What is your true rejection: Organ Trade Edition
One of the things that tells us whether we are actually thinking about an issue reasonably is whether there is any counterfactual that would change our minds about it. Given that we had a pretty angry conversation about this in Jason’s recent post, let’s hash things out here. Some of you are for legalising organ trade, some of you are against. What would it take for you to change your mind?
Perhaps it would be an assessment of the risks of donation? What if you found that donating your kidney was more/less risky than you thought it was?
What about whether there could be solid post transplant care for the donor?
Any other considerations?
Discuss
I’m lukewarm on the subject at best. I worry that advocates aren’t giving proper weight to potential problems stemming from perverse incentives and the like. I also have an instinctive revulsion to schemes that potentially treat the very bodies of the poor as a resource for the rich. Perhaps that’s just too many dystopian sci-fi novels. Anyway, here’s my list:
1. As I indicated to Brandon at 5:37 a.m. today, I would very much prefer to explore other avenues for increasing the donor pool first. Principally, presumed consent whereby the assumption is that you consent to be an organ donor unless you make a positive action to indicate otherwise.
2. No brokers. All you have to do is look at India to see how that can get real shady real fast.
3. No bidding. A standardized price schedule, perhaps with premiums for rarer blood/tissue types. Sorry, but Hayek can take a walk on this one.
4. Similarly to (3), insurance would be required to pony up for the standard payment amounts. Alternatively, the payment could come directly from the government.
As you can see, when it comes to matters of life, death, and health I have a strong egalitarian streak. It’s all well and fine for your millions to buy you a nicer house and car, and wealth is already a strong determinant on life-span and health. I’m only willing to put up with so much of that, though.Report
I support organ sales, and I agree with all of Rod’s concerns. I, too, like the idea of having some regulations regarding them (I also support some form of socialized health care, so it would work within that framework, somehow).
I also have a concern about the potential to kill the organ donation market, and, consequently, there be fewer organs available for transplant.
If I could be shown that these concerns were materializing, I would switch my position (unless there were other things that balanced out these problems).Report
I think one potential problem with allowing the sale of organs is that you might create a system where only the rich could afford organ transplants. Assume that there is a free market in organs and that most of the organ sellers are not doing so under duress. One would think that organs would sell for a rather high price, especially since I’d imagine that most people wouldn’t be keen on selling their organs even if they could. If organs are very expensive than lower and middle income people are going to be cashed out of the organ market and likely not to get a transplant if they need it.Report
I think your concern relies on an assumption that the sellers are all living people selling one of their kidneys. Any market scheme has to take into account next-of-kin selling the kidneys of the recently deceased.Report
Or bankers selling derivatives based on the value of tranches of debt obligations backed by future kidney sales.Report
No, that I’d allow. I just wouldn’t socialize their losses.Report
No Troubled Organ Relief Program?Report
It just encourages risky speculation in kidney-backed assets–it’s all the gubmint’s fault!Report
That, of course, assumes that the system allows next-of-kin to sell the organs of the deceased. Personally, I would be wary of implementing such a system.Report
I suspect your wariness is for the same reasons as my rejection point. I’d allow it as long as your concern doesn’t prove unfortunately justified.Report
But what if next-of-kin is a same-sex spouse? God never intended Adam to sell Steve’s parts.Report
A few years back, I considered putting myself on an organ transplant list, the sort where I could be called upon if anyone needed a transplant and I matched with them. Zazzy objected, primarily along two lines: 1) Sure, I’m healthy now and think I can do without a kidney but what if I fall ill in the future and 2) My donation would go to a stranger when a relative or loved one might later require a transplant from me but I would be unable to donate.
I thought these were sound objections. I recognize that the first one might seem self-serving and the second one might seem “xenophobic” in a way, but I think they are reasonable. Both would be mitigated if we had a more robust organ donation system. But we don’t. So they stand.
My objection to organ trade, which is soft at best, is in part predicated upon these objections. Folk who need a few bucks now might make decisions that have very, very dire consequences for themselves or their loved ones down the road, consequences that are very hard to understand and consider, especially when their are more pressing needs.
So while I have a deep respect for individual liberty and the right of people to make choices about their own bodies, even if we know those choices to be harmful, there is a part of me squirms at the thought of someone being told, “You’re experiencing kidney failure. Unfortunately, seeing as how you only have one kidney because you lost your job for a few months 8 years ago and sold the other one for $5,000, you’re 10x more likely to die than if you hadn’t done that.”
I think it is really hard to call that a truly informed decision, so I realize this is highly presumptuous of me and perhaps paternalistic.
All that said, I could still probably be convinced. What would get me there are the following conditions:
1.) No open market. A set rate for all donations of the same type. You could charge more for a particular organ that is harder or rarer, but this is an area that I don’t think folks should be able to manipulate by paying more.
2.) Those who donate get priority recipient status.
3.) Insurance covers the cost of the transplant fee.
Basically, rather than individuals bartering their own organs, we’d simply pay organ donors for their services in the form of cash, necessary pre- and post-operative medical care, and priority recipient status. We’d keep donation lists functioning as they do with the exception of the priority status and simply pull from a much bigger pool of organs and, thus, improve the system overall.
But, yea, I could be convinced by this or perhaps other plans. The reason I’m not there yet is because the specific plans I’ve seen articulated I find objectionable.Report
I would argue with your preferences for price controls but doing so would take us off topic.
I would suggest a simple requirement within an open market… Any contract to sell a kidney includes with it the insurance to get a “free” top quality kidney if ever needed any time in the future.* This benefit could even be extended to one’s family.
Thus the poor would benefit more than anyone. They would never be in need of kidneys, as the supply would be ensured (supply would rise to demand) and they would have a new source of wealth
* the insurance would also cover any complications arising from donation, ever.Report
Where do the free organs come from?Report
Hammond’s outreach program.
Seriously though, I did the little tags around free because of course kidneys aren’t ever really free and neither is any “free” service or repair program when you buy a product. That said, the odds of a donor needing to be a later recipient are extremely small. Let’s make up the number of a hundred to one. Thus the net price that a middle man would have to pay for a kidney would be the going rate plus the NPV cost of one one hundredth of the cost of a future kidney transplant. In effect you would be buying their kidney with a lifetime guarantee of them never needing to worry about needing a kidney.
Kidneys would thus be widely available, there could never be a shortage by definition, and the poor (actually any of us) would be able to work the system in such a way as to guarantee one is always available. It’s like kidney insurance that pays you to join the pool.Report
Imagine a poor donor is in need of a kidney. Imagine a rich non-donor in need. Who gets it first?
I’m prett close to agreeing though. Devil is in the details but I’m not beyond convincing.Report
Without price controls there is no shortage or wait as the price rises until a new donor steps forward.Report
Would the guarantee be transferable? My desire to keep my kidney is motivated not only for myself but in order to donate to family. Could I make a one-time transfer?Report
Seems reasonable to me. Or the guarantee for any future kidney could be for you and your immediate family.
These types of contracts could make the sale of kidneys more sacred and less icky commercial.Report
same place everything else does. chinese prisoners. this is just more directReport
I like this answer better.Report
My true rejection points lie along the lines of some of the objections made by others.
If we found people were being coerced into it, or found that people were offing granny early to sell her kidneys, and these problems proved intractable through normal law enforcement t means, I would oppose allowing the sale of organs.Report
To use a familiar phrase, “It’s my body and it’s my choice”. My body is my property, not yours or society’s. If I want to sell a kidney to fund my college education or just to spend the money on hookers and coke, that’s my call. I should also be able to sell my organs upon death and have those funds be part of my estate.Report
Fine. It’s up to the government though to establish laws and regulations regarding if there is a market and what form it takes..Report
Can it be up to me to choose which government rules I agree to play by? If I disagree with your rules, do you get to shoot me? Why?Report
I get to shoot you if i feel you are a danger to me. I can Stand My Ground gosh darn it.
Can you choose which rules to follow: So let me picture this. I’ll use a real life example i was tangentially part of last year. The gov has a rule saying someone cannot dump industrial quantities of shit into public waters. A guy who owns a septic tank pumping service decides to repeatedly empty his truck up stream of many communities. Does he get to follow just the rules he wants? I’ll say the answer is no he can’t follow the rules he wants but i don’t have the right to shoot him although i’m sure a few of the people downstream of him would have if they got the chance.Report
Though I have no problem saying that the police get to arrest him and if he resists they get to shoot him.Report
Yes, I believe we can move in that general direction.
Obviously I do not want to live in a world where people can dump toxic waste, therefore I agree not to dump it either. Thus I agree at a constitutional or rule setting level to play by the impartial rules. I don’t want to live in a world where people can shoot each other, so I agree to live in a world where nobody, including me, can shoot others.
Thus I recommend a state which moves in the direction of being voluntary where possible and practical.Report
greginak,
Your example is not really a good comparison, is it? Your case involves harming others against their will (negative externalities, yadda yadda, you know). The case you’re comparing that to is a case where at worst someone is harming themselves through short-sightedness, which is offset by helping someone else, and possibly is a case where no one is actually harmed at all.Report
J@- My example was fine and dandy. The point was that there are times when people have to follow gov rules even if you don’t like them. Roger made a general question and i provided an example where laws shouldn’t be voluntary. I’m completely fine with as much as possible being voluntary. The issue isn’t freedom, voluntary, coercion, externalities, etc. The better, useful questions are about how all those things interact in a specific situation. Just saying gov is coercive is correct and banal, so is things should be voluntary. They don’t really speak to a specific issue. If someone wants a neck tattoo that is fine. Its likely to look stupid and be embarrassing to them down the road but its their neck.Report
I’m afraid I must disagree. I think if the rules prohibit you from doing something that harms no one other than yourself, the rules are unjust and may justly be violated. I wouldn’t say that’s as strong a justification as sitting at a lunch counter to demand equality, mind you, but…oh, hey, they didn’t follow the rules, either, did they?
Of course there are “times” you have to follow even rules you don’t like, but that necessarily implies there are times you don’t have to. So we’re in a search for those times. Sitting at lunch counters to demand equality? Check. Doing something that harms no one else? Not so strong a check perhaps, but I think it will take a pretty persuasive argument to deny at least a small check.Report
Well i disagree with your disagreement. But really i think it is totally appropriate to have various authorities intervene if someone is trying to commit suicide. That really doesn’t harm someone else, well except for the emotional trauma and all. I think there is strong case for involuntary commitment for a very small number of people. So those would be two times when someone isn’t harming others when i think it is fine to stop them. But in most cases i think people can do what they want as long as it isn’t harming someone else.Report
Well i disagree with your disagreement.
That’s an outrage. I demand an apology.Report
I’d be outraged if anybody ever thought they would get an apology out of me.Report
I’d be outraged if anybody ever refused to apologize to me.
It seems we’re at an impasse, which is, of course, an outrage.Report
Don’t tell me where i am. I’ll decide if i’m at an impasse. Well actually my nifty iImpasse App will play Beethoven’s 5th whenever i get stuck at something in my life. Right now its playing Tubthumping so i’m screwed, i just don’t know how.Report
Beethoven’s tubthumping symphony is my fave.Report
A person is driving in their car alone. The state has made a rule that they should be wearing a seat belt. They’re not, consequently they get a ticket. Unjust?
I can understand Roger and your (j@) points, Roger at 2:21 and lunch counters, and generally fit them into a framework of conscientious objection. If someone feels strongly enough they can exempt themselves from the rule. Sometimes society will defer to the individual’s conscience and other times not. But the conscientious objector needs to be willing to take the punishment.Report
It is minimally just if the person agrees to abide or travel in a place where driving requires wearing seatbelts. It is becomes more just as they gain alternatives or degrees or freedom to these rules.
A just or fair game is one which I agree to join and which allows me alternative games from which to choose. An optimally just society would be one which I would choose to live in with an infinite supply of potential competing societies, including the right to introduce new rules of my own. Obviously the ideal is, to borrow from Jaybird, a vector, not a real place.
I’m fine with baby steps.Report
Roger,
A just or fair game is one which I agree to join and which allows me alternative games from which to choose.
Here’s a hypothetical. Suppose that insurance companies gave discounted rates to drivers who wear seatbelts all the time, higher rates for those who don’t. Now, it isn’t enough for a customer to merely promise the insurance company that they’ll wear seatbelts all the time, some sort of enforcement mechanism must be employed, right?, one that determines that the driver is actually abiding by the terms of the contract. I don’t imagine this would be all that hard to accomplish, actually.
Well, suppose that some guy who promised to wear seatbelts wrecks his car and himself while not wearing one. Presumably, since the guy violated the agreed to contract, the insurance company is off the hook for any medical or other payments resulting from the accident. As far as the contractual obligations go, the insurance company is within its rights to just let the guy die, yes? And hospitals too, of course (if not for a law).
Of course, this scenario goes against most (lots of?) people’s intuitions about caring for accident victims. The prevailing view (I think anyway) is that doctors, hospitals, EMS folks, etc, all have an obligation to save that guys life. And at personal cost to themselves. (That’s the sticky point, yes?)
Now, you haven’t made the argument that insurance ought to be mandated for the game of driving, but is driving without insurance one of the options people should be presented with for playing the driving game?
If the answer is that it isn’t (because driving can cause harm to others), then why wouldn’t mandatory seatbelt laws be justified on the same grounds: that not wearing one can potentially cause harm to others?Report
Interesting question, Stillwater.
I would recommend that adults be able to drive without a seat belt.
I am in principle OK with an insurance company being able to offer insurance that only paid if insured wore a belt, but would override my principles if it turned into a mess ( which I am pretty sure it would)
I am fine with a voluntarily agreed to rule or protocol among those in medical industry to agree to emergency care and bill the person for it afterward. I am also fine with a protocol that medical professionals declare up front that they will not perform emergency care without reasonable expectation of payment.
I guess the heart of the matter is that the only reason not wearing seat belts hurts others is if we force medical establishments to fix them. I wouldn’t do that.Report
/irreverent
Kill da poor people, kill da poor people!
/serious
Roger, surely you know that medical emergencies cause more bankruptcies than anything else, right? Because the more unexpected an emergency, the less chance a person will have budgeted for it.Report
Roger,
I guess the heart of the matter is that the only reason not wearing seat belts hurts others is if we force medical establishments to fix them. I wouldn’t do that.
I think that’s the right response, actually, but let’s explore how far it goes.
IF we don’t force medical establishments to fix broken people, then presumably lots of people die or remain broken who otherwise wouldn’t if they had received care. In what sense is this is just or even tolerable outcome?
Well, in one sense, it’s just and tolerable if we limit the obligations owed to people strictly to voluntarily agreed to contractual obligations. The folks who drive without insurance or violate the terms of their insurance contract are effed. Additionally, since there’s no legal compulsion imposed on medical providers to attend to these folks unless payment terms can be agreed to, they’re doubly effed.
Compare this scenario to the poverty stricken. We’ve had enough discussions about this for me to feel confident saying that you believe in a social safety net for the poor and unemployed. Presumably, the justification of care for the unemployed and others unable to pay their own way is to meet a minimal set of basic needs for each person in order to survive. Food, shelter, clothing, etc.
So here’s a question: does medical care constitute a baseline need in order to survive? IF it doesn’t, then are we justified in scrapping the whole social safety net thing? Or are the two things (medical care and food stamps) relevantly dissimilar?
Another question: if basic medical care is something you believe ought to be included in the social safety nets, then how do you prevent free riders (free drivers!) from driving while opting out of the insurance game?Report
Good questions. Let me try to explain my position less cryptically. Any criticisms are appreciated as I am just trying to make sense, not necessarily trying to convince anyone else.
I do not support forcing medical people to do emergency care against their will. I view this as exploitation.
I am totally fine with a hospital only hiring people who will donate a portion of their care to others pro bono. I am totally fine with an association of doctors and nurses agreeing that you can’t become a member unless you donate your time and expertise to the poor. I am fine with elite colleges or grant foundations making pro bono medical care pledge a part of their entrance qualifications. I am fine with a social insurance fund that establishes a pot to pay for the poor that comes out of our wages with an annual notarized opt out provision (requiring those opting out to owe the hospital at a later date if needing care, thus discouraging free riders) I could go on, but you get the point…
I believe if we JUST quit paying for the poor that the poor would indeed be screwed. I am not suggesting that at all. I believe that you, Kimmi, most doctors and most people in general do want to live in a society where even the poor are cared for. The quick and wrong solution, in my opinion only, is to force this obligation on someone. Instead I recommend doing it in a voluntary way.
In my original response to Jason’s question on what I believe is wrong and popular, this was my answer. I believe exploitation is wrong and popular. And by exploitation I mean just this. Forcing people to do things instead of taking the time and experimenting in ways to do things in a voluntary and positive sum fashion.
Please note, this often comes across as magical thinking to cynics. I am not assuming there is a solution to every problem. I honestly have no idea if any of the things I suggested will work. My point is that via social experimentation and local variation we can find some solutions to some problems that are better than what we do today.
And to again be clear for Greg and Rod. I don’t give a damn about markets or liberty. I care about problem solving, and believe markets and enlightenment liberty just happen to be good ways to solve certain classes of problems.Report
But the conscientious objector needs to be willing to take the punishment.
Yes. I remember a protest at the U. of Oregon, where some anti-Nike students occupied the admin building. They were stunned when, after closing time, the president called the cops and had them arrested. Up until that moment the protest had been easy moral posturing for them; they hadn’t understood that to really make your point you need to accept the cost of taking a stand. (Of course that was probably a bit of white privilege–I doubt any black person in the south in the Civil Rights movement had any illusions about the cost of taking a stand.)
I had a talk with a student who was really upset by the arrests. I asked if he thought the issue was worth being arrested on charges of trespassing. He said, “of course.” Shut up and take the arrest as your badge of honor then.
So I could hardly exempt a principled seatbelt scofflaw, or the legalization protestor who smokes weed outside the federal courthouse. Or the guy who sells his kidney on the black market–the question is whether he can use the proceeds to pay his fine or whether his earnings get confiscated separately from the fine. 😉Report
IOW, the answer to Roger’s question, “Can it be up to me to choose which government rules I agree to play by?” is a straightforward and obvious, “Not only can it be – it is!”
Roger had to have meant to be asking a different question.Report
You are using the definition of voluntary which is broad enough to include “have sex with me or you are fired.”
Obviously I am not good at explaining it, but I am suggesting that fair and just rules are fairer and more just as they become rules that we would agree to play by before the “game” starts — behind the veil so to speak.Report
Well, the word voluntary wasn’t present in the comment where you asked that question, so I can’t be using the wrong definition of it.
But you’re right that if you were asking that as from behind the veil, then I missed that. You appeared to be asking if you can choose which rules you want to follow. And the answer is yes. But if the question is whether we can undo all the rules (and laws), go back behind the veil, and re-choose them all, the answer is no. We’re just here.
But even if we could, we still couldn’t make universal assent to all the rules we choose a condition for settling on a legal regime. We’d never choose a society. And we’d start to descend into the Hobbesian abyss as hanging out together behind the veil slowly turned to malingering, distrust, and finally, to a war of all against all.
😉Report
Perhaps what you meant to ask is whether
1) you can participate in the choosing of the rules. You absolutely can. But so can others, and you don’t get a personal veto over the rules that end up getting chosen (unless you get elected to an office that retains that power).
and then 2) if you don’t like the rules that are chosen, you can have a personal exemption from enforcement of them. Um, no. We’re talking about laws in a state here. Do we need to go over why you don’t get an exemption because you don’t agree with the laws?Report
Michael,
I am once again doing a very poor job of expressing myself. Apologies.
I am indeed aspiring toward universal agreement on the rules before the game begins. Emphasis on aspiring. It has nothing to do with exempting one’s self from rules once agreed to.
The best serious literature echoing my views on the topic is The Calculus of Consent by the recently deceased James Buchanan (hat tip to JH). The idea is to pursue universal consent at the higher or constitutional level. Although more an ideal or vector rather than concrete possibility today, the concept is basically a serious attempt at making the Rawlsian choice real, or more real.
As is probably all too clear, I view coercion as suboptimal. A necessary evil at best which we should strive to eradicate. I believe we could solve problems more effectively by pursuing/ experimenting with voluntary and unanimous activities. Steps along this vector include the following:
1) Creating competing states or rules or institutions as practical.
2). Minimizing the scope of coercive state action, indeed primarily focusing it on stamping out coercion, where practical
3). Using voluntary problem solving systems such as science, insurance, voluntary associations and markets, where practical
4). Allowing opt outs with consequences at the rule level where practical (I have provided many opt out ideas on social safety nets in the past)
5) requiring supermajorities and sunset provisions into coercive state actions where practicalReport
Or as P.J. O’Rourke put it:
Report
No, either I own my body and can do with it as I please or I don’t. We call the latter “slavery”.Report
No. False dichotomy. There is a lot of space between owning one’s body in such a way as to do with it as you please and slavery. Equating any system of rules in which you cannot do as you please to slavery makes light of the experience of actual slaves. This is a paradigm case of cartoon libertarianism.Report
Not just “any body of rules”, rules to prohibit you doing what you please with your body. If I own my body, I can do anything I choose with it as long as it harms no one else. If I can’t, I don’t own my body 100%…i.e. someone else owns a part.Report
Specifying all your rights or lack of them in terms of property rights obscures rather than illuminates. The mere fact that you lack the right to do one particular thing to your body does not mean that someone else has rights over your body.Report
If someone else (gov’t, you, the pope, etc.) can dictate to me what I can do with my body, what else do you call it?Report
If someone else (gov’t, you, the pope, etc.) can dictate to me what I can do with my body, what else do you call it?
Social Morality. Every form of social morality except the libertarian one says that there are some things you cannot do with your body. Hell, if you want to be pedantic about it, even libertarian ones tell you what to do with your body: They tell you to not use your body in ways that violate other people’s rights. Also, a lot of libertarians think you should not be able to sell yourself into slavery.
Slavery is more than the mere restriction on being able to do what you want to your body. Slavery also includes the ability of me to do whatever I want* to your body.
*In the de dicto sense not the de re sense. The mere fact that I** think the current restrictions on your action are right doesn’t mean that I have control over what you do with your body. For that matter, neither does society collectively own part of your body. The problem is that you think someone else has to own your body just because there are some things you cannot do with it.
**hypothetically of courseReport
What if the freedom to use your body as you choose leads in total to a significantly worse world? What if it led, strictly hypothetically, to a substantially worse world of more poverty, more addiction, more crime, shorter lifespans and in general, shitty outcomes? Would you still support it?
In other words, do you support liberty for consequential reasons or is liberty sacred by itself?Report
“In other words, do you support liberty for consequential reasons or is liberty sacred by itself?”
Ummm Yes.
But really the answer is just yes. Liberty is sacred by itself but also leads to good consequences. But that doesn’t imply that there are many sacred (a nice moral word) values that need to meshed together. Its easy to have one value or right and aim to maximize it. What is hard is to try to maximize many values or rights.Report
The hypothetical assumes, just for argument, that liberty leads to overwhelmingly bad consequences.Report
Well first i have to admit that i have to testify in court every now and then so i get asked a fair number of hypotheticals by lawyers. So i don’t often think much of them since the answer to just about every hypotheticals is “it depends” and the question is aimed at leading to a desired answer.
So with that said, the answer is “it depends.” It depends on who the bad consequences are for? Are they old enough to consent? Are the consequences on others or just the individual making a choice? How bad are the consequences? ( to be clear i am completely for intervening in suicide attempts as an example)Report
That is because the lawyer is trying to trick you in court. I am engaging in rhetorical device to try to pull out differences in facts and value. If you don’t trust me enough to play though it makes the dialogue kind of pointless though.Report
I agree with drug decriminalization, or even legalization. I don’t want drug dealers plying their trade on my street, their liberty notwithstanding.Report
So certain are you that they aren’t doing that already?
I live in one of the best neighborhoods in the city.
… our drug dealers are well behaved. The ones in other parts?
Not so much…Report
If they’re on the street, they and their customers are invisible. So at least they’re selling some pretty good shit.Report
“My body is my property, not yours or society’s. If I want to sell a kidney to fund my college education or just to spend the money on hookers and coke, that’s my call.”
Ok lets say we refuse to intervene in your sale. Which goes bad, and you get shortchanged.
Do you want us to enforce your contract? To provide this valuable service to you?
Do we get to decide which contracts we enforce or not? Or are we obligated somehow to enforce any old contract you choose to create, without our consent or input?Report
Good points!Report
Yup.Report
I would not enter into a contract without enforcement mechanisms. Agreed.
Without trying to defend Damon, with whom I too disagree, but for different reasons, I also disagree with this line of attack.
The assumption is that I have consented to your enforcement provisions. Once the state outlaws competing enforcement mechanisms and sets itself up as a monopoly provider I believe we have established a big potential problem. It will tend to lead to bureaucratic bloat, never ending ecoansions of power, red tape, inefficiency, rent seeking by those in power and those seeking to align themselves with those in power.
I suggest competing enforcement mechanisms where practical. Private where practical. Local government where practical. Federalism where practical. Options where practical. Opt outs where practical.
Where not practical, I agree with monopoly state enforcement as it is better than no enforcement.Report
I am not sure anything could change my mind on the subject. We all have things we have drawn lines for and this might be one of my issues. Ideology might be the enemy but we all have our beliefs.
1. I don’t think the pro-side is recognizing the unintended consequences. As a liberal, allowing organ donation does not seem like a miminalization of harm. Rather it seems allowing one harm and possibly mitigating another. Organ donation is still tricky and you run the risk of rejection even with all the tests and batteries. Maybe the person getting the kidney will survive, maybe they will not.
2. As others have said, this seems like allowing people to make a short-term gain for a strong possibility of immediate and long term risk. Removing an organ is not a simple procedure and the recovery is not speedy. It might be paternalistic but I would rather find other ways to help people get over an immediate need for cash than putting them up for major surgery with a good risk of something going wrong.Report
Finally, someone admitting that this is a sacred line which they would not cross. That they believe it is just wrong.Report
Whether we want to admit it or not, we all have lines and all have issues where we believe somethings are just wrong.
These are different based on the ideology and the person but every human as at least one or possibly many of these line-drawn issues.
Including libertarians.Report
That is the point I have been making all day, including the call out on libertarians. Is this not obvious?Report
Those damn infernal reason-givers are at it again, eh, Roger?Report
Huh?Report
1. You’re questioning people’s forthrightness on this merely because they are giving reasons for their views. You’re saying, ‘Some large number of the reasons being given on this have been bunk; I’m convinced people don’t really believe the things they’re saying – that, rather, they just have their positions due to a gut feeling.’ That doesn’t fly around here if I have anything to say about it.
2. Just because people were giving reasons doesn’t mean they were denying that they “just think it’s wrong,” depending on what we think that phrase means. People tend to have reasons for thinking things are wrong. It’s messed up for you to be charging them with disingenuousness for simply giving those reasons.Report
You are reading substantially more malice into “rationalization” than I am. As LWA mentions, I am indeed riffing on Haidt and Kahneman and our inherent tendencies to come up with rational justifications of our moral taboos. I can see how I could have worded this better though.
There are extensive studies on how we all do this rationalization process constantly. It may be disingenuous, but if it is, then we are all lieing to ourselves though, not necessarily to others (but in a world where facts are never more than good theories, who is to say for sure?)
The reason I keep suggesting we engage in the hypotheticals of “let’s assume liberty led to a worse world, or let’s assume sleeping with your sister was Pareto optimal” Is to try to dig out this distinction.
I congratulated New Dealer on being frank with his moral line in the sand. I immediately apologized to Shazbot for suggesting that he was rationalizing when he assured me he was not (he did not have a moral line in the sand).
On a side note, I have obviously gotten under your skin recently. I hope we can put whatever it is causing this behind us. You are an honorable person with good intentions and I value your feedback, constructive criticisms and dialogue.Report
Roger,
I haven’t meant to give you the impression I have an issue with you, my apologies. We’re entirely cool from my perspective. I understand I’ve made some slightly harsh-sounding comments to you, but I’ve tried to balance them out with more pleasant ones which you may or may not have seen. I’m sometimes more restrained in saying what I think with words that convey how I think it, and other times less. I guess I’m on a less restrained cycle right now. Don’t put too much stock in it; again, I have no issue on my end.Report
I think Roger’s point is well made, that everyone has sacred lines that can’t be crossed, regardless of how seemingly illogical they are.
Like Jonathan Haidt’s experiments where he framed nonharmful taboo questions (like eating a dog or a human corpse).
Even if we can clear away the obvious harm of coercion, the marketplace is inherently a poor method of controlling organ donations, because the marketplace acheives its efficiency by removing sacredness from the goods.
As it is, we- generally- are pretty poor at understanding and coming to terms with our own mortality- (at this moment I am a living soul, tomorrow I could be rotting meat).
Tossing this sort of existential dilemma into the marketplace and expecting good results doesn’t sound wise to me.Report
So we’re down with letting people on the organ waiting lists wither and die because it’s better that they perish than that they get an non-sacred organ? Why does this feel like the same species of argument as the Catholic ban on masturbation or contraception to me?
Why is a person donating an organ for a friend for free a laudable thing but a person selling an organ to a stranger for fifty grand a deplorable one? Is the life saved somehow cheapened?
