J Med Ethics 33:473-474 doi:10.1136/jme.2006.017855
  • Global medical ethics

The ethics of poverty and the poverty of ethics: the case of Palestinian prisoners in Israel seeking to sell their kidneys in order to feed their children

  1. Miran Epstein
  1. Correspondence to:
 Dr M Epstein Academic Unit for Human Science and Medical Ethics
 Institute of Health Sciences Education, Centre for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Turner Street, London E1 2AD, UK;m.epstein{at}
  • Received 8 June 2006
  • Accepted 24 July 2006
  • Revised 21 July 2006

Bioethical arguments conceal the coercion underlying the choice between poverty and selling ones organs

In mid-May 2006, three Palestinian prisoners detained in Israel applied to the Israeli Prison Service (IPS) for permission to sell their kidneys in order to send money to their children for food. Whether truly sincere or merely propagandistic, the request was made against the background of Israel’s decision to suspend the transfer of Palestinian tax moneys to the Hamas-led Palestinian Authority, and the subsequent increasing poverty and famine in the Gaza Strip.1

An official decision was yet to be made when this paper was written. However, the IPS chief medical officer had already made it clear that the request is likely to be rejected. Aside from emphasising that the cost of the pertinent treatment of the prisoners could not be imposed on the IPS, especially as it would greatly exceed the sum to be obtained by the sellers (ca £3500), he asserted that the IPS “won’t lend a hand to endangering the prisoner”. He also reiterated the official IPS policy, according to which the prisoners’ consent to such transaction could not be valid, since they might have been threatened by people from inside or outside the prison.1

This is ironic. While the IPS’ professed concerns for the welfare and best interests of the prisoners are commendable, they conceal and hence reaffirm the real coercion implicit in the dilemma the prisoners face: to sell their kidney or let their children starve. Interestingly, approval of their request would have equally concealed the coercion, this time behind concerns for either their autonomy, or the welfare of their children, or both.

At present, it is unlikely that Israel will acknowledge the role of national oppression and poverty in producing this dilemma. Rather, the debate will remain focused on …