Table Of ContentExchanging Human Bodily Material:
Rethinking Bodies and Markets
Klaus Hoeyer
Exchanging Human Bodily
Material: Rethinking Bodies
and Markets
Klaus Hoeyer
Department of Public Health
University of Copenhagen
Copenhagen, Denmark
ISBN 978-94-007-5263-4 ISBN 978-94-007-5264-1 (eBook)
DOI 10.1007/978-94-007-5264-1
Springer Dordrecht Heidelberg New York London
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Preface
This book grows out of a longstanding interest in how one might explore “markets
for human body parts” in ways that destabilize and explore, rather than presuppose,
the meaning of the words “market” and “human body.” Bits and pieces taken from
patients and other persons are incessantly circulated in a boosting health industry,
and they are integral to the advancement of exciting new technologies. These bits
and pieces form the basis for a signi fi cant quantity of the economy in most high-
income countries. Nevertheless, body parts are generally regarded as somehow
beyond trade. How might we understand what takes place as people contribute to
the development of a highly pro fit able and booming sector by exchanging something
that is not supposed to be owned and used for pro fi t?
Scholars deal with this problem in various ways, but they tend to share certain
assumptions regarding what makes a “market” and what constitutes a “body.” They
rarely explain what makes an entity into a human body part, an object into a com-
modity, or an exchange system into a market. These categories are presumed, rather
than explored. Even if the categories are to some extent shared by scholars partici-
pating in the debate, the moral evaluation of the exchanges they describe differs
sharply. Either they are morally deplored and the agency involved described as
devoid of morality or markets are seen as (morally) superior mechanisms for distri-
bution of scarce resources and heavily advocated to solve (morally) important
problems in organ, tissue, and cell procurement. People adopting the fi rst position
tend to see existing moral norms as undermined through bodily exchanges, while
people advocating the second position typically see existing moral norms as
hampering rational allocation systems. Implicitly the analytical gain from the
former—the market critical studies—becomes reduced to awareness of “market
encroachments” on the integrity of “human bodies,” while market proponents tend
to deliver a call for market forces to solve problems, which remain focused on the
amount of tissue available for recipients at the expense of awareness of a wider set
of social implications of tissue exchange. Accordingly, policy options become
limited to prohibitions on commercial exchanges of human tissue (based on the
assumption that body parts are special and should never be sold) or deregulation of
v
vi Preface
prohibitions on fi nancial incentives (based on assumptions about market forces and
a view of body parts as tradable things).
I wish to take another route. I see the prevailing understandings of “markets in
human body parts” as constitutive for how such exchanges unfold. I see them as
enacting exchanges in particular ways. But I do not take them as adequate analytical
descriptions of what is going on. Instead I seek to develop an analytical vocabulary
that can help us explore, at a very practical level, what is at stake as various forms
of material move in and out of bodies.
I claim that technologies using and engaging with “the human body” challenge
ideas about body boundaries at both an ontological and an epistemological level.
Body boundaries are not given and never have been—they are under constant
establishment, biologically as well as culturally. Therefore, it is an empirical
question to explore when and how an entity comes to be viewed and experienced as
“part of” a “body.” Tissue exchanges interact in productive ways with the making of
historically and culturally speci fi c understandings of bodies and their relationship
to persons. Likewise, markets constitute a historically speci fi c understanding of
exchange. Market thinking is tied to the emergence of particular ideas about what
can and cannot be exchanged—and how—and these ideas create special tension in
relation to objects moving in and out of the bodily space we identify as persons. By
engaging a new vocabulary and using it to unravel some of the social implications
of bodily exchange, I hope to have written a book about exchanging the body that
avoids reifying its object.
For a decade now, I have studied various versions of what are typically called
biobanks, that is, structured collections of various types of tissue with adjoining
information about the person in whom the material originates. Biobanks are con-
structed for research purposes as well as for forensic, diagnostic, and therapeutic
purposes, the latter especially in transplantation medicine. The construction of the
word biobank has always aroused a certain interest in me: the connection between
the biological and the monetary realm. This book is my attempt of getting to grips with
the dilemmas faced by ethnographers like myself eager to explore the interconnec-
tions between human biological material and monetary interests. I hope it will serve
as a resource for future ethnographers traversing the same terrain and being drawn
to the same constellation.
The bulk of the book was written during a stay at the Institute for Advanced
Study (IAS) at the University of Minnesota thanks to generous funding from the
Andrew W. Mellon Foundation. The research preceding it was funded by the
Swedish Ethics in Healthcare Programme, the Carlsberg Foundation, and the Velux
Foundation, and my travel expenses to Minnesota were funded by a grant from Etly
and Jørgen Stjerngren’s Foundation. I would like to express sincere gratitude for
this support. The IAS proved to be the perfect nurturing ground for a book like this
thanks to the marvelous composition of excellent scholars and wonderful support
staff. The comfort of this academic environment I have only seen matched by my
current workplace in the Department of Public Health, University of Copenhagen.
Going to work is a true pleasure when it means meeting the inspiration, support, and
good humor of such wonderful people.