What am I missing here?Report
Well said, North. The notion that we should let somewhere around ten people a day die who could be saved because of a fear that some compenated donors might later regret their decision is just baffling to me.Report
FWIW after going through this thread i think i could move pretty close to supporting a kidney market. It does raise the hairs on the back of my neck a bit, but i think if regulated correctly it could be a positive boon. But it would be dependent on being set up correctly.Report
And FWIW, I am all about alleviating concerns where we can. Though I don’t actually have a problem with the eBay model and would think it an improvement over the status quo, Rod (as well as contemplation on the matter) has convinced me that a more regulated system could be even better (and would be, if done within proximity to the right way).Report
Well, if the market for organs is limited expendable ones …Report
I’d find the idea of anything approaching a pure free market for organs or human body parts hair raisingly terrifying. But the prospect of a strictly regulated one with intense oversight (by the Government natch) is quite a plausible policy to me. In fairness I don’t think many of the libertarians who threw their two cents in were advocating for a wide open unregulated market either tho.Report
I’m probably the most extreme libertarian here, and I’d support pretty strict regulation of the acquisition, just to make sure that nobody was having them stolen.Report
with all this agreement we are getting close to a group hugReport
Just so long as it stops with the hug, it’s all good.Report
I’m ok with the fight, as long as it is a pillow fight.Report
North, I think it boils down to what is the greater harm.
On one hand, banning sales of organs will definitely reduce the number of donors, resulting in deaths that otherwise wouldn’t have occurred. This isn’t a small thing, and needs to be acknowledged.
On the other hand, organ sales lead directly to the commodification of human bodies, in a world where vast numbers of people’s lives are already considered meaningless and disposable by those who pull the levers of power.
The assurances of regulatory protections are hollow in my view- as already mentioned, we as a group have so hard a time making decisions regarding life and mortality, I have no faith in our ability to have a well functioning marketplace in human bodies that doesn’t produce more misery and suffering than it solves.
To answer the premise of the post, in order for me to support the sale of organs, I would need to be persuaded that there are enough restrictions and oversight and regulations in place, that would make it a “marketplace” in name only.Report
[markets] “lead directly to the commodification of human bodies, in a world where vast numbers of people’s lives are already considered meaningless and disposable by those who pull the levers of power.”
If I could expres a world view that was 180 degrees from mine, it would look pretty much like this sentence. Just saying.Report
But there is some truth in this statement.
Look at the Bangladesh factory tragedy. Over 1000 people died in the collapse and you still have people arguing that the poor safety conditions are okay for some kind of neo-liberal, globalization fetish. Or the sweatshops benefit everyone!Report
It looks as if a lot of apparel manufacturing is going to be leaving Bangladesh due to the bad publicity about the deaths there. (That is, further deaths will be linked to the previous ones and heavily reported on, while deaths in other countries will be mostly ignored.) The lesson to take from this is that news agencies hate poor people. If they didn’t want to take away the Bangladeshi workers’ livelihoods, they’d have hushed the whole thing up.Report
I agree, New Dealer, there are degrees of truth in LWA’s statement and world view.
On the Bangladesh factory interpretation, the other side of the argument can be conveyed in a very simple phrase:
In evaluating the pros and cons of a complex decision we must consider the seen and the unseen.
We believe that when you include the seen and the unseen, the immediate , the secondary, the tertiary and all the feedback effects, that the people of Bangladesh are better off with free markets than over-regulated ones. Despite the economic support for our arguments, we could of course be wrong in part or whole. But we have some excellent arguments if anyone is interested.Report
“free markets versus “over-regulated ones.”
Those are the only options?Report
I’d say they are the relevant ends of the range on this topic. And by free markets I don’t even mean no regulation.Report
LWA, the human body is already commodified. People sell hair, blood, sexual services, their looks and universally they sell their time (which in essence equates to selling pieces of their finite lives). I find the squeemishness regarding organs and the bland acceptance of permitting people to perish for lack of them a bit surprising.
For clarity’s sake what sufferings do you think a market in organs would create that doesn’t exist now? Also what would make this particular market so unique that it would be utterly beyond the power of regulation to temper? Does it not matter that current regulation appears to be almost completely effective in preventing organs from being sold in the US?Report
The current practice of selling/ renting bodies and body parts you mention, is what creates my skepticism.
Again, saving lives is a powerful argument, one I grant. However, I don’t think I need to argue with libertarians that there are a lot of ways to save lives that libertarians don’t support.
Making organ donations mandatory, for example. I doubt anyone here find that persuasive, even if it was demonstrated to save lives.
But on to your question, what sufferings would exist if a robust marketplace were to be created?
Health and mortality are not things we deal with rationally or well. In the same way that sexuality itself is value neutral, while in practice sexuality becomes the repository of all of our fears and irrational anxieties and evil choices.
So also, mortality and death, when mingled with the demonstrable weaknesses of our society that libertarians themselves have so accurately pointed out- cronyism, public corruption, bureacratic foolishness- is probably not going to create the idealized marketplace of empowered agents.
In short, exactly what we have seen time and again, what we are witnessing right here and now, of fearful desperate people making foolish and evil choices to game the system to get to the head of the line. The current waiting list system performs reasonably well, but only because it is so rigorously controlled and is designed to resist the temptations of bribes and cronyism.
I won’t categorically reject the idea of paying people for organs; but as I said, the amount of controls and oversight would make it an “unfree” market.Report
I have no particular attachment to a free market though, nor have any of the libertarians in this thread. The consensus seemed to be that the market would need to be very closely regulated, not free, but that even a regulated market would potentially be enormously superior to the wait-for-charity-and-die model we have now.Report
The current waiting list system performs reasonably well
Without plumping for any particular proposed alternative, I think a system that results in 6500 deaths per year* is quite probably not performing well.
(About the same number as gun deaths per year)Report
Gun deaths number about 30,000 per year, about 40% of which are murders.Report
You’re right. I meant gun homicides, and I also somehow stumbled across a number that was low by about half.Report
The idea of “greater harm” does seem to be split in differences here.
This is probably true for most issues. The pro-organ market side sees the greater harm in people waiting for kidneys (and other organs) dying and not allowing commerce. My apprehension towards markets is skeptical about “Markets, yay!” argumentation.
The opposition sees greater harm in the perverse incentives, hasty decisions, and coercion/duress possibilities of allowing organ markets.
At best I see organ markets being a wash.Report
Because some people perhaps losing a kidney they would later regret selling is a greater harm than other people dying for lack of a kidney?
I just do not understand that calculation.
(I’d also add that nearly everyone on the pro side here has said this is not about “Markets, yay!” to the point of supporting significant regulation.)Report
Dude, something (differently) bad could happen to (a different) person somewhere (else), sometime (else). How can you possibly find that acceptable?Report
The options aren’t kidney market or people die.
There are other ways to distribute more kidneys, including my kidney lottery with buy outs for the wealthy, or kidney sales where the price must be over 1,000,000 (or set a really high number of your own, whatever), there is a psychological screening process for sellers to screen out the desparate-from-poverty who might not be thinking rationally, and all organs are distributed to people on a basis of need, age, health, etc., and not how rich they are. (The deperate from poverty should of course be helped, as they do in the more just countries.)
It is fair for people who need kidneys to live to get kidneys. But it is less fair to place the burden of losing those transplanted kidneys on the worst off in society. (The worst off are also in the worst position to make that choice: lack of medical advice, no ability to take time off from childcare and or work, stress of poverty leading to rash decisions, etc.)
Thus, an ideal solution takes kidneys (or encourages sales of kidneys) from the non-worst off and gives them to the kidneyless on the basis of need, not wealth. Thus an ideal solution must not be an open, free market, but a market that mostly excludes participation of worst-off sellers, who should be given help in exchange for being a person, not in exchange for giving up a kidney.Report
Almist nobody here is endorsing a “free market” as such, mostly just that donors can be paid. I’ve explicily endorsed a screebung process.
The lottery idea is a nonstarter.Report
a “screebung process” ohhh that sounds dirty or painful.Report
The lottery idea is much superior to a free market.
Add this claus to the lottery. Any wealthy person (let’s say making over 500,000) can not give up their kidney, if they pay 20% (or 35% or whatever to make it work) of their taxable income that year and the next two (or next five or whatever). That way no person is forced to give up their kidney, because any person can just accept the tax penalty instead, which could be a very sizeable some (100,000, 200,000).
If selling a kidney is no big harm, then my lottery does no big harm to anyone and violates no one’s right.
If the lottery is a big harm (bigger than jury duty), even though the wealthy consented by not choosing to donate the kidney and not paying more in taxes, then isn’t a market a great harm to the poor who find themselves in a situation (because of our failure to help them in many cases) where they need to choose between money and keeping thei kidney.
And don’t say the lottery sounds dystopian because the rich are forced to make a choice, because the kidney market puts the poor in a position where they are forced to make such a choice too.
And don’t say my position is politically unrealistic, because a kidney market is also very politically unrealistic, certainly now.
A nice compromise is my “kidneys sold with price controls” (a very high amount) where the kidneys are divided up on the basis of need, not ability to pay and where anyone selling out of economic desperation would be effectively screened out. My compromise system would not be a market at all, really, but a government program to reward those who volunteer for service, in the way that the military rewards volunteers with college payments, VA health service, etc.Report
The lottery system would threaten someone if they do not give up a kidney. That is not superior to somebody merely not getting paid for not giving up a kidney.
Shaz, I’m willing to meet skeptics halfway on a lot of things. Your lottery idea is not one of them. And it’s not because giving up a kidney is inherently harm.Report
No, it would make your taxes determined by whether you did such and such. Benefit the poor by paying a tax. Or benefit them by giving up a kidney. If you choose to do neither, you are choosing to not pay your taxes, which is illegal, though it is “theft” and “slavery” and all that.
Think of it as a kidney tax credit. (You could structure it that way: taxes go up massively, massively on all the wealthy. They get a massive tax credit for entering the lottery.)
D you think the rich matter more than the poor. A market puts the poor in the same position. Suffer greatly financially, or give up a kidney. Given that the rich can much more easily deal with financial suffering, a lottery is more humane, but perfectly analagous.
Again, a good compromise is my thinking of kideny donation as military service and their being a financial reward for service. (But we haven’t done a good enough job distributing military service and its dangers throughout the population, so we need to work on that and kidney-donation as a service too.)Report
Greg,
Ha. My typing is getting worse and worse. Sorry.Report
It’s clearly punitive, to me. The financial suffering is *caused* by the policy. That’s not the case with simply paying donors, where they merely lose a potential benefit they still wouldn’t have if it were not for the policy.
It’s not about thinking that rich people are more important than poor people. It’s about thinking that people should not be punished for declining to give a kidney. Taking an additional 20% out of someone’s paycheck is punishment. Declining to pay them for not donating a kidney is not punishment. If we were to threaten to withhold food stamps, that would be punishment. And I’d oppose that more vociferously than the lottery.Report
Of course, it also benefits the rich, because they could become in need of a kidney, or even poor and in need of a kidney.Report
Your lottery is not superior to the free market. It’s among the most morally reprehensible ideas I’ve ever seen broached. I keep waiting for you to reveal how it’s not meant seriously, but is intended to somehow show how horrible your opponents’ ideas are. Because the idea of mandating that people are randomly chosen and forced to surrender a body part is among the more illiberal ideas ever suggested here at the League.Report
If selling a kidney is no big harm, then my lottery does no big harm to anyone and violates no one’s right.
$100 to your favorite charity, Shaz, , if you explain why this argument is so obviously fallacious.Report
Then just conceive of it as a higher tax environment where the rich get a benefit for giving a kidney.
You see the lottery as making the world less free because it forces certain choices on the rich. I see the market as less free because it forces certain choices on some subset of the desperate poor.
Do you see a world where it is legal for (especially poor women) women to be asked to “sleep with me or your fired, or sleep with me or your not hired” as a world where women are more free? (Is this a world where rich people or employers are less free?)
One of the general problems with libertarianism is that libertarians don’t aim at giving lower class people more freedom that markets somtimes take away from them. A market for women who will get a job if they sleep with you is not a freedom maximizing market for the poor. So too a market that allows the poor to sell kidneys.Report
James,
That is a single proposition and therefore cannot be an argument at all. Aguments are collections of propositions where at least one proposition (the premises) are offered as justifactory support for a proposition (the conclusion).
Aren’t you a professor?
🙂Report
I can only conceive of it as what I see it to be. I do not want the government to threaten people who do are unwilling to donate a kidney. That’s what raising taxes for the purpose of getting people to donate kidneys is doing, even if the target is wealthy.
I cannot see it any other way.
It’s a non-starter. You’re not going to convince me otherwise. Frankly, I think the idea speaks for itself.Report
A. So you’re going to be pedantic in order to avoid responding substantively? Emoticon away, I am neither amused nor impressed. Anyone who thinks that an activity done voluntarily by some neither does harm nor infringes rights, when forced on others cannot be taken seriously. I can’t bring myself to believe that you don’t understand where the harm is.
You see the lottery as making the world less free because it forces certain choices on the rich.
Is it possible that you believe this? You’re so hateful of libertarians as to think that we don’t care about the poor person who loses your monstrously evil lottery, only the rich person who might have to pay pocket change to opt out?
Let’s not have any more pretense that you’re actually interested in real discussions with libertarians, ok? You’ve just definitively shown that you’re only interested in cheap and dishonest stereotypes.Report
James
1. Your comment that I responded to was hardly a charitable, friendly comment. “Condescending” comes to mind. You escalated, rhetorically.
2. The rest of your comment is some attempt to be bullying. I like you. But your comments are an awful lot like another commenter who you used to (before his absence) get in a lot of conflicts with.
I am interested in debate with libertarians that is charitable and open and not derisive. (You have been deriding my position all along, calling it “monstrous” at one point.) I have yet to deride you.
If you think my position is wrong, cite your reasons. But don’t imply that you know what I am interested in. I have ben having a cnversation about a policy that will never pass for hours now, debating you, James K, Patrick, Will, And Brandon.
So cut the bullying rhetoric out. It’s beneath you.Report
Will, if you mean it will never pass as legislation. Quite right. But neither will a kidney market.
If you mean it is morally uncomfortable, I agree. However, if the lottery is more morally uncomfortable to you than the market, your intuitions about harming the rights of the poor and the wealthy may be skewed.Report
No. That’s about as politely as I can respond to your line of reasoning here.Report
Shazbot,
No, there’s no bullying here. That forcing one person to do something against their will does them harm, even if some other person does it voluntarily is among the most simple of concepts to understand, yet you seem not to.
And if you really think either Will or I are primarily concerned with the price to the rich of opting out of the lottery, rather than the poor who are unable to opt out, so upon whom the real costs of the lottery will fall, then you most certainly are not interested in serious discussion. You cannot make such obviously false claims about others and still expect them to believe that you are operating in good faith.
I suppose I could say that your lottery idea shows your concern for the rich by allowing them an out that’s not available to the poor. If I did, would you believe I was debating in good faith?
