries, essentially the Indian subcontinent and Africa. In some English-speaking African countries, as many as fifty percent of doctors have migrated in the last twenty years. This organized migration of health-care professionals—both doctors and nurses—seriously weakens the capacity poor countries have to respond to medical crises. Here too, there is a supply, a demand and intermediaries, all the elements needed for the development of a totally asymmetric international market.

24Of course, these examples may be considered as mere sensationalism of the media. However, they provide indications of a reality that deserves to be examined by the research community.

What do these phenomena have in common?

25In these four examples, an identical mechanism is at work: patients belonging to a privileged population directly or indirectly purchase body parts or products from people who live more often than not in dire poverty and have nothing else to sell to survive. This trade is growing steadily and, due to a lack of sufficient international legislation, is doing so with little or no transparency and far from ethical standards. Its economy, because it focuses on raw materials, resembles a neocolonial economy. Isn’t the human body the most basic of all raw materials?

26Although there are some differences between these examples, there are also many similarities:

  • They were marginal before the 1980s for technical, ethical, economic and legal reasons, but have become a new kind of commercial activity based on the use of recent biotechnology and generate large profits.
  • They require the presence of health-care professionals in the chain that starts with the expression of a need and goes through to the satisfaction of that need. This raises the question of what role doctors play in activities that are often motivated more by gain than by their duty to treat patients.
  • They often occur on the edge of legality. They are a particularly violent illustration of how a globalized neoliberal market, by diminishing the role of the state, favors the development of illicit, and even criminal, commercial activities.
  • Finally, these activities participate in a desacralized vision of the body in which human beings are dehumanized. In these four examples, the human being is reduced to being an “object” that you can sell and buy, whole or in pieces, dead or alive.

27Ultimately, these phenomena reduce human beings to a function or a product that can be traded. Doesn’t that make them new forms of contemporary slavery? Yes, they may use medical technology with the goal of improving the health of some thanks to the “voluntary” contribution of others. This gives them an appearance of respectability that is sometimes reinforced by the application of ethical principles such as informed consent—when it has been given—or financial compensation—when it is paid. However, in extreme cases, such practices announce the development of a proletariat of object-people whose role would be to produce human substances and improve the health of those who could buy them.

28The fact that there are many similarities among these different events gives a certain legitimacy to the suggestion that these examples form a coherent whole that we can refer to as the “commodification of the human body for medicine, health or well-being.” And it is tempting to use the metaphor of cannibalism to describe this phenomenon and call it a “cannibal market.”

Why the metaphor of cannibalism?

29Using money to purchase the functions or products of a human body to improve one’s health is surprisingly similar to the ritual cannibalism of eating someone’s body to take on their virtues.

30As we know, cannibalism has very old and very deep roots in human history. Greek mythology gives many examples, starting with Kronos, Zeus’s father, right through to Dionysus and his bacchanals, and Prometheus, each of these being an attempt to explain the origin of humanity. One also finds the metaphor of cannibalism in Christianity, with Jesus’s words at the Last Supper: “Whoever eats my flesh and drinks my blood has eternal life” (New Testament, John 6:54). In psychoanalytic language, cannibalism expresses the notion of “incorporation,” a phase in a child’s development when he or she develops a perception of the world by “devouring” the maternal breast (Freud 1950).

31Finally, the expression “cannibalize” is often used in the trade of used parts, particularly of cars and machines. Here, we see how close this expression is to the realities of trade in the human body which, based on this image, is reduced to the simple purchase of used objects in more or less good condition.

32In a word, the metaphor of cannibalism could seem excessive to some, yet it admittedly does illustrate well the trading mechanism of appropriating bodies for medicine, health or well-being, a practice that is developing in the health-care sector on an international scale.

Trade in bodies: a neocolonial economy?

33Colonialism is a phenomenon that goes back to antiquity. It can be defined as a combination of policies and practices by which a group of people dominate another group, often through the use of violence. It translates specifically into the exploitation of resources in colonized countries and the enslavement of populations generally deprived of their most basic rights. Immense wealth has thus been pillaged and hundreds of millions of people reduced to slavery. Between the fifteenth and the twentieth centuries, European colonialism imposed its power on a good portion of the world, and colonial economics largely contributed to European wealth (Galeano 2009).

