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requires to sustain his life. This right becomes meaningless when the law forbids you to buy a kidney or liver that would preserve your life.’ Holcberg argues that poor people ‘do have the capacity to reason’.
    But, of course, it isn’t as simple as that. Donating a kidney is not an everyday, harmless procedure like selling a chair. Undergoing the operation to remove the kidney can be traumatic, and very occasionally fatal. Sometimes a botched operation carried out in secret can leave the donor desperately ill. Even if the operation goes smoothly, the donor may survive perfectly well on one kidney, but is left with no back-up. Many poor fishermen in southern India who sold a kidney in the wake of the 2004 tsunami now bitterly regret it.
    The question does not address whether someone should buy an organ, but it’s a question worth answering – and the answer, to my mind, has to be ‘no’. Of course, it’s wonderful if a kidney is donated freely and generously, but as soon as money is involved, the pressure of payment becomes the dominant issue. You cannot avoid the possibility that you are exploiting someone’s desperation – and risking their health. It’s no coincidence that paid donors cannot befound in the rich countries of the world; they can be found only in poor countries where people often feel they have no choice and would willingly sacrifice their health for the sake of a better life for them or their families. As William Saletan wrote in
Slate
magazine in 2007, the donor will be ‘a fisherman or an out-of-work laborer who needs cash and can’t find another way to get it. The middlemen will open him up, take his kidney, pay him a fraction of the proceeds, and abandon him, because follow-up care is just another expense. If he recovers well enough to keep working, he’ll be lucky.’
    Interestingly, though, the question comes at the issue from the donor’s point of view and asks should the donor sell a kidney. Here the answer isn’t so clear. As a (comparatively!) rich Westerner, of course I can’t say the donor should sell, and yet nor can I disapprove of the donor who chooses to sell, even at risk to his or her health. I would never want anyone put in the position where they are tempted to sell a kidney, but I can entirely understand how someone would willingly accept the suffering and risk to give themselves or their family a better life. Indeed, maybe I would even admire their courage, while condemning the terrible inequalities that drove them to it. If the question was ‘would I?’ and I could transform the lives of my friends and family by acting as a donor, I might hesitatingly say ‘yes’ and prepare myself to live with the consequences. The hesitation would be that by putting myself at risk I could increase, not reduce, my family’s hardships, and that might be enough to stop me. But to the question ‘should someone?’ the answer must clearly be ‘no’ – because that is a question only the donor can decide, and no one else. It’s a hard choice; there is no ‘should’ about it.

Is it moral to hook up a psychopath (whose only pleasure is killing) to a reality-simulating machine so that he can believe he is in the real world and kill as much as he likes?
    (Philosophy, Cambridge)
    It’s certainly a gruesome, distasteful idea and reminiscent of some low-budget horror film – with the terrible twist being that the simulated killing turns real. And the idea of allowing a psychopath to indulge in this ghastliest of fantasies seems deeply shocking. But however much the idea provokes outrage, it is a valid question.
    Of course, if the situation posed were to arise, the chances are it would be in a hospital where the psychopath was already being treated for his affliction. In this case, it would be our moral duty to ensure his well-being. It’s hard to imagine how the killing machine could be anything but a retrograde step in his treatment. So unless there was strong evidence to the