As to calling your lottery idea monstrous, I used that term advisedly, not simply as derision. I could have said stupid, cockamamie. I sane if I intended to be derisive. I chose monstrous because of its moral connotations–it is monstrous to force people to give up their organs against their will. The market idea does not force anyone to do so, even if the choice to do so falls predominantly on the poor. Even if they are in desperate straits that cause us to legitimately wonder how much choice they really have, it does not involve having some other person tell them that they absolutely must. You can disagree with that, of course, but if you prefer a system of no choice to a system of unpleasant choice, it seems to me a perverse conclusion. I truly do not think morally monstrous is too strong a term. I am strongly tempted to submit this question to my colleagues who teach ethics, to get their sense of it.
But I can accept you having that position and still be willing to engage in debate with you. But when you take recourse to the stereotype of “you only care about the wealthy,” you persuade me that according you the respect of believing you are sincere would be a foolish error. If you want continued debate where I take you seriously, then recognize that in response to your lottery proposal we are repulsed by the burden you put on those who cannot afford to opt out. The rich? They can take care of themselves.Report
James and Will,
(I’ll just ignore James’s bluster as I do Blaise’s. It’s the same thing in both cases.)
Suppose we live in Libertania, and our country is engaged in war all the time (not hard to imagine for us) with the awful Rawlsite Empire and one out every four soldiers who goes off to war dies (just to make it an extreme case to sharpen the edge of our intuitions).
Suppose the Libertanian government recruits it’s army in the following way. It puts ads up in poor areas, where there is unemployment and a lack of health insurance, where there are people with great debts, amd sick children whom lack access to better healthcare that money could buy. Those ads say “Work for the army for minimum wage. Save the lives of decent Libertanians.”
As a result, the army of Libertania is composed almost entirely of poor people, many of whom die in battle. There are a few wealthy and middle class volunteers, but they are rare.
The Nozickite and Rothbardian religious sects of Libertania support this policy, and are against a draft that requires the wealthy or any attempt to coerce the wealthier to enter the draft through tax penalties (even those structured as tax credits).
Would you be with the Nozickites and Rothbardians? Or would you aregue the fact that the fighting and dying falls disproportionately on the poor is unjust, even if the poor have consented to fight in order to get a wage?
(If you want, imagine the Nozickites have an anti-kidney bomb that removes kidneys and the only way to defend against it is to have soldiers donate kidneys to those citizens who have been hit with it.)Report
I’m going to throw one more thing out there before I try again to retire from this conversation…
Here is some interesting background on financial incentives and who would donate. If you pay donors, the poor are most likely to donate. But! If you don’t pay donors, the poor are most likely to donate as well. In fact, a willingness to donate goes up by almost the exact same amount across the economic spectrum, a 12-14% or 16-18% bump, depending on how much money.
If you measure it against the no-payment baseline, the percentage increase is much larger among the higher classes than the lower classes. Among those making more than $100,000, the increase is 80% and 105%, while for those making under $20,000 it’s 50% and 60%, depending on the amount.
Now, these numbers apply to “Would you donate for family or friends” rather than a blind donation. So the numbers across the board would be lower. But I don’t think the effect on money and donation would be remarkably different. And, honestly, if we paid donors, we would be less likely to need blind donations anyway because family and friends would be more likely to donate.Report
Shaz,
Not to pile on, but I have real trouble establishing what your motives are of singling out the rich. Do you dislike them? Are they morally reprehensible? Or are you picking on them as a rhetorical device? I truly do not get it. How is your suggesting the wealthy be forced into a lottery any different than I suggesting it for Jews?
The other thing that I cannot grasp is how you seem to suggest that markets harm poor people. Reality harms people. Voluntary market transactions empower the poor, and have done wonders for them. I have been reading history in massive doses and I have never read a history which was even slightly convincing that markets harmed, or even failed to benefit, the plight of the poor. Could any
Liberal believing that markets have harmed the poor please lay out their logic. I have heard attempts, but they are always silly.Report
Shaz, I am exiting this conversation. It honestly feels like you either haven’t been listening to what I have been saying or don’t care what I am actually saying. We’ve had good conversations in the past and I believe we will have good ones in the future. This isn’t one of them. I believe that I have properly adjudicated myself of what you’re accusing me of.Report
The other thing that I cannot grasp is how you seem to suggest that markets harm poor people. Reality harms people. Voluntary market transactions empower the poor, and have done wonders for them.
This really does cut to the heart of a lot of the nonsense about “exploitation” that’s being thrown around in this thread. I’m genuinely convinced that the people making these arguments simply don’t understand the distinction between forcing someone into a bad situation so that you can get him to give you something you want (e.g., mugging), and helping mitigate a bad situation you had nothing to do with (e.g., poverty) by offering to trade someone something he wants for something you want.
It should be obvious that the former is (or at least has the potential to be) socially destructive rent-seeking, and the latter is mutually beneficial. But so much of anti-market ideology is built squarely upon the failure to grasp this obvious distinction.Report
Shaz,
Calling my criticism bluster doesn’t make it so. The word can make for a good smokescreen. As to your war example, you so poisoned the well with your “Rothbardian and Nizickran religious sects” that I cannot perceive any semblance of good faith. You know where I stand, I know where you stand, and it’s very dubious that real discussion can be realized now. So I, too, am exiting. I doubt this will be very distressing to you, but it seemed courteous to be clear about it.Report
He’s the conclusion of a peer-reviewed paper in “The Journal of Medical Ethics” on a kidney market:
“Current understanding of a regulated kidney market is insufficient. It is unclear whether a regulated market would result in a net gain of kidneys. Most kidney vendors would only sell in a particularly difficult financial situation, raising concerns about the validity and consent and inequities in the provision of organs.”
Would you sell a kidney in a regulated kidney market? Results of an exploratory study
A Rid, L M Bachmann, V Wettstein and N Biller-Andorno
Journal of Medical Ethics , Vol. 35, No. 9 (September 2009), pp. 558-564
Published by: BMJ Publishing Group
Article Stable URL: http://0-www.jstor.org.opac.sfsu.edu/stable/20696639Report
The last sentence of the conclusion says we need more info. The paper is based on fairly minimal data, but still important.
I will suggest an ideal compromise policy later tonight if I can.Report
Shazbot5 I’m going to try and be clinical here and dial back some of the heat from the thread and try and go after the merits of your alternatives here.
I want to address the second suggestion fist because I think it’s the most easily disposed of. The idea of permitting a market but setting a base price of, say, a million dollars doesn’t seem particularly advisable for a couple of reasons:
-The 1 million ceiling would land like a boulder on the poor and middle class. Insurance for these people would choose to opt for the misery of dialysis rather than shelling out the money for the price floored organ. This would result in burdening suffering on the poor while eliminating the wait for organs for the affluent.
-On the other side of the ledger there’d be lines around the blocks of people eager to donate a kidney for a million dollars. This system would eliminate the shortage of organs, but only for the wealthy.
As such it appears to me that it would achieve the exact opposite of your purported aim of aiding the poor.
Your first proposal, a lottery, I want to summarize first to make sure I understand it clearly.
The proposal is that there be some kind of draft system by which people are randomly chosen to be forced to donate kidneys (for compensation if I read you correctly). People can opt out of the system by opting to pay a steep fee instead.
Again I think this proposal is ill advised and would, in practice achieve the opposite of your intentions and be an utter plague on the poor and middle class and a boon for the wealthy.
-It should be noted first that there’d be terrible logistical challenges involved in such a lottery system. Organs aren’t like AA batteries, one size doesn’t fit all donor recipients. A system to randomly select matching candidates for a recipient would be massively complex and difficult. To be honest I’m somewhat doubtful that it’s even logistically possible. If it were it would most assuredly be very expensive.
-This leads to my second point. Since the organ donations are mandatory (no voluntary) and since the lottery system would be complex and costly there would be enormous downward pressure put on the compensation paid to the organ donor. The system would need to be paid for and there’s an upper limit to the amount that could be charged to the organ recipient (exceed the cost of dialysis and they would opt for that instead) so I would assert that the compensation mandatory donors would receive would end up being significantly below the rate they could expect in a regulated market or free market.
-The third point is that the wealthy, when presented with this lottery mandate, would simply pay their fee and move on. The middle class and poor, on the other hand, would be incapable of doing such and thing and would essentially be frog marched into organ donation (for which they’d likely receive a pittance in compensation).
-I would note that the fees the wealthy pay could not rationally be expected to make this system fiscally balanced. If the lottery is fair then the wealthy, being numerically small, would face it far less frequently than the poor or middle class.
The proposed system, by my analysis, would be, at worst, an inconvenience for the wealthy and an utter bane for the poor and middle class. Again the reverse if your intentions as I understand them.
I would also note, though I hope clinically, that the morality of the second proposal is deeply suspect. This immorality comes from multiple levels:
-A system with a pervasive lottery would require a level of invasion of privacy, identification and tracking that would be unprecedented in any country in the developed world.
-The incentives of this system would be incredibly dark: contract a disease, take care of your self poorly or abuse substances and you would render yourself an unsuitable donor and be free of the threat of the lottery.
-The system would be fundamentally a massive violation of individuals sovereignty over their body. To demonstrate let me translate your proposal over to the question of choice, an area where I believe we share the same positions. An equivalent system in this realm would be to establish a lottery for infertile couples. All fertile women would be required to submit to it and would be randomly selected. The randomly selected woman would either pay a steep fine or else be forced to carry a child to term for the infertile couple (with some compensation).
I would think that you, like I, would find such a prospect horrifying. Frankly it reminds me a bit of a Handmaids Tale which is a distinctly dystopian novel but I would assert that this theoretical policy is fundamentally the same as your organ lottery proposal.
So, in conclusion I question your proposals on pretty much every level. From the math to the practice to the morals it seems more like an alternative cooked up out of the depths of an authoritarian fringe. I’d note also that these are being proffered as potential solutions to the suspected problem of poor people being desperate for money and thus choosing to donate organs which would be given to the rich. In this case I’d say with no hesitation that the proposed cure is several magnitudes worse than the disease.
When you first proposed it I assumed you were making an argument ad absurdum to make some kind of point. I’m a little astonished that you’re continuing to defend it.
If I’ve missed some angle of your argument I’d welcome your clarification.Report
An equivalent system in this realm would be to establish a lottery for infertile couples.
Previously asked, and repeatedly ignored.
When you first proposed it I assumed you were making an argument ad absurdum to make some kind of point.
That was my first thought, and I still incline toward thinking it’s so, and just went a little awry. For the record, absent the opt-out fee, Shazbot seems to be working off this. There is a philosophical provenance here, as is to be expected from Shazbot, but it is one that is subject to much criticism. For example it violates the Kantian principle that we not use others as means, and does so in a way that also justifies the Bush administration’s torture regimes (harming this one person can prevent harm to more than one person, so torture is a moral act–not that Shazbot claimed that, I hasten to add).Report
North,
You’re missing a key detail in each of my proposals that protects the worst off.
In the lottery case, only the wealthy will participate. They will be allowed to exit the lottery by paying more than whatever the other wealthy people bid. It is an assumption here that it is rational to sell your kidney for, say, 20-50 grand, so some of the wealthy will sell instead of paying, say, 200 or 300 grand. The middle class and poor will be exempt automatically.
So too with the 1,000,000 proposal. To enter into a system where you would have a chnce to get that much money for your kidney, you would have to demonstrate that you are not doing it out of desperation and poverty and that you have fully thought through the ramifictions of your choice. The million dollr kidneys would be distributed by the government according to need, not who can pay. I calculated the cost of this at about 30 dollars per person in the U.S., but we could create a kidney tax that would fall more heavily on the wealthy to pay for the whole shebang.
Regarding morality, I suspect the rich would not become alcoholics or hep C sufferers just to avoid the lottery. Aft all, an assumption of all of this is that a kidney donation is no great harm. When a poor person sells a kidney for 20 grand, we are assuming they are doing something wonderful. So, when a rich person decides to donate instead of paying a 50,000 “kidney donation exemption tax” he also is making a great decision.
Indeed, all of your intuitions and worries about the dystopia of a kidney lottery should be, mutatidis mutandis, intuitions and worries about the dystopia of a world where the poor are “forced” to sell their kidneys out of desperation.
Now Hanley and the libertarians will say thepoor aren’t forced to sell in a a market in the same way that the rich are forced to sell in my escapable lottery. But this is wrong. If a women is told she has to sleep with her boss or be fired, she is “forced” to sleep with him. By analogy, if your kids are sick and you can’t get a better job, and your boss says “give me your kidney or your fired” the person is forced to sell their kidney (this happens in the Iranian kidney market).
The reason we ban certain kinds of sales (sex trade, kidney trade) is because we are afraid of a certain vicious kind of exploitation that does occur. This is what the medical ethics paper I cited states and what often happens in Iran. (It is also what happens when you don’t have a military draft and you offer financial rewards for military service: only the poor serve, die, and give kidneys. None of this is just.)Report
Because the U.S. is just like Iran. Of course.
I hadn’t realized that your lottery only included the wealthy, and that the non-wealthy were exempt from it. So you’re absolved of harming the poor–I’m happy to admit that.
But here’re the problems. 1. While I don’t give a crap about the rich, I do give a crap about any system that singles out a particular class and places a unique burden on them.
2. We have to set a wealth standard for who gets included in the lottery. Say we set it too high, so too many pay to opt out, and it doesn’t produce enough kidneys. So we lower the bar progressively until we get enough kidneys. We may never have to reach down as far as the poor, but w almost certainly will reach down to people who can’t afford to pay the fee to opt out, and they’re providing the kidneys instead of the truly rich. So your lottery requires taking kidneys from people who aren’t really willing but can’t afford to escape it.
3. Any system–including the draft– that says your body ultimately is at the disposal of the state is an immoral system, based on disdain for the liberty of the individual. Society over the individual is among the world’s most dangerous ideas.Report
Wow. That comment fits my 6:41 comment to a T.Report
James,
I never said the U.S. was just like Iran. How uncharitable.
“While I don’t give a crap about the rich, I do give a crap about any system that singles out a particular class and places a unique burden on them.”
You mean like the burden of higher income tax falls on the rich? You really are an extreme libertarian if you think all laws, presumably including the income tax, are unjust just because they target the rich for punishment.
“So your lottery requires taking kidneys from people who aren’t really willing but can’t afford to escape it.”
But the market (if the poor and the desperate aren’t explicitly excluded, at which point it might look very little like a market) takes kidneys from poor people who aren’t “really” (this “really” is a big concession on your part) willing but can’t afford to escape the situation where they have to sell a kidney or suffer some economic calamity.