34One can note that the majority of countries in which body resources are “purchased” today are emerging countries that have a colonial past. India, a former British colony, is the most characteristic of these countries. There, the privileged categories speak English, which contributes to the country being the world’s top exporter of health-care professionals (Mullan 2005), and it is the country with the most developed markets for assisted reproduction and for organ transplantation for foreigners. English-speaking sub-Saharan African countries, who see their health-care professionals “sucked up” by the United Kingdom and South Africa, can also be considered victims of a neocolonial pillaging of the human resources in a sector—health-care—in which the needs are tremendous and recognized by the international community as a priority (Sharples 2015).

  • 4 One poor neighborhood in the capital city of Manilla has 20 million inhabitants and is called the (...)

35Egypt, an organ provider for the privileged in the Arabian peninsula, is another example. And finally, the Philippines, a former American colony, are the top exporter of nurses around the world, particularly to the United States and the Gulf countries, and an unlimited reserve of organs, particularly for the well—off in Japan.4 These are just a few examples of many that demonstrate how the flow of resources—both material and human—continues in essentially the same direction as during the colonial period, even if today, for technical and economic reasons, it is often the patients that travel to benefit from these services. The areas covered in this book are no exceptions.

36Despite efforts from some neoliberal economists to convince us that, when the money sent back by emigrated professionals is greater than the cost of their training, the source country benefits from the exchange, proof shows that the patients from rich countries are the main beneficiaries in this especially unequal exchange (Amin 1973). And presenting organ trade in the light of freedom to do what one wants with one’s body is intellectually dishonest when one knows that the large majority of “sellers” are poor and illiterate and that in the end many receive only small amounts of money for the use that is made of their bodies. Are there fundamental differences between pillaging primary resources by violence and human beings by money? In both cases, there is no real negotiation. And in the commodification of the body, there is only a relationship of power disguised as consent and politely called an exchange. Very little progress indeed has been made since the time of colonial economics.

Appropriating the other’s body: an attempt at classification

  • 5 A search on Pubmed (www.ncbi.nlm.nih.gov/pubmed) in January 2015 using the keywords “commodificati (...)

37Commodification of the human body for medicine, health or well-being is a growing area of research, although the number of scientific articles in the literature remains modest.5 In fact, the literature covers either specific topics (organ trade, reproductive tourism, blood and plasma trade, tissue banks, etc.), or more general questions such as those related to ethics and morality. The marginal amount of research in the area is certainly related to these technologies being relatively recent—with the exception of the collection, storage and distribution of blood—and also because it tends to only look at problems from a relatively specialized perspective (transplantation, assisted reproductive technologies, blood, etc.) and not as a coherent whole in which there are similar mechanisms. Indeed, as is common practice in medical sciences, each specialty works in its own specific field with its own criteria and, in a way, is unaware of what is going on in other specialties. For the moment, the various medical fields in which there is trade in human body functions or products for medicine, health or well-being are rather impermeable. They form a list of practices without obvious connections. And until now, little effort has been made to better analyze their possible similarities.

38By bringing together the contributions of researchers from a wide variety of disciplines and countries who found themselves together for the first time to share their experiences in areas considered to be very different, this book aims to raise certain questions that could lead to a more general vision of these emerging commercial activities in the health-care sector and potentially foresee how medicine will be practiced in the near future. For this, an interdisciplinary approach is essential, as it enables classifications that could facilitate the search for shared solutions.

39Using the human body or products of the human body in an unregulated manner to treat others leads to forms of exploitation that are incompatible with a respect for the most basic human-rights. To observe, analyze and better understand this phenomenon, it is first of all useful to provide a methodological framework based on a classification of the various practices. At the current stage of reflection, at least two types of classification can be discussed. A first type could, for example, use resources from the human body as criteria and could be called an “anatomo-physiological classification.” A second type of classification could be based on a more functional notion: the way in which the human body is appropriated to be exploited for its resources; it could be called a “functional classification.”

