I am dragging myself along, I am no longer worth anything... Affected by old age, "organ" disease or accidents in life, my body no longer responds, it has become my best enemy and remembers me at the slightest wrong step. This body loved, adored, pampered since early childhood, my ally in good health, was nevertheless ready to carry me day and night while doing its job as a body in silence - the silence of the organs, said the French surgeon and physiologist. René Leriche. I felt good in this body: my mind, my soul, my emotions and him were one. But here comes the disease, the coming of age, this body which knew how to function implicitly, renounces itself, demands care, dissociates itself from me, imposes its rhythm on me. Surreptitiously, it becomes omnipresent, and I tell myself that if I had a good capital, I only have a vague usufruct of it. Besides, how much is a human body worth?
Let's ask ourselves about this body, which may be a... scoundrel or be overinvested. Can the human person be reduced to it? Can the human body be sold in parts? Does it have a price, or rather a value?
Distinguishing price and value
In France, because of the inalienable value of the human body and the framework of bioethics laws, the sale of organs is prohibited. The elements and products of the human body (kidneys, liver lobe, blood, sperm, oocytes, bone marrow, etc.) can be given under certain conditions, but cannot be sold, because the human person has a value, exactly the same for all, without degree or sharing. This value has nothing to do with a price, which could be negotiated.
Based on values inherited from KantBioethics affirms the principle of non-commercialization of the human body as contrary to the "dignity of the human person". The confusion between value and price in fact devalues the human being as an object.
In addition, it imposes an ethical reflection: am I separable from my body? Can I sell my body or one of my organs without "selling my soul", in other words can I separate my brain from my mind? According to what standards, criteria, abacuses, can I put a price on my kidney, my eye, my liver? Is it because I am still autonomous, able to decide for myself and that "my body belongs to me", that I could negotiate the price? And why not increase its value, according to certain criteria: gender, ethnicity, IQ, social origin?
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It is quite desirable and legitimate to "repair" the body with the best techniques offered by medical advances, when it is affected by a disease or accident. But can a body be dismembered, sold as spare parts for, as this young Chinese to afford an iPad 2 ?
The body in parts
According to the magazine Popular ScienceIn India the price of a kidney is $20,000, in China $40,000 and in Israel $160,000. In the United States, a kidney is valued at $45,000, a liver at $40,000 and a cornea at $5,000. Not counting the surgeon's fees and ancillary costs... In some countries, there is a real black market in the sale of organs, sometimes in the context of "transplant tourism".
In France, certain questions could also arise, particularly following the bioethics law review. The extension of the medically-assisted procreation (LDCs) to all women, outside the context of infertility, asked about gamete donations (sperm and ova): if there was a shortage, could their remuneration be envisaged, at the risk of changing the altruistic profile of donors and opening a breach in the principle of free donations and the non-marketisation of the human body? This is already the case in the USA 3,000 per egg donation, and about 70 euros for a good quality sperm donation.
In the United States or Spain, the "rental" of women's bodies is also already possible, in the context of surrogate motherhood (GPA. Forbidden in France, this commodification of surrogate mothers' "bellies" also raises questions about the essential values of human dignity and the unavailability of women's bodies. Because when a woman carries a child, it obviously happens many other things between a mother and her baby than the simple act of disassociating and renting out a body part during pregnancy.
What can medicine do? What does the doctor owe?
A human person is never reducible to a body, and to the end of life it has an inestimable value linked to its intrinsic dignity. If life is priceless, we doctors have a duty of humanity, to care for the other suffering person. If medicine has a duty to be at the forefront of the latest scientific discoveries, to make them available to all (despite their cost), it must do so with benevolence, with the humility of the wisdom of limits, in conscience and responsibility. It is the (primum non nocere), "First, do no harm" attributed to Hippocrates.
To do this, the physician must not only know how to resist utilitarian injunctions to provide services, but must also be concerned about the vulnerability of the other. He must, again according to Hippocrates, "heal sometimes, relieve often and listen always". It must be as close as possible to the sick person, in his or her essential singularity. Who would not wish to increase the performance of his body, erase the stigma of time, delay the advance in age or even flee from our finitude? But when societal demand has nothing to do with an illness, when it is motivated by desire, what can, what must the doctor do?
Its role is to question and accompany the "desire to" expressed, consciously or unconsciously, by patients, however compelling it may be, because it can change over time and lead to disappointment or even depression. Thus this patient who wanted a new nose : once operated on, and still as unsatisfied as ever, she realized during her psychotherapy that she actually wanted a newborn baby, at the age of 48 and without a companion... An example which illustrates that in the age of technical medicine which repairs and changes the parts of a damaged body, counts, measures and figures, the doctor must not forget to leave room for solicitude, for the impalpable nature of the relationship, for the expression of souls wounded by life.
Véronique Lefebvre des NoettesPsychiatrist of the elderly subject, associate researcher at the Laboratoire interdisciplinaire d'étude du politique Hannah Arendt, Université Paris-Est Créteil Val de Marne (UPEC)
This article is published in the framework of the conference "What is the human body worth? Medicine and values of the body"which will be held at the Collège des Bernardins on December 5.
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