Inequality and Markets in Bodily Services

Anne Phillips argues that markets in body parts and bodily services intrinsically depend on inequality in a way that other markets do not. Phillips argues that unlike other markets, neither asymmetries in taste or talent can explain markets in bodily services; the only conceivable explanation is inequality between the vendor and purchaser. ¹ For this reason, markets in bodily services are uniquely morally problematic. Phillips therefore proposes limits on bodily service markets that are designed to prevent potential purchasers from profiteering from their economic advantage over the vendor.

In this response, I first argue that asymmetries in taste and talent can explain markets in bodily services, as much as they explain other kinds of work. Second, while inequality is a powerful explanation for participation in bodily-service markets, such markets are not unique in their reliance on inequality. Finally, Phillips overlooks another kind of inequality that deserves our attention in some of these examples, the advantage of the providers of bodily services over those who require them. While those who suffer the pain of infertility or the terror of organ failure may have a financial advantage over others, they may still be worse off than fertile and organ-rich people who suffer economic or social disadvantage. Egalitarians ought to concern themselves with the whole scope of disadvantage, not just economic disadvantage.

First, even if everyone could provide bodily services, it doesn’t follow that the only conceivable explanation for why some would specialize in bodily services lies in our inequality. The variety of tastes and talents can explain specialization in bodily services just like other jobs. Consider variations in taste. Many women do enjoy pregnancy, even pregnancies for children that they will not raise. ² While few would argue that prostitutes enjoy sex work, many enjoy sex work more than other kinds of employment that they could access. ³ Further, there is surely variation in how much sex workers enjoy their jobs. ⁴ Even if no one has a taste for participating in sex work, the undesirability of the work might be explained by poor working conditions and the stigma of sex work, and not the job itself. Organ donors might also have diverse tastes—some people won’t even permit their organs to be taken after they are dead, while others readily donate kidneys and bone marrow to strangers. Some pass out at the sight of blood and would never consent to a medically unnecessary blood-draw, whereas others go out of their way to donate without any compensation or inducement.

The same can be said of talent. Talents are often understood as natural gifts or aptitudes. Natural gifts include good looks, two working kidneys, fertility, type O Rh negative blood, and sexual charisma. For these and all our other traits, there is variation. So while everyone has a body, bodily service vendors have special talents like working organs, compatible blood types, fertility, and attractiveness. Some might have even more unique talents. Some surrogates will be uniquely conscientious, some prostitutes are uniquely charismatic, and some organ donors have especially large organs that can benefit multiple people. On the other hand, bodily service purchasers do not have these talents, nor do many other potential bodily service providers.

Therefore, asymmetries in tastes and talents can explain why some people might specialize in the provision of bodily services. We all have memories and intelligence, but some people specialize in the provision of cognitively demanding tasks like law or medicine because they have are comparative advantage in memory or cleverness. Similarly, we all have bodies, but some people may specialize in the provision of bodily services in virtue of their tastes and talents. For this reason, inequality is not the only conceivable reason that some of us become positioned as sellers of bodily services.

The worry about inequality still persists if selling bodily services is so intrinsically dehumanizing, stigmatizing, or unpleasant that even providers with tastes and talents for bodily service work only choose it because of economic disadvantage. Phillips writes that the goal of social change is to minimize the number of people who are economically compelled to work in jobs they hate. She argues that intrinsically unpleasant jobs should be eliminated wherever possible, and that necessary unpleasant jobs (e.g., cleaning toilets) ought to be shared. ⁵

At this point we should question what it takes to economically compel someone to work in an intrinsically unpleasant job. Even if no one has much of a talent or taste for toilet cleaning, someone will have a taste for money that exceeds his or her distaste for toilet cleaning. Inequality is therefore not the only explanation for why someone would take an unpleasant job because comparative tastes for money may also explain why people work. This insight is as true for bodily services as it is for cleaning toilets. Consider the old joke where a man approaches a woman and asks her whether she would sleep with him for $10 million. “Probably,” she replies. He then asks if she would sleep with him for $50 and cab fare. “What kind of a woman do you think I am!” she exclaims. The man replies, “I think we’ve already established what kind of a woman you are; now we’re just haggling about the price.” Imagine that the woman in this joke is relatively wealthy, but her interest in $10 million might still exceed any unpleasantness she would suffer from sleeping with him. Similarly, even in an egalitarian society that has secured a basic income for all citizens so that no one’s poverty forces him or her into employment, some people will be willing to do unpleasant work like toilet cleaning or selling bodily services for enough money.