Anatomo-physiological classification

40An anatomo-physiological classification would distinguish three categories of trade in the human body.

  • 6 According to the ILO, implementation of the Decent Work Agenda includes four strategic objectives, (...)

41a) Trade in the human body as a whole to have a workforce. This kind of contemporary work resembles slavery, in other words, the reduction of an individual to the state of a good that can be used to meet the needs of an economic activity. Reduced to the state of being merchandise, whose muscles are rented and can be disposed of at will, the “contemporary slave,” like his or her ancestors, has little or no possibility of deciding on his or her own destiny. He or she depends on the person who pays for the use of the labor. Except in certain regions of the world where slavery exists in its traditional form, today it takes the form of overexploited individuals who generally do not have their basic rights respected and who live in such poverty that they do not have other means to survive than to sell their capacity for work day to day in often inhuman conditions. These are rural migrants in China, landless farmers in India or Latin America, undocumented migrants in Europe or the United States, indentured workers in Asia, laborers imported to work on major construction projects in the Gulf countries, and others. According to the International Labor Organization (ILO), the condition in which these people work today—there are probably hundreds of millions of them—are so similar to those of slavery that this institution has set up rules that define what they call a “decent work agenda” and guarantee basic labor rights that could legally be demanded of all employers.6

  • 7 The term “reproductive functions” is used here in the meaning of “reproductive health,” a concept (...)

42b) The trade of whole human bodies for the use of a specific organ. The body is used as a whole, but reduced to a specific function. The function will be rented to respond to the needs of an individual or a group of individuals. Of course, prostitution is the oldest and best-known model for this kind of trade. In addition, it is also a very ancient practice for the upper classes to “rent” nursemaids’ breasts to provide milk for their children. Today, there is a new type of trade that involves renting wombs to carry someone else’s child. In these three examples, it is specifically the woman’s body involved, in its “sexual and reproductive functions.”7

43Although not literally trade in the human body, one can be tempted to add to this category the theft of brains from poor countries to respond to the needs of rich societies lacking specialized human resources, and specifically health-care professionals. This pillaging can also be considered, at least metaphorically, as trade in a human being reduced to an organ or a function—in this case, the brain and its skills.

44c) Trade in a part or product of the human body: organs, tissues, blood, cells or gametes. This is a new form of trade that requires the use of very specialized and recently developed medical technology, although trade in blood is older. An organ or body product is bought from one human being—called the “seller”—to be introduced into the body of another human being—the “buyer”—through the intermediary of a qualified professional. This kind of intervention requires the use of biotechnologies and often sophisticated medical and surgical techniques. Some body parts and products are renewable—blood, gametes, cells, genes, etc. Others are not—organs, tissues—or can only be removed from deceased individuals, such as the heart.

45In the two initial categories, the human body is kept whole and in general it is in the interest of users that the body be maintained in good health for as long as possible, even if the unlimited supply makes individuals easy to replace. However, in the third category, harvesting organs and body products can be done either with little damage or, on the contrary, cause irreversible mutilation.

Functional classification: new forms of appropriation8

  • 8 This attempted classification is in part inspired by Fabre-Magnan (2013, 2014).

46A second classification, more legal, can also be proposed to simplify the analysis. It is based on how the human body is appropriated.

47a) The appropriation of the “right to use the human body” and more specifically:

  • its muscles, that is its work capacity;
  • its sexual organs, through prostitution;
  • its brain and skills, which refers to the pillaging of health-care professionals from poor countries;
  • its womb, or the human reproduction function in order to carry out someone else’s pregnancy.

48This category thus covers some very ancient realities—slavery and prostitution—as well as more contemporary forms of servitude, including brain drain of health-care professionals and surrogacy.

49b) Appropriation of the “fruits” of the human body. These “fruits” could refer to substances removed from the human body and that renew themselves without a significant alteration to the individual. They include hair, sperm, ova, and blood, although some nuancing among them is necessary, as the conditions and consequences of harvesting are quite different.

