But what if Aiman O. derived no financial benefit from his conduct, and acted in an economically disinterested fashion? What would have been wrong with his conduct in this case? After all, the doctrine of medical ethics is that all human life, with perhaps a few exceptions which do not apply here, is equally sacred, that all men are born morally equivalent. From the point of view of medical ethics, therefore, it does not matter whether a life is saved in Outer Mongolia or next door.
The Lancet itself is a strong proponent of this view, at least to judge by the proportion of its attention it devotes to the health and disease problems of the Third World, where only a small proportion of its readers and subscribers live and practice. The very edition in which the scandal is reported carried stories about the success of Niger (a Sahelian African country with a small population) in reducing its child mortality, and the need for a campaign to make anti-epileptic therapy more widely available in poor countries: very laudable, no doubt, but far from the main concerns of most of the journal’s readers.
German organ donors (or their relatives) might complain that the surgeon had broken faith with them: they had intended that the organs be used to save their fellow countrymen. But this objection is itself open to the objection that donors have no say as to the required characteristics of the recipients, for example that they should be of above average intelligence and education, or without a criminal record, much less that they must belong to a specified national, sexual, racial or religious group. They could object only that Aiman O. had himself failed to observe this neutrality by favouring recipients of one racial, geographical, or religious group. But the rules he had broken had specified that he did precisely that, albeit for a different group from the one that he actually favored.
The Lancet did not mention the possibility that the German authorities had been lax or tardy in this case precisely because of Aiman O.’s minority status. A bad historical conscience can have surprising consequences. Of course, it is also possible that incompetence, a much underestimated factor in human history, explains the failure of the German authorities.
More from Theodore Dalrymple on health at PJ Lifestyle: