Welcome to the Bioemporium

In 1974, the bioethicist and physician Willard Gaylin published an article in Harper’s with the unsettling title “Harvesting the Dead.” It had recently become possible to keep brain-dead patients on life support for extended periods so that their organs could be removed for transplantation. I use the words patients and life support, but as Gaylin pointed out, if a patient is brain-dead, it isn’t really a patient anymore. It is a cadaver on a ventilator. To distinguish these kinds of cadavers from the cold ones in the morgue, Gaylin proposed that we call them neomorts. And to distinguish a specialized unit used to house neomorts from ordinary hospital wards, he suggested the term bioemporium.

To Gaylin, it was clear that organ transplantation was saving lives. But why stop there? Look at all the hormones a neomort produces. Insulin, growth hormone, estrogen, testosterone—a neomort is a veritable hormone factory. Even better, consider how useful neomorts would be for medical training. Students could practice potentially embarrassing pelvic and rectal exams on neomorts, and surgical residents could use them as practice dummies for hernia repairs and limb amputations.

Neomorts are also ideally suited for medical research. Take, for example, Phase 1 drug trials, in which pharmaceutical researchers test the safety of an experimental drug by giving it to healthy subjects. Such trials are uncomfortable, lengthy, and potentially hazardous. Often the researchers push the dose higher and higher until the subjects start to experience side effects. But if researchers could use neomorts instead, they could administer as much of a drug as they wanted without worry, or even infect a neomort with a virus to test the cure. Researchers could poison neomorts and try out an antidote, administer a carcinogen and test a potentially toxic chemotherapy, or give them an experimental vaccine followed by a deadly infectious disease like Ebola or anthrax—all without endangering the life or health of a conscious subject.

Gaylin’s proposal never really took off: Medical students still practice pelvic exams on living patients, and drug safety is still tested on healthy, conscious subjects. Yet neither has the proposal entirely vanished. In 2021, a surgical team at NYU tested a genetically modified pig kidney by suturing it to the leg of a brain-dead research subject. Shortly afterward, another team of surgeons implanted two pig kidneys into the body of a brain-dead subject at the University of Alabama at Birmingham. Some bioethicists have suggested a similar experiment for childbirth. Noting that the bodies of pregnant women who are brain-dead or irreversibly comatose can be maintained for months before a child is delivered, Anna Smajdor has proposed that brain-dead cadavers could be artificially impregnated and used as gestational surrogates.

Whether Gaylin intended “Harvesting the Dead” as a serious plan or a modest proposal is unclear (he died in 2022 at age 97), but either way, his utilitarian logic is not easy to refute. When I raise his ideas at conferences or in seminars, the response is often an uneasy silence. Many people seem disturbed by the idea of impregnating a brain-dead body or using it to practice limb amputations, yet being able to explain their reactions is another matter. “This whole thing makes me feel squirrely,” they’ll say, “but I can’t really say why.”

Bioethicists often refer to such responses as the “yuck factor”: a gut feeling of disgust or repulsion that a proper philosophical education could put to rest. My diagnosis would be a little different. For me, the point at which each of Gaylin’s proposals feels unsettling is roughly the same point at which it starts to feel degrading. To be degraded is to be reduced in rank—to be lessened, diminished, or demeaned. Adults feel degraded when they are treated like children; workers feel degraded when they are treated like robots; patients feel degraded when they are treated like medical curiosities. Degradation doesn’t necessarily involve people. Sometimes objects are treated in a way that is degrading, such as when a grave is desecrated. The currency of degradation is disrespect. If it is possible to imagine someone or something as deserving of respect, it is usually possible to imagine it degraded when the proper respect is withheld.

Degradation takes many forms, but one of the most familiar ways to degrade something is to commodify it and bring it into the market sphere. This is part of the argument against prostitution, commercial surrogacy, and organ markets. When something is put up for sale—priced, advertised, perhaps discounted for a special summer blowout—it is being valued instrumentally, as a means of generating income. This may seem fine if the good in question is a mattress or a propane grill, but it seems degrading for the kind of good that ought to be valued for its own sake. This is one reason we have adoption agencies rather than baby markets: Treating children as property would threaten their status as human beings.