The Kidney Patient Analogy: A Reply

by Jay Johansen
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A number of pro-abortion people have written to us recently offering the following argument. A nursing student I know told me this argument was given in her "medical ethics" class. It must be making the rounds, and I don't doubt that some people find it convincing, or at least disturbing. So here's the argument:

Suppose one day you woke up to find yourself in a hospital, with machinery and tubes connecting you to a stranger in the next bed. Doctors explain that the person next to you has suffered kidney failure, and the only way he can survive until a transplant becomes available is to live off your kidneys. And so his friends have kidnapped you and brought you here to save his life. They expect to be able to get him a transplant in about nine months. In the meantime, you are immobilized in the hospital. They assure you that there is minimal risk to your health, that your kidneys are capable of sustaining both of you, but they admit that there is some danger.

Would you be morally obligated to go along with this arrangement? Surely almost everyone would agree that you do not, and any law forcing you to do this is a serious infringement on your freedom. No one may demand that you sacrifice months of your life and possible risk to your health to assist another person, even if he will surely die without your help. (Or the help of someone else, of course, but that just shifts the question to a different person.) You have every right to get up, disconnect yourself, and walk out the door.

And so, the argument goes, the same thing should apply to pregnancy. Even if the baby will surely die if removed from the mother's womb, it is unjust to force her to sacrifice to preserve the life of someone else. She has every right to abort the baby and walk away.

But there are some serious differences between this hypothetical situation and pregnancy which make the analogy suspect. Let's take a look at a few.

Identity of the "needy" person

Let's consider a slightly different analogy:

One day a homeless person knocks on your door and demands that you provide him with food, clothing, shelter, etc. He says that he will need this assistance for ten to twenty years. If you do not provide it, he will surely die of starvation or exposure.

Would you be morally obligated to give in to this person's demands? Surely almost everyone would agree that you would not, and any law forcing you to do this is a serious infringement on your freedom. No one may demand that you sacrifice years of your life, your money, your privacy, etc to assist another person, even if he will surely die without your help. (Or the help of someone else, of course, but that just shifts the question to a different person.) It would certainly be noble of you to make such a sacrifice, but you have every right to throw the homeless beggar out into the street and tell him to get a job and take care of himself.

And so, the same thing must apply to children. If I decide that the burden of caring for my four-year-old daughter is just too much, I can throw her out into the street and tell her to get a job and take care of herself. If she starves to death in the street, too bad, but that's not my problem.

Right? Surely not. Anyone who did such a thing to his children would surely be denounced -- and rightly so -- as one of the lowest forms of scum on the planet. Indeed, we have numerous laws that require parents to provide reasonable levels of care for their children. In most if not all states, parents are specifically required to provide their children with everything from food and shelter to medical care to an education. People who fail to do these things can be fined or jailed. You would be hard-pressed to find someone who claims these laws are an unjust infringement on the parents' right to choose not to care for their children just because they have decided that this would be inconvenient or would interfere with their chosen lifestyle.

Divorced or never-married fathers are routinely required to pay child support, even if they never see the child, even if they didn't want the child to begin with. The fact that he didn't want this child or never "bonded" with her is not a defense against a paternity suit.

There is a vast difference between someone being required to provide for a stranger, and being required to provide for her own child.

The "donor's" responsibility for the problem

Another flaw in the analogy: In the story, the kidney donor just wakes up to find herself in this predicament. But a woman does not just wake up one morning and "find herself pregnant". It requires some very specific actions on her part. Unless this pregnancy was the result of rape -- which makes up a very small percentage or pregnancies -- she engaged in these actions willingly. She has brought these circumstances on herself. Of course she may not have intended to become pregnant, but unless she is extremely ignorant, she must have realized that this was a possible outcome of her actions.

Thus, to make the analogy fair, we would have to assume that the woman somehow caused the other person to have the kidney failure by her own deliberate actions, and then caused him to be hooked up to her, and now wants to disconnect him. I can't think of any plausible way to modify the analogy to take this into account, but let's consider a scenario that highlights this aspect:

One evening you go to a party and drink too much. You become drunk, but you insist on driving home yourself. On the way home you cause a serious accident. You are unhurt, but the driver of the other car is now lying on the ground seriously injured. He needs immediate first aid, and surely someone should call an ambulance.

But ... there were no witnesses. If you stay and try to help and call the police or paramedics, your family and friends will find out that you were driving drunk, which will surely hurt your reputation. Even if you do not get into legal trouble, the accident will go on your record, and your insurance rates will go up. You could end up paying for this one little incident for many years, perhaps the rest of your life. If you just leave now and tell no one, this person might die, and that's too bad, but you have your own problems to consider.

Would you be morally obligated to help this person, or would that be an infringement on your freedom? Surely no one may demand that you sacrifice your reputation and money, possibly for the rest of your life, to assist another person, even if he will surely die without your help. You have every right to just get up and drive yourself home.

Right? Surely not.

When your actions endanger someone else's life -- even if you did not deliberately set out to harm them -- you acquire special responsibilities to help that you would not have if you were simply a bystander.

Note that in many ways this analogy is far closer to the reality of abortion than the kidney patient story. In the kidney-patient story, the "donor" had nothing to do with the problem she is suddenly being asked (or rather forced) to solve. But in the drunk-driving story, as in abortion, she is directly responsible for the problem.

Even if we accept that you did not intend to harm the driver of the other car or to place him in a position where he was dependent on you to survive, this does not make your responsibility disappear. Yes, this was an accident in the sense that you did not plan it to turn out this way. But when you got behind the wheel of your car knowing that you were too drunk to drive safely, you should have realized that this was something that could happen, and now you should accept the responsibility for your actions.

Similarly, even if we accept that a pregnant woman did not intend to become pregnant, this does not make her responsibility disappear. This was an accident in the sense that she did not plan it to turn out this way. But when she engaged in sex, she should have realized that this was something that could happen, and now she should accept the responsibility for her actions.

Some pro-abortionists say that if the woman used birth control, then she did everything in her power to prevent pregnancy, and so she cannot be held responsible for an accident that took place despite her best efforts to prevent it. But suppose the drunk driver in the above story was careful to drink some coffee to sober himself up, wear his seatbelt, drive slowly, etc. Would this change our conclusions about his moral responsibility?

It is one thing to demand that someone who had nothing to do with causing a problem should make great sacrifices to fix it. It is certainly admirable when a person is willing to do that, but we would not expect it or require it of someone.

But it is something quite different to demand that someone who caused a problem should have some responsibility to fix it. Especially when the person who would suffer most was a totally innocent bystander who did nothing to bring this problem on himself, and who is physically incapable of doing anything to help himself.

The "needy" person's intent

The woman in the kidney patient story is kidnapped and forced into this situation. But as noted above, a woman is not forced to become pregnant. (Unless she was raped -- back to that point in a moment.) She deliberately took actions that led to her becoming pregnant. The baby did not. She has imposed herself on him. He has not imposed himself on her. He had no intent to harm her or even inconvenience her in any way.

There is a vast difference between our responsibilities to someone who is deliberately trying to harm us, and someone who accidentally inconveniences us.

If a hired killer breaks into your house with the intent to murder you, most people would agree that you have the right to kill him in self-defense. But if someone accidentally enters your house with no intent to do you any harm -- say a senile old person or a small child who is lost and confused -- you surely do not have the right to kill him, no matter how much his visit inconveniences you.

The original version of this argument -- or at least an early one, from 1972 -- included an interesting touch on this point. The person with the failed kidneys was described as a famous concert violinist, and you have been kidnapped by the Society of Music Lovers to save him. He himself had no role in this abduction. This certainly helps to confuse the issue. You have been dragged into this situation without your consent, and thus your rights have been violated, but it wasn't done by the person who is now in need. We could debate the exact moral implications of this, but it's ultimately irrelevant to the present discussion. Again, women do not just "find themselves pregnant".

Still ... Let's consider another analogy:

You open the door one cold winter morning to find that a baby had been abandoned on your doorstep. If you do not do something, the baby will be dead within hours.

Would you say that you have zero responsibility to take any action to save this baby?


I think most people would agree that you have a moral obligation to help this baby, even if it causes you serious inconvenience. Exactly how much trouble you could be expected to go to is debatable, but you cannot just leave the baby there to die and do nothing.

The people who dumped the baby on your doorstep have dragged you into this situation without your consent. They have violated your rights. But the baby was not a party to any of this. He was completely innocent. You may have a right to be angry with the people who dumped him here. If you could get a hold of them, you could demand that, whatever their problem is, they must solve it themselves without imposing on you. But if this is not possible, the baby still needs help. It is surely unjust to say that an innocent baby should suffer because of the irresponsibility or crimes of his parents.

What if she really isn't here voluntarily?

At several places in the above discussion I've pointed out that pregnancy is usually the result of voluntary actions on the part of the woman. But of course sometimes it is not: sometimes pregnancy results from rape. Such a circumstance makes several of the arguments here invalid.

This is, I presume, why many people believe abortion is justified in cases of rape. While they have probably not thought out the moral issues exactly as I have outlined them here, they have had thoughts along similar lines.

I disagree with this conclusion because only some of the arguments are inapplicable in cases of rape. Others still apply. Most notably, the final one: No matter what crimes his father has committed, it is not at all clear why the baby should be held responsible for them. If I rob a bank, the police will not arrest my son, they will arrest me.

Conclusion

The kidney patient analogy may sound convincing at first. But it has many serious flaws. For any conclusions based on this analogy to be valid, we must assume that people have no more responsibility to provide for their children than they have to support complete strangers. We must assume that someone who causes a problem has no more responsibility to fix it than anyone who just happens to be passing by. And we must assume that there is no difference between killing a deliberate aggressor in self-defense and killing an innocent person who unintentionally inconveniences us.


Posted 5 Sep 2000.

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