  • 9 A phenomenon apparently known in Ancient Greece as it appears in the Prometheus myth.

50c) Appropriation of human body “products.” These would include parts of the body that are removed and in general do not regenerate. Organs and tissues that can be transplanted fit this category, even if livers can regenerate9 and the heart can only be removed from a deceased person, no matter how you define death.

51Are the new forms of exploiting the whole human body or parts of it that we see today a foreshadowing of how the human body will be exploited in the future? This kind of exploitation on an industrial scale could not have been imagined even thirty years ago, but now could, if we are not careful, lead to the rise of a new group of human beings who are more or less forced to participate because their survival depends on renting or selling their bodies, a kind of “object-person” who would be “cannibalized” as needed.

Towards an object-person proletariat?

52Part of humanity lives in social exclusion, which means it does not have access to essential social goods as defined by the United Nations. These hundreds of millions of people live in precarious housing, without running water and sanitation; they do not have enough to eat, and the majority of their children remain more or less illiterate; their health is fragile and they do not generally have access to health-care.

53These people who have been “left behind,” who are “useless in the world” (Geremek 1976; Castel 2002) try to survive in face of greater and greater indifference, and little by little become “others” to the welloff. The “others” are more and more distant, and less and less considered to be human. A mass of anonymous individuals, a kind of proletariat who, if we go back to Karl Marx, is made up of people who “must sell themselves piecemeal, are a commodity, like every other article of commerce, and are consequently exposed to all the vicissitudes of competition, to all the fluctuations of the market” (Marx 1848). This definition is particularly visionary and consistent with the idea of a proletariat of “object-persons” whose function would be to sell and rent their own bodies to produce human products that would improve the health of the better-off.

54This function is described in such novels as Never Let Me Go by K. Ishiguro, in which children are cloned to supply needed organs, or in M. Atwood’s The Handmaid’s Tale (1985) in which women are chosen based on their fertility to produce children for officers of the regime, an image that brings to mind the Lebensborn set up by the Nazis to ensure the reproduction of the Aryan race.

55Controlling women’s fecundity has always been an obsession of totalitarian regimes. What then can be said about the two Silicon Valley giants, Facebook and Apple, offering to freeze oocytes so that their employees don’t need to choose between having a career and having children (Friedman 2014)? Will these star tech companies set examples that bring into question a woman’s basic right to have children when she decides to and not when it is in her employer’s interest? Is fiction, with its totalitarian horrors described so well in dystopian literature, becoming reality?

56In these novels, however, the topic is planned desubjectification by a totalitarian system. Today, the situation seems to be different. It is not an imposed plan, but rather the insidious and generalized apparition of a cultural and economic environment that is favorable to the increased use of products of human origin, be the reasons therapeutic or hedonic.

57Unfortunately, medicine does not escape the influences of the neoliberal revolution in which everything can be bought and sold, a reality that moves the doctor progressively away from Hippocratic Oath and sometimes reduces people to nothing more than a “living currency” (Klossowski 1997).

Doctors or merchants?

  • 10 www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/principles-medical- (...)

58Considering the complexity of the medical techniques needed to harvest human products and for assisted reproduction, medical professionals are necessarily involved in these new markets of the living. It is hard to imagine that the involved doctors are not aware that they are participating in a lucrative trade that is not always legal and not always ethical. At this stage, we can even wonder if the use of new technologies to improve the health of some by using the body functions and resources of others is not in the process of changing the objectives of medical practice. The Hippocratic Oath, which has served as a framework for medical practice for centuries, reads: “I will take care that they suffer no hurt or damage.” The Principles of Medical Ethics proposed by the American Medical Association10 stipulate that “a physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights” and that “a physician shall support access to medical care for all people.” How far from these guidelines do medical doctors stray when they participate in the commodification of the human body?

Conclusion

59Many other questions deserve to be raised. It appears that, in effect, commodification of the human body for medicine, health and wellbeing is turning our world upside down. Behavioral changes line up, the insidious growth of the idea that money can buy everything including human beings—whole or in pieces—for the sole reason of satisfying one’s needs, the lack of questioning among the beneficiaries of such markets regarding the origin of these products are all factors that contribute to the fear that these practices will develop even more.