The poor will sell their kidneys even when they aren’t “really” willing to do so, sometimes when they consent to do so out of desperation, as the medical ethics journal that I cited elsewhere here predicts will happen, and as does happen in Iran (which isn’t just like America, but is filled with actual human people, just like the U.S.)
—
To make my lottery even more fair allow people to compete to exit the lottery by offering percentages of their income, not set sums. So the millionaire could offer to give up 10% of his millions, and outcompete the billionaire who was only willing to give up 5% of his billions.
Oddly, I weep for the poor effected of the market, as in Iran, than the wealthy who wouldn’t bid a bit more in a lottery, where the proceeds would also go to save lives. They all have the same amount of being able to do what they “really want” to do, regardless of what they choose to do.Report
Value is subjective. There’s no objectively right or wrong answer to the question of whether it’s worth $25,000 to give up a kidney. It depends very much on an individual’s marginal utility from money*. When selling kidneys is voluntary, the only people who sell kidneys are those who value the money more than not donating a kidney. When the donors are selected by lottery, many who are selected value keeping the kidney more than the money.
It should be really obvious that this has nothing to do with favoring the rich over the poor, and everything to do with making sure that the only people who sell their kidneys are the people who would rather have the money. Really, the only tenable argument you could make against this is that the poor are just too fishing stupid to make that decision for yourself. Everything you’ve been saying in this thread just screams that, but are you willing to say it in so many words?
*While this is correlated with wealth, it’s far from a strict function of wealth. There’s considerable heterogeneity of utility curves for wealth, so marginal utility can vary significantly even among people with the same amount of wealth.Report
“Really, the only tenable argument you could make against this is that the poor are just too fishing stupid to make that decision for yourself.”
For themselves.Report
Brandon, now Shaz can’t get my money for his fave charity!Report
So people who slept with their boss instead of losing their job got value out of the whole thing. Good to know.
Also good to know that people do (pace Hanley) use the “value is subjective” claim to argue for libertarianism and libertarian conclusions.Report
, this seems like allowing people to make a short-term gain for a strong possibility of immediate and long term risk.
Like playing football? Or being a race driver? Or joining the Marines?
I don’t think the pro-side is recognizing the unintended consequences.
Likewise, I don’t think the anti-side is taking the unintended consequences of the status quo seriously.
It might be paternalistic but I would rather find other ways to help people get over an immediate need for cash than putting them up for major surgery with a good risk of something going wrong.
It’s been said at least twice before, but it’s worth repeating–these are not mutually exclusive policies. So I really don’t think our arguments ought to be treating them as such.Report
Well, from someone in favor:
1) If I saw it being abused as described by some people here, I would support reforming it. If reforming it wouldn’t work, I’d support abolishing it. I think concerns over what might happen fall ridiculously short as a rationale not to allow it, but if it did start to happen that way, my position would change accordingly.
2) DavidTC suggested an alternate way to get the organs. If that worked, and more kidneys weren’t actually needed, then I’d be more than happy to leave the ban in place.
3) My calculation here is based on the comparatively minimal risk to the donor (seriously, it’s not like donating a lung) and the benefit to the beneficiary. If that turned out to be wrong, my position would change.Report
Also this shows one of my main objections to libertarians.
Some decisions are really serious and not to be made on a snap. I do believe in the autonomy of a human but I also believe in mitigating harm by perhaps helping people make decisions that they will not regret later or cause them significant damage.
So I would want a lot of the are you really really really sure kind of psychological counseling before the person says yes.Report
“I do believe in the autonomy of a human but I also believe in mitigating harm by perhaps helping people make decisions that they will not regret later or cause them significant damage.”
i don’t exactly have “murray rothbard is the illest” tattooed on the head of my junk or anything – in other words i am very far from doctrinaire – but it does strike me that you kinda have to rewrite that sentence more along the lines of “i believe that one limitation of human autonomy is an obligation by society/government to help people make decisions they will not regret later nor cause significant damage to themselves or others”. i took some liberties there (HA HA HA GET IT?) but i don’t think you can really hold up believing in autonomy as a stand alone value and then mitigate it with a bunch of stuff about bad decision making.
the ability to make decisions, good or bad or stupendously stupid, is the core of autonomy.
and yes i know something something something somalia but the same can be said of all religions – most democracy enthusiasts aren’t into direct election for every idea #ows style, etc etc and so forth.
i don’t really have an opinion about the paid organ thing, though. i’d probably rather have a compensation program built into super medicare or whatever we end up having in ten years as both incentive and brake but there’s a lot of sticky wicket involved regardless. that we can even save some people now is pretty tremendous, but post death organ donation is still a hard sell.Report
Some decisions are really serious and not to be made on a snap.
Boy, that’s some really clever framing going on there with that “on a snap” line. What in the world makes you think people would make this decision on a snap? For god’s sake, by the time they screened someone for match and health, and scheduled an operation, there’s no
snap left; you’d have plenty of time to think about your decision.
It’s not like somebody’s going to think, “Oh, the rent’s due tomorrow and I’m busted, so I’ll go down to the hospital and have them take out my kidney tonight so I can pay the landlord tomorrow.”Report
People will certainly think approximately like that, but it won’t go down that way. Except maybe at places run by people like Kermitt Gosnell, which is already probably happening to some extent now.Report
I would also want intake interviews that helped deal with coercion or duress situations. Something like:
Q: Why are you selling your organ?
A: I lost my job, the bank if foreclosing on my house, and my husband was just diagnosed with ALS.
At this point, we would look for all alternative means necessary to help the person get aid and charity without having them donate their kidneys or part of their pancreas.Report
So far, I’m not sure anybody has objected to screening. Both James Aitch and I have expressly endorsed it. And there is already screening in place for live organ donation.Report
But doesn’t my screening sort of defeat the purpose of an open market? Beyond the normal health screenings and organ rejection issues, I am asking for the system to have alternate needs of help for the desperate. This does not exactly increase the number of kidneys available.Report
Compared to no sales at all?Report
Under what conditions would you sell a kidney to a stranger?
Not donate, sell.Report
Only if you assume the only reason someone could possibly be willing to sell a kidney is abject desperation.
I wouldn’t at all mind if we show people who want to donate kidneys because they are hard up the government programs that they might be eligible for. And I know that as a liberal, you want more such programs available. That’s a separate argument as I am sure you want to see such programs whether kidney sales are legal or not and I wouldn’t let whatever effect it may have on kidney availability affect my support or lack thereof of a new welfare program. In other words, we’d both hold the exact same position regardless of the status of kidney sales.
But back to the main point… which is that I don’t think we’d be relying on the out-and-out desperate folks if kidney sales were legal. We could screen out those that are financially desperate and doing it just for the money. I don’t believe the system would be nearly as reliant on that as you do. It would rely on people like Patrick and myself as much as anybody.Report
“Only if you assume the only reason someone could possibly be willing to sell a kidney is abject desperation.”
The problem isn’t that this is the only reason, but that it is one of the reasons that will cause people to sell.Report
My response was to ND who seemed to suggest that absent desperation there wouldn’t be kidneys. I think there wouls be enough non-desperate donors to fulfill the need. Even if we eliminated the desperation, as he wants.
As for your stance, I just don’t think the *possibility* of desperate individuals doing it warrants a scuttering of the whole enterprise. I’m down with trying to screen them out.Report
As we see in Iran, the evidence is that the desperate sell out of desperation.
“Give me your kidney if you want a job and to not live in poverty” is common enough (though we have anecdotes, more than data from Iran’s kidney market) in Iran. Sell a kideny to avoid bankruptcy. Sell a kidney to make some mortgage payments, but then lose the house anyway (ouch).
I also think it’s really naive to think the desparate won’t sell, and sell for less, which means the buyers (hospitals, wealthy individuals, whoever) will buy from them more than the rest.Report
You don’t think we could have a regulatory regime superior to Iran’s?Report
I don’t know. Does Iran allow local fire codes?Report
Under what conditions would you sell a kidney to a stranger?Report
Knowing then what I know now about kidney donation, it would have been an ideal option from 25-year old me. I was unemployed and could have used some money, but wasn’t desperate. I was about to move to Deseret with Clancy and was dealing with a bit of uncertainty. A compensated donation of $10k would have been extremely helpful. I would have spared me from taking a couple of jobs I didn’t want to take.
You can paint this as “desperate” but I don’t think it is the kind of thing you were talking about. Rather than keep me from starving, it would have kept me comfortable for a little while longer. It would have doubled the amount I had in the bank.
As I’ve mentioned, donation is something I would like to do ten years or so from now, once the kids are in school. If I’m eligible. If I’m eligible, I don’t know if it’ll happen or not. The ability to take $10k, $25k, or $50k and put it in my kids’ college fund would certainly make me more likely to do it.
You can say that I don’t count because I might be willing to donate anyway, but it’s actually people like Patrick and myself that are ideal. Both of us are interested, and money would help move the needle. Ideally, you’d have candidates that wouldn’t be doing it just for the money. Honestly, if we could just get more people to donate to family and friends, and money would help, that would free up a lot of cadaver kidneys for people that can’t find a donor.Report
I’m firmly in favor of organ selling assuming there is a strict chain of title (thus preventing the injection of extorted or stolen organs into the system), a strict legal exclusion of organs from being considered claimable assets* (no seizing them in bankruptcy or anything else) and extremely harsh penalties for violating those rules.
I’d have a couple things that’d make me reverse that position.
If it turned out that somehow legal chain of title was easily breached and a black market in organs flourished I’d turn against my support. I would note, however, that currently black markets generally exist in the presence of bans on normal markets. If illegal organ trading (in an especially brutal and hard on the poor manner) is going on then it’s likely going on right now and legalization of organ selling would likely put an end to it.
If it turned out that the market balanced out by making organs not worth selling (a significant possibility when you calculate in the influx of organs potentially being sold from the remains of dead relatives) and we ended up back where we started with insufficient organs I’d also turn against it.
I’m puzzled by the vehemence of the “this would fall on the poor and only benefit the rich” argument. It seems to me that the potential supply of organs that could be donated massively outstrips the need for organs to be donated. The primary barrier to the supply being connected to the demand is ennui and a soft “ick” factor both of which are calcified by a law that prevents the application (filthy lucre) of any countervailing force other than flabby appeals to altruism. If my understanding of the numbers involved is correct then organs would probably only end up being worth a a few thousand dollars, there’d probably be a waiting list -to- donate them rather than to receive them and the phenomena of people dying from organ scarcity would vanish. In that case organ sale legalization would eliminate the problem likely without creating another one which would be an unmitigated boon for the poor and rich alike.
*Also associated I more softly think there should be a band on financial instruments based on them. No kidney reverse mortgages or similar such nonsense.Report
You can have my kidney default swaps when you pry them from my cold, dead hands.Report
What would make me change my mind? When we have at least attempted the _slightest_ effort to actual encourage organ donations after death, and that attempt has then failed.
I like how we’ve nonsensically leaped to ‘Letting people sell organs’, which at best would just let people sell organs that they have two of. (So, uh, kidneys then. And lungs, maybe?)
And not given the slightest amount of thought to ‘Hey, maybe the government should somehow reward signing up to becoming an organ donor enough that people actually do it.’, which would, duh, not only result in even more kidneys and lungs but also hearts and retinas and whatnot.
It is _trivially_ easy to create an organ donation system that does not have perverse incentives and does not take advantage of the poor, so why on earth would we create on that did?Report
which at best would just let people sell organs that they have two of.
No, it would also let people sell the organs of their deceased next of kin.
But don’t let that critique detract from the fact that I fully agree with you about paying people to sign up as donors.Report
DavidTC, could you please point me to a system that you could say “Dude, we should be like *THAT*”?
Thanks,
JaybirdReport
By ‘a system’ do you mean somewhere else? Because I really have no idea of what the laws are elsewhere.
Here is my invented system: Pay people $500 to sign up to be organ donors, starting at age 18.
That’s it. Currently, the signed up organ donor average seems to hover around 20%. And based on poor college students that I know, something like 90% will sign up for anything that will pay them $500, especially if they don’t actually have to do anything, and this has the added bonus of being for a good cause.
Now, you’ll notice I didn’t invent any way out of this system, because I don’t actually care. I think if, by signing up, you committed to be an organ donor for five years, and then at the end of the five years, you can opt out or stay in, almost all people signed up would just stay in. (If everyone actually does opt out, we could fix that by providing renewal payments, but I suspect we don’t need that.)
If 90% of people were organ donors, we wouldn’t have to worry about ‘buying’ organs from anywhere, or try to carefully figure out incentives and laws to keep people from being worth more dead.Report
Incidentally, my state already does this…for $5 off the driver’s license registration. Yes, apparently donating your organs is worth five whole dollars. (But only if you drive.)Report
I like this.Report
Golly, that’s not bad.Report
You can actually solve a hell of a lot of problems in society by just _paying people to do the right thing_.
There’s some sort of Philosophical Truth in that statement, somewhere.
Of course, the problem is that, at this point, the right sees the government actually handing money to human beings, especially _poor_ human beings, as the greatest horror imaginable, so would likely object to this. (1) Instead, they would demand it as a tax rebate…which would hilariously mean it was the middle class ‘selling their organs’, not the poor.
Incidentally, we can solve the problem of people not serving jury duty the same way…actually paying a _reasonable_ amount of money for their time, instead of wages that would actually be illegal under minimum wage laws. And provide child care.
And low voter turnout, too. And low voter registration. And recycling.
And the fun thing is, instead of paying for _enforcement_ of stuff, you can simply set up an office and have people _come to you_. If you’re going to fine people for something, they will hide it and dispute it and you need court and whatnot, whereas if you’re going to pay people for something, especially something that is no real effort on their part, they will show up at government offices and provide evidence to you. With no work on your part!
It’s a crazy idea, I know. Paying people do things we want them to do.
1) Despite the fact it is not actually handing money to anyone, and is in fact exactly the same thing as the usage fees the far right seems to think the government should collect from everyone instead of taxes…except in the other direction. But I honestly believe that the right would rather DIE IN A FIRE than to hand poor people money.Report
While the right wants tax cuts for everyone else, it wants tax increases on the poor, though this is usually euphemized as “wanting everyone to have skin in the game” or “broadening the tax base”. The obvious flaw has been the inability to get metaphorical blood from a metaphorical stone, but this ceases to be a problem when the metaphorical stone has monetizable organs.Report
I’m with ya on a lot of things Mike but I don’t think even our current debased and pathetic right wing honestly would seek what you’re suggesting now and, if they did, they’d be swept from power and sent to the wilderness for a fine long time to reconsider. The right in the US has a significant internal constituency that freaks out about life issues. I can’t imagine they’d sign onto this kind of agenda.Report
Dave started with some great points, and then you guys basically suggest that those on the right are evil and want to screw the poor. I am definitely not on the right, but your interpretation of their motives is worse than comical.