Preface vii
With two such workplaces, it seems reckless to call special attention to some
colleagues at the expense of others. When I nevertheless do so, it is merely to let
everybody know that sometimes I doubt whether the ideas in this book (the good
ones at least) are mine or happen to be something I have picked up in conversations
with Morten Andreasen, Lene Koch, Henriette Langstrup, Stuart McLean, Sebastian
Mohr, Maria Olejaz, Inge Kryger Pedersen, Kelly Quinn, Mette Nordahl Svendsen,
Signild Vallgårda, Sarah Wadmann, or Ann Waltner. Lene Koch and Karen-Sue
Taussig in particular pushed me (in different ways) to write this book and I appreciate
their encouragements. I have presented elements of this book in both departments
and bene fi ted immensely from the comments given. Susan Craddock, Jennifer
Gunn, Christine L. Marran, Karen-Sue Taussig, and Leigh Turner volunteered for a
workshop discussing a sample chapter, and they provided just the needed encour-
agement and advice. Milena Bister, Anne Carter, Penny Edgell, Henriette Langstrup,
Emily Martin, Ingrid Metzler, Reecia Orzeck, Juliana Hu Pegues, and Omise’eke
Natasha Tinsley will all fi nd that speci fi c suggestions that they have made have had
very direct impact on the manuscript. The result might not be exactly what they
meant to suggest, but I am still grateful for the fact that they tried to make me under-
stand what I needed to do. Over the years, discussions with Helen Busby, Kathryn
Ehrich, Sarah Franklin, Herbert Gottweis, Maja Horst, Lotte Huniche, Julie Kent,
Dorthe Brogård Kristensen, Margaret Lock, Niels Lynöe, Lynn Morgan, Sniff Nexø,
Carlos Novas, Naomi Pfeffer, Barbara Prainsack, Silke Schicktanz, Tine Tjørnhøj-
Thomsen, Richard Tutton, Lars Ursin, and others have changed how I think about
several of the topics in this book, and I wish I could have provided suf fi cient credit
to all of them. A central concept in this book, ubject, was introduced to me by Stefan
Helmreich and liberally followed up with further suggestions.
Many people have helped me by introducing me to speci fi c cases relevant to my
often bizarre interests. I would like to extend particular thanks for such tips to Hans
Okkels Birk, Anne Carter, Louise Kragh Engell, Mette Hartlev, Naomi Hawkins,
Jane Kaye, Julie Kent, Karen Kinoshita, Ivan Lind, Naomi Pfeffer, and Tobias
Rudolph. Carol Bang-Christensen has helped with appropriate translations of diffi cult
passages from Danish and Swedish to English, Sofi e Birk was a great student
assistant, and Kirsten Jungersen has helped with Latin phrases.
Elements of text have previously appeared in Hoeyer K (2004) The emergence of
an entitlement framework for stored tissue—elements and implications of an
escalating con fl ict in Sweden. Sci Stud 17(2):63–82; Hoeyer K (2005) The role of
ethics in commercial genetic research: notes on the notion of commodi fi cation. Med
Anthropol 24(1):45–70; Hoeyer K (2007) Person, patent and property: a critique of
the commodi fi cation hypothesis. BioSocieties 2(3):327–348; Hoeyer K (2009)
Tradable body parts? How bone and recycled prosthetic devices acquire a price
without forming a ‘market’. BioSocieties 4(2–3):239–256; Hoeyer K (2010) After
novelty: the mundane practices of ensuring a safe and stable supply of bone. Sci
Cult 19(2):123–150; Hoeyer K, Nexoe S, Hartlev M, Koch L (2009) Embryonic
entitlements: stem cell patenting and the co-production of commodities and person-
hood. Body Soc 15(1):1–24. I thank the respective journals, as well as my coauthors
viii Preface
on one of the pieces, Mette Hartlev, Lene Koch, and Sniff Nexø, for permission to
use this material again in a different form and context.
The thoughts of this book are, as I have just admitted, to a great extent communal
products of discussions with good colleagues and generous interlocutors. But there
is another, more personal, dimension to the writing of this particular book and my
work with it. Family and friends and Jesper, more than anybody, continue to remind
me of the embodiedness of love and care. Had you, Jesper, not gone along to all the
strange places ubjects have taken me, I would never have had the courage or
inclination to begin exploring what they mean. Thank you.
Contents
1 Introduction ............................................................................................... 1
Making the Case for a New Vocabulary: Exchange, Ubject,
and Entitlement ........................................................................................... 4
Relational Concepts in a Moral Landscape ............................................ 6
The Wider Analytical Framework............................................................... 7
Bodies and Persons ................................................................................ 8
Wetlands: Clarifying the Analytical Ambition ........................................... 10
Market or Gift Economy? Outlining the Debate
About “Markets in Human Body Parts” ..................................................... 13
Pro-market Arguments ........................................................................... 13
Against Markets ..................................................................................... 16
Neither Gift Nor Market ......................................................................... 19
Structure of the Book .................................................................................. 21
References ................................................................................................... 27
2 What Is a Market? .................................................................................... 35
The Moral Paradigm of Market Thinking ................................................... 36
A Dichotomy Between Persons and Commodities ................................ 37
From Market Thinking to Analysis of Exchange ....................................... 40
Exchange Studies ................................................................................... 40
Performative Effects ............................................................................... 42
The Historical Rise of the Person-Commodity Dichotomy ........................ 42
Entitlements: From Authority to Property ............................................. 44
Power, Morality, and Property Regimes ................................................. 45
Bodies: Hybrids and Purification ................................................................ 48
Establishing a Legal Mandate for Ubject Exchange .............................. 48
Entitlements of the Living: The Rise of Agential Giving ...................... 49
Contemporary Contestations .................................................................. 51
Power, Resistance, and Morality ............................................................ 53
Exchange as a Set of Evolving Practices .................................................... 54
References ................................................................................................... 59
ix