Another objection to markets in bodily services is that they lead to a troubling commodification of providers. This is why Phillips proposes that compensation for bodily services is permissible, as long as the payment isn’t a decisive reason for the provision of services. ⁶ This policy proposal reflects a confusion between two forms of economic compulsion. No one should be compelled by poverty to provide bodily (or any) services, but as Phillips herself points out, almost everyone is compelled to work by the promise of payment, even those of us who love our jobs. ⁷ Against the backdrop of severe inequality, Phillips’s suggestion that compensation be limited in order to prevent profiteering would have the perverse effect of decreasing the wages or limiting economic opportunities for the very workers whose poor economic prospects compel them to sell bodily services. ⁸

Last, Phillips also argues that markets in services like egg donations “allow for disturbing differentials between different categories of people,” but so does any market that rewards tall, athletic, Ivy League–educated white people (which is probably most markets, unfortunately). ⁹ These differentials are disturbing, but not because they involve the body. For all these reasons, the fact that everyone has a body does not make bodily service markets uniquely more problematic than other markets.

At this point, I want to address a kind of inequality that has been overlooked in this analysis. Egalitarians may reply that the provision of sexual services, unlike cleaning toilets, is a job that doesn’t need to be done because sex with prostitutes is fundamentally recreational. Even if we grant this, other bodily services, fertility services and organ sales, are not recreational; they are jobs that need to be done. The pain of infertility is devastating for women and their families. For many people, having a child is one of their main projects in life; and for some, surrogacy is the only way. ¹⁰ We might debate whether people are entitled to prefer genetically related children to adopted children, but we must concede parents can have legitimate reasons for wanting biologically related children. While “most women of child-bearing age can do-babies,” many cannot. Even more urgent is the demand for organs. Every year tens of thousands of patients suffer while waiting for kidney transplants. While it’s true that everyone has a body, not everyone has a body that works, and thousands of people die every year because lifesaving organs are not available. ¹¹

Viewed from the perspective of a patient, inequality is the only explanation for the existence of surrogacy and organ markets, but it is the disadvantage of sick and infertile patients, not the providers, that ought to concern us. This troubling inequality can only be addressed by expanding access to lifesaving organs and fertility services. Even if economic inequality were the only reason that would compel people to sell bodily services, health inequality is the only reason that would compel people to buy them. Few mothers, if any, would prefer to pay a surrogate to bear her child if she was able to do so herself. No one would spend thousands of dollars on a kidney if they didn’t need it to live. Even the case of prostitution highlights a kind of regrettable inequality between the sex worker and the client; many clients would not pay for sex if they could find partners otherwise.

For these reasons, the provision of bodily services is a necessary form of employment. If ever there were a candidate job that needed to be done, it would be saving lives. This is why the world needs health care providers, medical researchers, and workers who provide other necessities like food and clean water. Without these services, people would die. Without organ transplants, thousands of people do die, so this job is necessary. Other necessary jobs are those that facilitate extremely important ends, like pursuing major life projects, developing a sense of the good, or having and raising children. This is why education and child care are necessary professions, and the same argument tells in favor of commercial surrogacy.

In addition, Phillips’s proposal that societies share the burdens of unpleasant but necessary work is an unacceptable solution to the need for bodily services because it would force people to cede control over their own bodies for the benefit of others. ¹² This kind of policy is wrong in the same way that slavery is wrong. Like Phillips, I am troubled that some people are economically compelled to take jobs they hate. Yet her proposed policy solutions, which would either force everyone into unpleasant work, limit compensation for those who do unpleasant work, or eliminate unpleasant professions, stand to intensify the problems faced by the economically disadvantaged as well as their disadvantaged potential clients.

Ideally, societies would be able to provide everyone with a basic income and a social safety net, to avoid many of the problems of economic compulsion. Failing such measures, public funds should further compensate those who provide necessary but unpleasant work, including organ sales and surrogacy services. Instead of limiting or condemning markets in bodily services, I am suggesting that necessary bodily services ought to be subsidized and encouraged. Not only would such a proposal further benefit bodily service providers, but it would also promote public health. Subsidies would also publically affirm the value of bodily service providers, thereby combating the stigma faced by providers without limiting providers’ or purchasers’ options. Even limits on unnecessary bodily service markets, like prostitution, would further compound the disadvantage of would-be prostitutes by limiting occupational choice. Instead states ought to focus on enforcing workplace regulations that make prostitution safer and further expanding occupational choices (e.g., subsidized vocational training and adult education opportunities) so that sexual service providers have better options, but not fewer.

I have argued that markets in bodily services are not incompatible with economic and social equality. Even in conditions of equality, some would be willing to sell and others would have reason to purchase bodily services, so bodily services are not uniquely problematic market exchanges. This insight deproblematizes bodily services by putting them on par with other kinds of employment, and will hopefully go some way to mitigate the stigma that is associated with bodily service markets. The problem of social and economic inequality is real. No one should be forced by their poverty to do something they find unacceptably unpleasant, risky, or repugnant. But egalitarians ought to concern themselves with the whole scope of disadvantage, not just economic disadvantage, and markets in bodily services can correct for inequalities in health. Egalitarians who remain concerned that markets in bodily services exploit the economically disadvantaged ought to advocate for subsidies for undervalued but necessary bodily service work in addition to an extensive social safety net. But policies that limit the choices of the disadvantaged just because those choices seem intrinsically unpleasant would, perversely, compound the disadvantage of purchasers and providers alike.