It is possible to disagree with them and to understand why they could morally and even admirably come to the conclusions they do*. You guys are either not trying or joking.
* They have different values and or different understanding of the world than we do.Report
They’re very religious, except when it comes to helping the poor.Report
Even the article you link gives more gracious interpretations. If you were to, just for shits and giggles, assume good intentions on the right, how would you explain or defend their beliefs? Or in other words, what value differences do they have, or what different assumptions or facts are they operating under?
Or are they really just monsters?Report
It always interests me how self-professed libertarians who claim to disdain both sides are far more sympathetic to the right.Report
Nice jab while totally evading the point.
But, in my case it is probably kind of true, with some qualifications. I have always been able to do what I recommended you try to do with the far right. I reject their values and their facts, but totally get how they start with those values and come to the conclusions they do. If I believed gay sex condemned your soul to eternal hell and that abortion was murder I would probably come to their same conclusions. I dispute their assumptions and do not share their values of hierarchical obedience, sanctity and purity.
That said, if you put me in a room with a room full of Mormons and baptists I can ” get” them.
The main reason I love this site is that it allows me to learn more about the underlying values and factual assumptions of those on the far left. Occasionally I play back what I hear, but then often encounter strange cognitive dissonance. The left frequently denies the assumptions they are making (while the right wraps their values proudly around themselves like a Dorothy Lamour sarong).
The solution I have learned is that one way to broach this is to play back what I have learned about the far left AND to simultaneously attack it. When I do this, the prevailing response is no longer to deny but instead to defend. Of courses this makes me a total ass.
I can play back what I have learned about the far left’s assumptions and values now, but LWA summarized an extreme version pretty well with his paragraph I quoted earlier.Report
What’s the point I evaded? Biblical values are applied to sex, but are rationalized away when it comes to charity.Report
I have wondered about this seeming tendency myself – by which I mean, I have even noticed it in myself – it sometimes seems to me that I am more often defending the right from the left, than the other way around, though I do not feel entirely at home with either side.
I have come to the conclusion that a lot of it has to do with venue (and my own cussed contrariness). Here, and IRL (i.e., about 80% of the time), I am generally interacting with far more lefties than righties. Since it often therefore seems that the left’s viewpoint is in ubiquitous ascendance, and needs no defense from all right-thinking people (no pun intended), I often find myself coming to the defense of the right whenever I feel they are being caricatured or misunderstood unfairly.
Conversely, when I go to say family holiday dinners, where right-wing viewpoints are very much in ascendance and unfair interpretations and malicious motives are being ascribed to the left, I find myself defending the left’s viewpoint, which (in that venue) I see as very much embattled, and not getting a fair shake.
IOW, in a debate I’m likely to stick up for the side that seems to need the help, so long as that help can be given in good conscience. I am not going to defend a racist, for example. But someone being, in my view, unfairly accused of racism (IOW, someone whose actual *views* I may not even agree with per se, but who it seems to me is getting an unfair shake, argumentatively/rhetorically)? Yeah, I might stick up for that guy.
Something to keep in mind. May not explain all of it, but in my own life it seems to hold. And it helps explain why righties often see us as lefties, and lefties see us as righties.
And take comfort that it sure seems to me that the right needs the help, far more often than does the left; not only do I see the left generally winning the cultural and political wars at this point in history, but they also have no shortage of articulate spokesmen. Trying to find someone on the right who can explain why they are correct, even when they clearly *are* correct, can be a real challenge.Report
Your experiences ring similar to mine, Glyph. And it is great to see us admit we are contrarians. A libertarian movement would be like herding cats.
Mike, I meant evading the issue of trying to imagine them as other than monsters. Or are they REALLY monsters?Report
That herding cats would be easier then getting a sizebale libertarins movement togehter is true and also a major weakness. Unless you can put some of your ideas in practice, a lot of it is just theory. Putting things into practice entails all those evil things R’s and D’s have to do like compromise, settling for far less than we want, being partisan and muddling through.
The contrariness of lots of people is noted. Often times its hard to tell whether the root of all sorts of political or social movements is just being contrary. Or course people have the right to be contrary. Hell i wouldn’t even want to regulate THAT. But it does make me wonder how firm views are that are fueled by being different. Sort of like with teens. They have lots of views, passionately held ones, but how many are just fads or them individuating themselves from their parents.Report
I’m not imagining anything; I’m reporting on what I observe. Am I obligated to invent reasons it’s not as bad as it appears?Report
Count me in to the Glyph camp, too.Report
Of course people have the right to be contrary
No they don’t.Report
Oh, come now, Greg, we have a two-part democracy, and libertarians, even when you count the nonLP ones, are a third party. It’s surpassing ridiculous to criticize any third party for not getting their policies enacted. Their “failure” is their inability to persuade enough liberals and/or conservatives to buy in more than just in part. And is that their fault or liberals’ and conservatives’ fault? There’s really no way to say (although I’d venture to suggest it’s all sides’ fault, bad messaging and bad listening).Report
greginak – In my prior comment I was speculating about personality type and venue as major *drivers of others’ perceptions of me*, rather than as *drivers of my actual viewpoints*.
Now, when it comes to my actual views, I do identify my own personality type (skeptical, argumentative, not a “joiner”) as *a* driver (maybe even a major one), but not necessarily as the *sole* driver of the political views I hold. I imagine the same is true, in varying degrees, for almost everyone.
IOW, it’s potentially a factor, but not the whole enchilada (and bear in mind also that I think personality differences are far more profound, and have far more effect, on political discussions than we realize – but that is a whole different discussion).
But rather than laying aside the implication that libertarians hold their views only out of some adolescent urge to rebel and can therefore be safely dismissed, let’s instead treat it as true.
Isn’t it equally true that many (maybe most) people simply accept the ossified faith of their forefathers and peers (religious, political, etc.) without much thought, because of tradition/imprinting/socialization?
Is that somehow more “genuine” or better?
Don’t we *want* adolescent rebellion (literal, and figurative), as an agent of critique and driver of societal change? When Hippie Johnny sneers, “Yeah, well, you’re just repressive hypocrites, Mom & Dad”, isn’t it sometimes (though not always) true?
Me, I think 90% of the Sixties can be put down to adolescent contrariness, and I still think they got much of it right, except for maybe some of the fashions and hygiene.Report
That a good point James. I’ve wished we could have more parties with actual influence for years. Our system is geared towards two parties and that leaves lots of folks (libertarians, greens, etc) out. But i’ve also had approximately a kijillion arguments (give or take a billion) with various libertarian or other third party people who have told me how bad i am or the D’s are for settling for less then we want since that shows we don’t have principles, or compromising or dealing one thing for another. Those are all unpleasant often but are part of actually working in a democracy. It is too easy for groups without any power to criticize groups with power for engaging in democracy. And to be clear it is very , very good for those out of power groups to keep pushing and yanking at those groups with power.Report
Glyph- I would agree personality has a huge part of leading us to our political beliefs. I didn’t mean to suggest libertarianism was all about adolescent rebellion. I don’t believe that. I do feel being contrary has a huge appeal for many people. There are natural contrarians on all sides although i would guess they skew towards being liberal or libertarian. There are a few big times writers whose entire schtick is being contrary.
Being a noble truth telling outside who sees so much more clearly then everybody else has a strong appeal. ( see the 60’s as you noted) Being contrary can lead to good points and views, but it takes some time to seperate the contrary from the truth or value.Report
Mike, I am speechless. I can’t find any nice way to answer, so I won’t.Report
Ditto everything Glyph said.
Steve Sailer once characterized libertarianism as “applied autism.” He meant it as an insult, of course, and I’m not entirely sure that none of the negative implications he intended are true, but I think that it also describes a strength of libertarians, namely that we’re less susceptible than most to social pressure to accept popular beliefs as true.
Which is not to say that all leftists and conservatives believe the things they do for purely social reasons, but I think a large majority of people do. Libertarians, not so much, because you pretty much have to go against the crowd to become a libertarian.Report
It’s also a common behavior to reject the mainstream, find a smaller crowd to identify with, and adopt its attitudes, which I think explains a lot of the libertarians I’ve met both in real life and online. (Present company excepted, as all the professed libertarians here are very capable of drawing their own conclusions and making up their own minds.) It certainly explains the comment section at Reason, unless all of them invented the nickname “Moochelle” for the First Lady independently.Report
…’my interpretation of their motives’?
I don’t believe I interpreted anyone’s motives. I merely pointed out that _any_ plan whatsoever that involves writing checks and giving them to poor people, for any reason whatsoever, is going to _incredibly_ unpopular with the right.
I ascribed no motive to this. Nor did I condemn it in any way. (I did use a bit of hyperbole, but hopefully everyone understands that most people would rather pay people money than be burned to death, and that was, indeed, hyperbole.)
Do you disagree with my statement? Do you think that the right _would_ be willing to pay for poor people signing up to be organ donors? Do you think they’d approve of any government plan that resulted in poor people lining up to receive money?
I actually find this habit of people objecting to me stating _what is clearly the actual position of the Republicans_ to be rather annoying. And it’s never ‘The right doesn’t think that’ or ‘Republicans wouldn’t do that’, it’s always ‘David, stop painting them to be evil’.
I didn’t call them _evil_. Neither did Mike Schilling for that matter. We made no moral judgments at all.
I simply stated what I suspect would be their position on a hypothetical law, based on other positions they have. If you disagree with what I think, then say so. Perhaps you can make an argument that Republicans _would_ be in favor of it.
But if you agree with what I thought, and you also think that position is morally wrong, then that’s _you_ calling them morally wrong, not me.Report
Well yeah, I am fine with the hyperbole, but no I do not think the right would rather die a horrible death than give to the poor. I am confident they care about the poor as much as those of other political leanings.
That said, I agree that the right doesn’t want more handouts. I can explain their logic, indeed the logic in this vase probably matches fairly well with libertarian logic, so it isn’t hard for me to explain or rationalize (delete whichever does not apply).
My guess though is that you and Mike could pretend you were a conservative and pass a Turing test if you really tried.Report
The only people in this thread who have been objecting to paying people for providing something of value are on the left. $500 is probably more than is necessary, but paying people to sign up for organ donation is fine. People on the right object to handouts, not to anything that results in poor people having money.Report
There’s a guy walking around with a lab-grown bladder. Cloned from his own cells, IIRC. They’re working on kidneys now.
Not exactly on-point, but I look forward to the day when “organ transplant” means “they grew you another heart, and we’re slapping it in your chest. Also, when we manufactured this from your own cells, we fixed some of the basic defects.”Report
Yes. In the future, no one will transplant organs from one person to another. Organs will be grown from stem cells taken from you, so there will be no chance of rejection.Report
That seems extremely likely in the future, agreed, but in the interim until this development is perfected?Report
What’s the turnaround time on a heart? Is it pretty much a fixed process, or do researchers think it can be sped up over time?Report
Growing one? Dunno. The process they used for the bladder — and what they’re trying to extend — is somewhere between “manufacturing” and “growing”.
They basically manufacture the shape and seed it with stem cells that then grow around the shape (and actually eat it — cell division needs food badly!).
It doesn’t take decades, since they’re not growing it from an embryo. I think the bladder took a couple of weeks to grow.Report
A couple weeks, eh? That’s quite encouraging.Report
To grow. I think harvesting the cells, getting the scaffold together, and all took a LOT longer. And the bladder is about as simple as you can get. 🙂 (There was a recent paper showing how a group finally managed to get stem cells out of skin cells — there was a serious roadblock in the process. Part of the key to getting past it? Caffeine!)
However, take a look at skin grafts — how the material is grown and how fast they can grow it. That’s about as speedy as it can really get.
But yeah, we’re on the cusp of some serious bioengineering. Give it 20 years or so, and I think what we’ll see is more focus on keeping you limping along as they tease a replacement organ together.
Trauma victims are still kinda in trouble, but any sort of lingering issue? You’ve got time.Report
Sweet!Report
A bladder is just about the simplest organ there is; it’s basically just a bag. If I had to guess, I’d say the heart would be next, since it’s mostly just specialized muscle. Other organs are more complex.
The new big thing in organ engineering is decellularization. Instead of building a scaffold, they take a cadaver organ and strip out all the cells, leaving a natural protein scaffold behind. They then seed it with stem cells and try to guide them to develop as needed to fill in the scaffold. It still requires a cadaver organ, but the requirements are much more lax—you can even use nonhuman organs if they’re more or less the right shape and size—and rejection isn’t an issue because rejection is a reaction to marker proteins on the surface of foreign cells, which have all been stripped out and replaced with the patient’s own cells.Report
I’m disappointed that probably the two most qualified LoOG’ers to comment on this subject haven’t shown up. Where’s Russell and Rose?
We’re not starting from a place of Free Market, Yay! and debating whether regulation is warranted. We’re starting from a place where organ sales are considered to be contrary to medical ethics and our transplant system relies strictly on voluntary donations and a triage/waiting list where your position on the list is (ideally, at least) determined solely by considerations of urgency and likelihood of ultimate outcome.
This is one of those places where what little conservative streak I have kicks in. Before we go all Freedom, Yay! and start setting up kidney auctions, it might be well to ask–and by that I mean ask someone with subject matter expertise–why precisely the medical community generally feels this way on this subject. Is what we’re doing here actually amount to debating how much we should ask or demand that our medical practitioners violate their standards of ethical care?Report
We definitely should not demand that medical practitioners violate their standards of care. If they won’t do it, then we won’t do it. The AMA favors pilot testing. I should note, I am not a fan of the AMA and do not believe that they should be considered to “speak for doctors”… but it’s something.Report
I had the same thought: does anyone know whether surgeons generally will do these surgeries for these reasons?Report
My guess is that if it will save a life, or get someone off a dialysis machine, they won’t refuse to do it on the basis of the kidneys origins. Unless it becomes a contraindication (the kidneys aren’t good). I speak of a controlled process here. If the ban was lifted, they would probably refuse to work with kidneys obtained outside the controlled process.
That the AMA is supporting pilot programs is a positive sign (though not definitive one, as the AMA does not actually speak for doctors).
On the other hand, the National Kidney Foundation is against it, as is Dr. Wife.Report
For anyone interested, Virginia Postrel has a piece that is absolutely loaded with information. It talks about what has been done, what is being done, and what could be done. It also provides a lot of good numbers for how long the waiting list is (80k), how many likely cases there may be not on the list (another 80k), how many more we could optimally get from dead people per year (7k), how many are done a year (16k), how much longer the list gets every year (6k), how many people on the list die each year (4k), how much donors might get paid ($25-50k), and how much each lack of a kidney costs us ($100k).
I still like DavidTC’s idea of reaching out to people for post-mortem donations, but it doesn’t at all look like that would close the gap. It sounds honestly like the cost of payment wouldn’t actually be a problem since it would likely pay for itself.Report
Oh, yeah. Dialysis is expensive and living that way sucks. No dialysis machine or method does the job like a real kidney.