60Other key questions are raised in this book. For example, how do religions, which position themselves as the “guardians of morality” view trade in human bodies? Do they have clear opinions on the topic, or are they exceeded by the rapid changes and not capable of providing overall answers?

61The fact that even beyond assisted reproduction technologies and surrogacy, these cannibal markets affect women in particular raises other important questions. In India, women represent a significant portion of organ “sellers.” That reality cannot be kept under wraps, much like the conditions near slavery in which live thousands of Philippine nurses in the Gulf countries. Must we consider that commodification of the body is also a gender issue?

62Would it be possible to imagine international regulations that could reduce this trade when supply and demand are all but unlimited? Can market forces be limited by a national and/or international legal framework when the profits generated by these activities are so high? Unfortunately, one can imagine that the opposite will happen.

63As a matter of fact, for two years, in great secret—with no official announcements and no documents made public—meetings have been held at the World Trade Organization preparing for greater commercial flexibility in the services, and particularly in the health-care sector, in order to transition the General Agreement for Trade in Services (GATS) towards a new agreement—the Trade in Services Agreement (TiSA). This agreement would reduce the role of the public sector in one area—health-care—an area where it plays a key role in developed countries other than the United States. Such a change would deliver health-care right into the “invisible hand” of the market.

64Clearly, commodification of the human body raises a considerable number of questions, not all of which are treated in this book. It may still be a marginal phenomenon compared to others that touch billions of people, yet it raises the symbolic question of our relationship to others. Isn’t the respect for the other, including the sacred value of his or her body, one of the key principles that allow us to live together?

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Notes

1 Concept proposed by the World Health Organization, Geneva. See document EB136/CONF/3. January 2015.

2 Oxford Dictionaries define “natural resources” as: “Materials or substances occurring in nature which can be exploited for economic gain: ‘the sustainable use of natural resources.’” Retrieved from www.oxforddictionaries.com/definition/english/natural-resources (emphasis is the author’s).

3 See Wieviorka (2012).

4 One poor neighborhood in the capital city of Manilla has 20 million inhabitants and is called the “one-kidney island.” Nobody knows the number of its inhabitants who have sold one of their kidneys, nor how many have died from it. See Derbyshire 2007.

5 A search on Pubmed (www.ncbi.nlm.nih.gov/pubmed) in January 2015 using the keywords “commodification” and “human body” resulted in 119 articles published since 1985, of which 13 (10.9%) were published in 2014. The number of articles is much higher using the keywords “trade” or “commercial” with an organ, a tissue, “blood”, a gamete or “surrogacy.”

6 According to the ILO, implementation of the Decent Work Agenda includes four strategic objectives, with gender equality as a crosscutting objective: promoting jobs, guaranteeing rights at work, extending social protection, and promoting social dialogue (www.ilo.org/global/about-the-ilo/decent-work-agenda/lang--de/index.htm).

7 The term “reproductive functions” is used here in the meaning of “reproductive health,” a concept used by the World Health Organization to cover “the reproductive system, processes, and functions at all stages of life” (www.who.int/topics/reproductive_health/en).

8 This attempted classification is in part inspired by Fabre-Magnan (2013, 2014).

9 A phenomenon apparently known in Ancient Greece as it appears in the Prometheus myth.

10 www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/principles-medical-ethics.page. (retrieved on January 12, 2015).

Auteur

Professor of international health and humanitarian action and holds the Social Inequalities, Health and Humanitarian Action chair at the College of Global Studies, Fondation Maison des sciences de l’homme in Paris. Previously he was professor of international health at the Graduate Institute of International and Development Studies in Geneva and director of the Geneva Center for Education and Research in Humanitarian Action. He was also invited professor of development studies and/or humanitarian assistance in various universities, including the Université libre de Bruxelles, Leopold Senghor University of Alexandria, Hanoi School of Public Health and Tel Aviv University, as well as former director of CREDES in Paris, and author of numerous articles, reports and books.

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