The waste products in your blood make you feel like crap all the time. Literally like you constantly have a low-grade case of the stomach flu. At least that’s what it was like for the wife when she was on it prior to the transplant. We would go out to a restaurant and she would have to excuse herself half-way through the meal to go throw up. She lost a lot of weight during that year or so. FWIW, the best treatment for that was good old weed. She could get through a meal, keep it down, and actually enjoy it. We confided that fact to her doctor and she was like, “Whatever works.”
Yep, I agree with your assessment of this situation. Too bad they can’t get their act together to get things done like this in Washington.Report
Rod,
I am sorry to hear about you and your wife’s troubles. I hope everything is working out for both of you.Report
Well, thanks. But that was 28 years ago. Successful transplant; life lived, including two kids, one of which is in college now. (The other is in 3rd grade; family planning at its finest ;P )
But admittedly my life experiences have heavily colored my opinions on how healthcare should be delivered in this country. What works, what doesn’t, etc. It’s not the kind of thing you necessarily want to be a subject matter expert in.Report
Kidneys are one of those things that I don’t have problems with paying for, if you can convince me that there is very little harm in donating a kidney. And the article is right…having a backup kidney is almost completely useless, as they always fail together. It only helps if someone shoots you in the kidney or something.(1)
So if we can invent some sort of public system to pay people to donate kidneys that was are sure are not going to make the person who donated life’s worse off, and cover expenses in case it does, than I am okay with it.
1) You know, whoever designed a human to have backup part was stupid. Backup hands and backup eyes and even backup testicles, sure, those are on the outside, and can get physically damaged. But the stuff _inside_ fails because the system fails, and hence both of them fail at once! (Well, barring cancer, but for most of human history no one had any ability to remove the defective one.) What would be much saner is to only run one kidney or one lung, and only turn the second one on if the first failed.Report
Not so simple. As far as I understand it, claims that we can live as we did before with just one kidney are overstated. We can live a normal life only in the sense that we so long as we take extra care with our diet, nothing will go wrong. i.e. Usually at least some minor changes to our lifestyle are necessary once we donate kidneys. This is why organ trade is not so simple an issue.Report
Yep.Report
The bottom line for me is that if two adults want to engage in a transaction with no major externalities, it’s not my place or anyone else’s to tell them they can’t. The only situation under which I could see myself endorsing a ban on organ sales is if murdering people to steal their organs became a real problem. And even then I wouldn’t, because that problem could easily be solved by chain-of-custody regulations on organ sales.
However, I would cease to regard opposition to organ sales as fundamentally unworthy of respect if it were shown that it didn’t save QALYs on net.
And of course, this will become a non-issue once a solution that doesn’t involve living donors is found.Report
On the “Popular and Wrong” thread you stated that this wasn’t about “Markets – Yay!” for you and I take you at your word. My primary objection is given the income distribution stats outlined by Patrick here, and my estimation (okay, pure f***ing guess) of what a reasonable asking price would be in my convo with Will T., I don’t believe that opening up organ sales in the manner you seem to prefer would actually have nearly as much effect as you believe. It’s a purely empirical question and I freely admit I could be wrong about how many more organs would enter the “market.”
But if I’m correct in that estimation, it seems to me if you’re truly most concerned with enticing a supply to meet the demand there are better ways to go about it that would be much less prone to possible abuses, albeit at the the expense of public expenditures. I mean… we both want the same thing I believe, but we are just approaching this from different philosophical stances. What’s new?Report
I actually think an even more generalized version of the question would be even more illuminating. To those on either side of this question: what principles or set of considerations is it that leads you to conclude that a market in any given product or service ought to be legal, or outlawed? Just generally, what are the conditions about a commodity, item, product, or service that do or would lead your to decide that it should be made (or kept) illegal?Report
Michael Drew, for me, it’s more the question of “when are you ready to deputize your neighbors, kick down your opponent’s door, and then shoot them until they stop moving?”
For me, it’s somewhere to the right of “where we are now”.Report
This is a point of some kind about the war on drugs, I take it.Report
Sadly, no. I’m not even talking about people using substances that make them feel good.
I’m still back here in “kidney swapping” world.Report
Okey, let me take another wildly unfair, speculative stab, then. (Reminding you that you do actually always retain the option to employ clear, direct communication involving straightforward declarative sentences that not only are, but purport only to be banally directly on the topic at hand and not indirectly related by way of allusions to unstated other matters and concerns)
You have a pinscher-effect thing going on here where you act like you think that the tactics used in the WoD are outrageous, but all the while you also think that the only things we should make illegal are those things we’d be willing to use those tactics to enforce. Is that about the size of it?Report
Sorry, didn’t see this.
Dude. What does “illegal” mean to you if not “we will send police over”? Would you like me to provide a couple of recent examples of police killing people in the line of enforcing trivial misdemeanors? I’ve got ’em.
From here “illegal” seems to mean “police can kill you”.Report
Okay, I hear you. It’s not actually the case that the tactics you mentioned (which are not present in the examples you give) have to be or are used in enforcement of all crimes. We can seek to control what tactics the police use – to enforce particular crimes, and generally. Can you point to a kick-down raid in which people have been killed by police enforcing the kidney trade ban?Report
Ironically, the one I found was not US-related but Canada-related.
So I don’t know if that counts or what.
http://www.citynews.ca/2013/04/30/prosecutor-calls-for-law-to-bar-canadians-from-buying-human-organs-overseas/Report
The raid in that story happened in Kosovo; there’s no mention of anyone dying or being injured in it. It happened at a clinic not a home.
The one death talked about in that story seems to have been caused by someone having an kidney implanted in him that he shouldn’t have. which is a good reason for Canada to make it legal for people to stay in Canada and make use of a tightly-regulated domestic market in human kidneys (though a not a dispositive reason in my view).Report
…to look at making it legal, I meant.Report
So not only do the cops have to have guns drawn, they have to actually use them?
You may not understand my problem with the authorities in this case: authority means that the cops can kill you under color of law. I gave examples of cops killing people under color of law… and the cops not being arrested, reprimanded, or otherwise hindered.
“Illegal” means setting up a situation where the cops can show up with guns drawn and if they kill you, it will be under color of law.
Asking for, specifically, guns being drawn, then used, then the cops not being reprimanded or anything for organ sale-related crimes seems to miss the point that by making organ sale-related crimes illegal, we’re opening the door to the police killing people under color of law.
If that happens, however, I have no problem with assuming that those shot are organ donors.Report
So not only do the cops have to have guns drawn, they have to actually use them?
I don’t know. You’re the one who said the thing above, not me. You remember:
it’s more the question of “when are you ready to deputize your neighbors, kick down your opponent’s door, and then shoot them until they stop moving?”
So if it’s something else, then it’s something else.Report
Yes, it’s the when are you ready part that I seem to be putting the emphasis on.Report
…Anyway, so in any given law enforcement action, the worst-case scenario can go down. For you, that’s the (a) prime consideration in thinking about what to make illegal. I asked; you answered. Thanks.Report
…Well, it’s when are you ready, since it’s you who choose to see law enforcement that way. I can will it be illegal and also will that what I deem reasonable measures be used to enforce the law (which is reasonable since I’m not faced with tons of examples of what you describe happening pursuant to the kidney trade ban that’s actually been in place for years and years).
But I do understand you view better now, thanks.Report
it’s you who choose to see law enforcement that way.
Dude, I gave an example of the police killing someone in the process of dealing with a seatbelt infraction.Report
Shit does happen, no one’s denying that. Especially on roads with two-ton steel machines hurtling around at speeds of 25-85 mph.Report
Though those are recent, sadly they are nothing new.
Motorcycle incident: County of Sacramento v. Lewis (1998). Wiki here. (The skinny: Does not meet the “shock the conscience” standard)
Shooting a guy over a traffic ticket: Thomas v. Durastanti (2010) (Firing of several shots not “objectively unreasonable,” as the vehicle failed to stop with the first shot)
When you give people the power of life & death, and you go out of your way to make damned certain that they will never be held accountable, what do expect would happen?Report
” what principles or set of considerations is it that leads you to conclude that a market in any given product or service ought to be legal, or outlawed?”
If rational adults freely choose to do it, my default posiion is to assume they are doing so because they believe they will benefit from doing so (subject to all the caveats at defining improved conditions). Thus I tend to see no reason to override their personal judgment. I care as little about free markets or liberty as I do about math or science. They are all just problem solving systems. They are primarily instrumental.
“what are the conditions about a commodity, item, product, or service that do or would lead your to decide that it should be made (or kept) illegal?”
When voluntary exchange leads consistently to mistakes or regrets, short or long term. I suspect some drug use and markets may fall in this list. Or when there are significant negative externalities. If selling kidneys led to a total mess like Shazbot fears, I would join all six of him in opposing their sale, or at least reforming the market to work better.Report
I appreciate the forthright response, Rog. Especially the second part – your willingness to lay out when your general inclination would not survive your encounter of its results. And especially especially your volunteering that consistent regret of a certain strain of voluntary choice is salient in this calculation.Report
…Also, I have to say, I essentially concur in what you laid out as the considerations you make as to the question I raised. Basically, we agree, though I’m assuming you took as given that transactions with significant negative externalities were subject as a matter of course, potentially, to being outlawed where the external costs can’t be reliably redirected back to the parties.
(And keeping in mind that the question was as to outlawing commerce in particular things or services. I suspect we would continue to have disagreement about the desirability of the creation by government of artificial incentives around various markets/transactions within the context of legal frameworks allowing them – pursuant to the inclination about that that we share – with the aim of achieving some public purpose through the operation of the resulting altered market.)Report
I would want to intervene in the market for organs if it were found that
(a) Organ transplants have been a giant fraud all along, conferring no health benefits at all.
(b) I learned that it’s morally better to let people die rather than allowing them to engage in commerce.Report
Well, you have to understand that since only rich people would be able to afford kidneys, we’re only letting rich people die rather than allowing them to engage in commerce. They probably own stock in corporations, so they’re not really even people.Report
I disagree. Rich people can afford to (and probably do) fly to third world countries where they can buy an organ (with a much higher likelihood that it wasn’t acquired ethically) and have it transplanted in a state of the art medical resort. It’s the middle class and the poor in first world countries that truly get screwed by the ban.Report
I was just making fun, of course.Report
What about a situation in which both your conditions are met and people opt to sell their organs – even to the point of suicide – to engage in commerce as a matter of common practice? Would you then rethink whether meeting those two conditions are sufficient for permitting it? If not, why not?Report
So we’re talking about organ selling being legalized and people not only selling their spare organs but that they ccould get such enormous prices for them that they would willingly kill themselves by selling vital organs and… pass the money on to their kids or something?Report
Is the only objection to permitting organ sales a bias against individuals engage in commerce?Report
So far, running down the thread, and the previous ones, there’s been a couple objections as I read it.
-That legalizing organ selling would lead to the poor becoming organ donors for the rich.
>The numbers don’t support this objection. All indications are that a market for organs would eliminate or massively ameliorate organ scarcity. So while the rich likely wouldn’t sell their organs they would get organs as would middle class and poor people. Middle class and poor people would also then get a not inconsequential chunk of money. I’d also note that the existing status qos is already a poor to rich organ transfer. The rich can jump the line right now by getting organs abroad in more shady third world countries where the organs quite possibly have been stolen or immorally acquired.
-That legalizing organ selling would lead to people being coerced into selling their organs.
>The agreement was that any organ market would have to be very strictly regulated; no stolen organs, no organs donated out of the most sheer privation and no organs being considered claimable assets in any form of collection system. The existing organ system right now is very strict, it’s hard to inject organs of hazy origin into it. There’s no reason to weaken that “chain of organ title” so to speak in a legalized setting. If organs can’t be easily injected now (when their cash value is likely many times higher than it would be if the organ market was legalized) then it’d be highly unlikely that they’d have mass penetration of a legal organ market system (where their cash value would be much lower).
-That legalizing organ sales would commodify an essentially sacred part of the human state of being: parts of people would become salable and marketable.
>This strikes me as dressed up ick factor and also internally inconsistent. The human body has been commodified for millennia. body parts of religious figures and celebrities are bought and sold. People sell their hair, their blood. Models and actors sell their bodies and their looks.Report
Not just that, but they can also sign on to registries in multiple locations at once. Steve Jobs can afford to be on registries across the country, and when one becomes available in Memphis, he’s on the first plane. This is harder for most people who don’t have private jets. (Virginia Postrel talks about this in her piece that I linked to elsewhere. Postrel I should add, a pretty staunch libertarian, advocates a regulated system.)Report
Are kidneys really stolen in third world countries or is that just an urban legend? Anybody know?Report
I honestly don’t know, but I am pretty sure it’s something that could be prevented here. Postrel mentions a case of an American going abroad for a kidney and there was a paid donor there (India, I think). The recipient guesses the donor was paid about $30k.Report
I’ve read an article somewhere about retinas being stolen. I’m off to google.Report
Hair, blood, bodies and looks are all poor analogies for an internal organ.
I think the only aspect of potential regulation i haven’t seen addressed is the issue of compatibility. By that i mean at this time docs test to see how good a match a person is for a particular kidney to determine who will get it. I wouldn’t want someone to be able to say here is 5o grand over going market price to get Kidney A even though they are a poor match. That could lead to people with money and who are desperate taking a kidney that isn’t likely to work for them and that could work much better for someone else. I have no idea how likely that would be and would also be dependent rejection rates and how well they can match donors with recipients.Report
The Postrel link talks about how much care they put into compatibility. No American doctor would even try a kidney that wasn’t a match.Report
The thing is, Greg, that our existing system already has grappled with and handled these kinds of logistical concerns. What is on proposal is not some kind of butchers market with blood spattered vendors hawking ice packed organs. What we’re talking about is something very similar to the exiting system. The organs origins and characteristics are extremely heavily vetted. Mysterious organs of unknown providence don’t just appear in the system now; they wouldn’t in a market system either. Matches are calculated carefully now; they would be in the future too. The only change would be that you’d be allowed to take monetary compensation for the exchanged organ. Considering the titanic cost of non-organ alternatives in medicine the amount of money that could be offered would be significant even to middle class donors. The math strongly suggests that as a result we’d go from having a waiting list to get organs to having a waiting list to donate organs. There appears to be genuine potential, by my reading, for a change in this policy to produce a post scarcity situation in transplants and that would be an incredible advancement on the collective well being, poor and rich alike, of the people in this country.Report
North- For one thing “Mysterious Organs of Unknown Providence” sounds like a great band name.
Second. Yeah after reading through most of the pro side i can see how if regulated well it could work out well. Hell even the libertarians are saying it would need some regulation. When the topic first came up i think there were a lot of potential problems to hash out and mostly they have been. A poorly regulated system would be nearing Soylent Green or Clonus: The Parts Horror levels of badness and scenery chewing acting.Report
I’m 110% with you on an unregulated market Greg, potentially nightmarish would be an understatement. FWIW reading the discussion on these threads drove home for me that regulation would need to be quite strict.Report
You make a good summary of the objections.
However I think you are glossing over too quickly the sacred aspect, by dismissing it as merely preference.
I think sacredness and taboo are perfectly valid reasoning- stipulated they can and often have been abused and lead to unjust outcomes even still, they are important and need to be recognized and accepted as a reality, even for those who don’t share them.
At base, all value systems- like libertarianism- are founded on some sort of sacred notion, that must be upheld even if we can show they lead to a suboptimal utility.Report
It’s probably no surprise to anyone that I disagree. The idea that my kidney is sacred to you or to anyone else who’s not me is such a puzzling idea that I can’t begin to really parse it. It’s extra razzleberry special if you are an abortion rights supporters who doesn’t agree that a fetus is sacred (I don’t know your position there). But if you don’t think the kidney is too sacred to donate for free, I don’t understand how you could think it was too sacred to donate for compensation.Report
At the risk of inflaming an already touchy topic, abortion is relevant here.
Namely, that it illustrates how resistant to simple logic the subject of humanity and the sacredness of the human body is.
I believe (entirely as intuitive faith) that personhood begins at some undefined place during the second trimester.
Which is every bit as bizarre as it sounds; like, yesterday it was a mass of cells, today it is a human?
Yet of course we know it has to be that way, somewhere- unless you take the maximalist approach of personhood at the precise moment of conception, you will end up drawing a line somewhere arbitrarily. And no, sorry, medical science isn’t much help in deciding when personhood begins. Or ends, for that matter.
We- libertarians and everyone else- assert that there is something sacred and valued in human life and liberty- presumably your life and liberty are supposed to be sacred to me, yet your body itself is not?
If your kidney was forcibly removed from you, should I regard it as merely a property theft? Or is there something intrinsic to the violation of your body that we should find alarming and objectionable?Report
This is one advantage of a market in kidneys; it helps us place the crime of stealing one accurately on the scale from petty theft to grand larceny.Report
Of course, it doesn’t, any more than legalizing prostitution would transmute rape to theft.Report
Since I’m very strongly pro-choice, LWA, I don’t have quite the same conflict as you do between this subject and that one. The problem with sacredness/taboo is that you can’t easily set policy by it unless it’s a universally held consensus.
I can respect an individuals squeamishness but I just don’t accept that it gets much of a seat at the table for setting mass policy. This may be simply because I come from a background where a lot of things that are of significant impact to my minority spent decades being squashed by policies that were at their foundation based on notions of taboo and sacredness.Report
Does anyone else read a comment on here, write for half an hour furiously, read what they wrote and hit ctrl a/delete/cancel reply as they think to themselves it just isn’t worth hitting send, or probably prudent either?Report
Nope, it’s…Just You (rimshot).
Just kidding!
My time has been so short lately that I have done that several times, because I knew that I wouldn’t have time to respond to the inevitable replies, and it didn’t seem right to start a discussion, or seriously attempt to participate in one, and then have to bail.Report
Yeah me too. Some really good topics have come up but I am always on my way out the door lately.Report
Believe it or not, yeah.Report
Yeah, sometimes I try three or four variants of a comment and then decide it just won’t work.Report
So. Folks who get the death penalty.
Should they be allowed to be organ donors (for the parts that aren’t messed up by the process, that is… probably corneas)?Report
I’m no doctor but I would presume getting pumped full of lethal chemicals or electrically cooked precludes even using corneas.
Setting the medical questions aside assuming that the relatively small number of people involved were executed in a manner that didn’t render their organs unusable I don’t see why they wouldn’t be allowed to be organ donors.
I would note, however, that sci-fi and television has taught us that there’re serious long term side effects from getting transplants from convicted mass murderers and people killed by the justice system. Some people may find their spouses new hand trying to strangle them or their child’s new cornea guiding them to poison their breakfast. Politicians and district attorneys should also beware, their own donated kidney might contact a prisoners rights group with new DNA evidence that proves that they executed an innocent man and are carrying his organ inside their bodies. *cue twilight zone music*Report
Easy solution: execution by organ removal. Put the prisoner under, remove his organs, and close him up. It’s about as humane a method of execution as possible.
That said, even though I’m generally in favor of the death penalty, giving the government a real incentive to kill people makes me very wary of allowing death row inmates to donate organs.Report
I can’t imagine a surgeon willing to participate in such a thing.
I mean, there are always Kermit Gosnells out there, I guess… but, seriously, I can’t imagine a surgeon willing to do such a thing.Report
History demonstrates otherwise.Report
“Is it safe?”Report
“It’s so safe you wouldn’t believe it.”Report
I can’t imagine a surgeon willing to participate in such a thing.
I suspect that this is just a limitation of your imagination. There are doctors willing to perform euthanasia, are there not? Granted, that’s voluntary, but the patients aren’t murderers, either. Support for the death penalty is quite high, and even if most people who support it wouldn’t be willing to participate in it, I’m pretty confident that there are enough surgeons who would do it to meet demand, especially when it saves more lives than it ends.Report
Larry Niven wrote some stories about this. People were getting the death penalty for jaywalking.Report
One if the reasons I would oppose live donations from prisoners for sentence reduction is that I fear penalties would increase to take the option/reduction into account.Report
Last word on the surrogacy analogy.
I am against the legalization of a market for surrogacy as is in place in many countries.
Thankfully, the surrogacy market has yet to become exploitative or common.
The reason, I would not institute a surrogacy lottery (where you are forced to give birth for someone or pay a tax) is that there is no need to do so to save lives. 1. There is adoption and a huge need for international adoption. There are lots of babies for loacl parents. 2. If you don’t have a baby, you don’t die. If you don’t have a kidney, you do die. Thus, there is no need to create a system where people save lives by being surrogates.
If there were a need for aurrogacy to save lives, I would be more in favor of an escapable surrogacy lottery than a system where people said to poor young girls from impoverished families “have my baby (and sleep with me) (and then give me your kidney) or your fired”
Thankfully, there is no need for aurrogacy to save lives, though.Report
Finally, here is my last compromise position on organ donation.
Compensation for donation is a good thing and will increase donation thereby saving lives. (And my lottery ain’t happenin, so that’s moot.) But a market could result in exploitation. Ater all, kidney donation is a moral act (like military service, jury duty, blood donation, etc.) and should be rewarded.
The solution is to offer compensation in a way that is very unlike a market.
We do compensate soldiers for their service. However, it is not clear that there is a market for soldiers. We reward people with medals and honors for acts of heroism and great scientific achievements (Nobels), but it is not clear that there is a market for being a Nobel or a hero.
I propose that the government offer a reward for kidney donation of, say, 500,000, plus expenses. To be considered for this award and to donate, you must make more than 3 times the federal poverty wage (to prevent exploitation of the poor), you must have no outstanding debts past such and such ability to pay them off, you just pass comprehensive psych testing over a set time period, you must be employed at your current job for at least 6 months, and you must not have children between 0 and 10 years old.
The government will distribute all kidneys to those most in need, regardless of insurance. There will be no contracting of individual sellers and buyers of kidneys, to prevent exploitation. There will be a choice to ask to be a donor or not, no negotiating, and no contact between donors and those donated to.
It may be objected that the poor and the indebted are being unfairly excluded, but they are being excluded to prevent the worst off amongst the poor from being exploited. If you want, you can write in exemptions.
(Also, I propose that the government offer a tax incentive for signing organ donation cards, which would solve the problem.)
I would create a similar system for surrogacy and would ban and impose severe criminal penalties for any other kind of organ donation where the donor needs to die to donate.Report
Well, this puts us back on the same planet at least. Unfortunately, if this is your last compromise, we still can’t quite meet in the middle. $500,000 is excessive. I’d prefer the price tag be set at what is required to get the necessary number of non-desperate donors. I think $50,000 would be reasonable. Or in that ballpark.
I do think excluding the poor would be doing them a disservice, though I am down with trying to exclude those who are doing so out of financial desperation. Twenty-five year old Trumwill would not want to be ineligible, and I’m not sure he should be. Or maybe his college degree should have been a sufficient sign of non-desperation? Some combination of income and education? Not sure, but there could be room to negotiate here.
But as your final offer, I’d have to reject it, I think.Report
I should add that Postrel also advocates that compensated donations not be able to be directed. I’m actually not sure this is wise. I think two different dollar amounts, one for a directed donation and another for a non-directed donation, might be in order. If we can get more donors through directed donations, then we can free up a lot of cadaver kidneys for other folks, which would be a win.
So, if I was writing the policy, it would be one number for directed donations*, a higher number for non-directed donations, and the numbers would be calculated on what it would take to get enough donors to plug in the gaps. I’m willing to agree that regardless of what that number is, it should be above a certain amount and/or should include certain health care provisions.
(Also, in an effort to encourage employed – and therefore non-desperate – donors to contribute, disallowing employer sanctions against donors – as we do with National Guard and Jury Duty, or at least try to do – would be something to look into. Unpaid time off, but a job when they return.)
* – One might say that a paid donor shouldn’t be considered a donor and his donation shouldn’t be considered a donation, but I’m going with it because it’s the same terminology we use for sperm donors, who are compensated.Report
Shazbot, I’ll move the discussion down here if you don’t mind.
Okay I definitely see I missed an element in your proposal. I’d note as a legal matter that this proposal now strikes me as massively unconstitutional. I’m not a lawyer myself but I find it hard to believe any court would uphold a law that targeted people and their families for forcible organ removal based on income bracket.
Your reasoning here also doesn’t make sense to me. The wealthy are supposed to bid against each other for the privilege of not being in this lottery pool, so the amount then would scale up having no upper limit? I’d note also that you’re proposing to levy this lottery on a significant numerical minority of people to provide organs for everyone else. Mathematically this would be an astonishing burden, I’d assume that the wealthy would swiftly exit the country to escape such a nightmarish policy if it ever one were so proposed.
The lottery again is a head scratcher. We’re proposing here that people compete to get into this program like a reality show (though I gather televising is optional) and that the cost over overpaying for organs by a factor of around 20 is just shrugged at and taxed away? It sounds like a massively inefficient and wasteful program all designed to make sure that people who sell their kidneys are really super sure they want to?
Morally I agree; the wealthy would not hurt their health to avoid having their organs forcibly confiscated. I’d assume they’d flee, as would anyone who’d approach those income brackets. As such the program would not promote bad health; just the flight of the country’s wealthy and an enormous motivation to hide one’s wealth and temper one’s success. I’d note also that whether they fled or paid the fine it’s a safe assumption that the organ donation rate would be quite low so your lottery has the distinction of not only being logistically impossible but also not actually addressing the problem of waiting lists. An impressive feat.
My intuitions and worries about the dystopia of a kidney lottery cannot mutatidis mutandis, be applied to allowing people to sell their organs. The reason is that the changes that you make are massive in that you’re switching from a consensual system to a non-consensual system. In a strictly regulated organ market the potential donors would be voluntarily, and likely eagerly, coming forward. Medical information for finding matches and determining the health of donors would be gathered at the prompting of and with the voluntary participation of the individual prospective donors. Under your system all of this matching work would have to enforced on the selected disfavored group of people by some form of enforcement and monitoring arm of the government. I’d note also that I suspect you’d have a significant difficulty in finding medical professionals who would participate in the forcible confiscation of organs from unwilling donors. I’m not a doctor or medically trained myself but it seems to me that the policy violates multiple doctors standards for medical care and their oaths on multiple levels. This policy is not merely different; it’s quite literally the opposite of a voluntary organ donor market where people can be compensated for their organs. I invite you to elaborate specifically on how you would propose to deal with these functional, logistical and medical problems or else concede that your policy is non-functional as a practical and organizational matter.
I’d also like to reiterate that, at around 50k for a kidney and scaling up from there, you seem to be entirely ignoring the mathematical probability that the majority of donated organs would be coming from the middle class, not the poor. Especially, as all the proponents of an organ market in the threads have agreed, if the market was strictly regulated and specifically screened against desperate poor people trying to sell their organs.
I don’t understand your analogy about Hanley and the libertarians. It seems to me they do have a point. Under your system the rich are either forced to sell their organs (and I’d note that you’ve ignored the point that under your system they’d presumably be massively underpaid for their organs) or else they opt out and the system has no organs to distribute. Either way it fails at it’s intended purpose of ameliorating the waiting list for donor organs by the needy.
I’m also not getting the connections you’re making with coercion for employment. Women are not allowed to be extorted for sex in exchange for being employed. A person who does that in our country is liable to be sued (and to rightfully loose) and also would be terminated by their own employers or see their business fail in a wave of public outrage. I see no potential universe where a person would be able to use threat of termination as a cudgel to force their employees to donate organs. Firstly in that it would be illegal (we are nor Iran) secondly in that the same logistical and medical barriers that would make your lottery proposal unworkable would block an employer from identifying employees who would be a match for their needs. I’d also point out that there is absolutely nothing in our current system that blocked your nightmare scenarios from occurring; the coerced organ donor simply wouldn’t be paid. Since this is not, AFAIK, a common or even present phenomena today I see no reason to think it would arise in a nearly identical system where people were allowed to be compensated for their organs.
The reason we ban certain kinds of sales (sex trade, organ trade) is because we have a visceral ick reaction to the idea of it and a series of moral and religious knee jerk reactions against it. These are primarily driven by ennui and a disinclination to re-examine the facts and trade offs rationally. The paper you’ve cited, for instance, is extremely light on any facts and is based almost entirely on anecdotal info from Iran. You’ll forgive my cultural imperialism but we’re not Iran.
Will Truman has cited this http://www.theatlantic.com/magazine/archive/2009/07/with-functioning-kidneys-for-all/307587/ piece which has a detailed examination of the particulars involved. I find it quite persuasive myself, I’m puzzled why you seem so certain that if we allowed compensation for donors that suddenly we’d be thrust into a situation where the desperate poor are providing organs for everyone else. It’s an unusual leap for you to make and your, forgive me, almost flailing alternatives seem more designed to hurtle venom at the wealthy than address the actual problem at hand.Report
Especially, as all the proponents of an organ market in the threads have agreed, if the market was strictly regulated and specifically screened against desperate poor people trying to sell their organs.
For the record, I’m not signing off on this. I mean, if that’s what was needed to reach a compromise, I’d be willing to go along with it, but I certainly wouldn’t screen out the poor if it were solely my own decision.
Certainly we should screen for organ quality, and people with impaired cognitive ability, both of which would likely disproportionately filter out the poor. But the idea that we should specifically discriminate against those who would most benefit from the money is nuts, and exactly the sort of thing I was talking about in this comment.Report