The National Kidney Foundation opposes compensation on the grounds that it would "cheapen the gift"--that it may be an "affront" to those who have already donated. ("The argument that paying organ donors is 'an affront' to unpaid donors is disgusting," Virginia Postrel, who donated a kidney to her acquaintance Sally Satel, wrote on her website. "Are unpaid donors giving organs to save lives or just to make themselves feel morally superior?")
Having volunteered for Habitat Humanity several times in college, I am personally offended by the existence of Toll Brothers. Also, I've worked in a soup kitchen, so I'm suing Friendly's for defamation. As for hotels, as the former employee of an organization that provides homeless shelters, I can only say: have you no shame, sirs? At long last, have you no shame?
Surely the reason one would oppose compensation for donation is because it creates a market where one should not exist and creates a circumstance where wealth rather than medical need is a determining factor?
At the end of the day, even if kidneys were selling for $100K each, the price would be only a fraction of the total cost of the kidney transplant surgery. So I don't think that is the answer -- right now, you've either got insurance (which should cover the cost of the kidney donor payment) or you don't, in which case you're not going to be having kidney transplant surgery anyway.
Actually, I believe that the cost of a kidney transplant is currently on the order of $100,000, so that would roughly double it. I guess 1/1 is a fraction, but that's probably not what you meant.
RE's argument is still invalid because:
1. Wealth is already a factor. Case in point: Steve Jobs.
2. There really aren't that many rich people who need kidneys, because:
A. There aren't very many rich people, period.
B. Kidney failure is usually a complication of diabetes, so I'm pretty sure it skews lower-class.
3. Insurance would cover the donor fee, so anyone with insurance could afford a kidney transplant. Yeah, some people don't have insurance, but they're not getting kidney transplants anyway because they can't afford the procedure, either.
4. Why shouldn't wealth be a factor? I'm getting pretty tired of leftists who, having failed to win public support for radical wealth redistribution, are now trying to render the entire concept of wealth meaningless through an endless list of things they think rich people shouldn't be able to buy. By and large, rich people* are rich because they've contributed a lot more to society than they've taken back. If they want to call in those favors in the form of kidneys to save or dramatically improve the quality of their lives, more power to them.
* Preemptive note to leftists: Don't say "You mean rich people like Bernie Madoff and/or Paris Hilton?" Really. Don't. It's embarassing for all of us. We all know that they aren't representative of the rich in general.
Brandon Berg,
I think MDF's point was to say that if you can afford the surgery (because you have insurance [or enough money to pay for expensive surgeries out of pocket]), you can also afford a kidney. But this isn't really necessary, since as John Thacker et al have pointed out, dialysis is an entitlement so the gov't could use the money saved on dialysis to compensate kidney donors. In other words, we could have a new federal entitlement (free kidneys for everybody!) for free (or cheaper) -- yes, our current system is so screwed up that we really can have our cake and eat it too.
I'd give a variation of your #4. If we want to help the poor, the best thing to do is give them money, not create an artificial shortage of kidneys (and in doing so prevent them from getting money). So it's kind of irrelevant whether someone thinks we redistribute too much or too little -- either way, the current law is dumb.
Huh? By that argument it's immoral for the doctors and transplant centers to charge for performing the surgery, which costs far more than what paying for the organ would. Paying for the kidney would be far, far cheaper than paying for dialysis treatments as well, as those are incredibly expensive (and time-consuming for the sufferer.)
Why does it "create[] a market where one should not exist?"
Let's quantify it. For those who oppose compensation, how many people are you willing to let die for that repugnance?
If there were a legal market for body parts, I guarantee that not one scrap of our bodies would go to waste. Even if the flood of new body parts drove the value of a fresh kidney to $500. All the agonizing over whether George "would have wanted this" would end.
Locking up the legal market for kidneys, hearts, lungs, livers, etc is CRUEL, since it ensures that people will remain on waiting lists for years...even until the die for lack of medical aid.
It is this sort of thing that hurts the entrepreneur -- the hardworking fellow who, with nothing more than a knife, a bathtub full of ice, and a spiked drink, provides for his family while satisfying a legitimate societal need.
Um...there's nothing to prevent this sort of blackmarket now.
The only thing that the current laws prevents is some poor family getting paid by an insurance company for their loved-one's kidney.
The current law benefits only insurance companies who don't have to pay for operations that never occur because of a lack of organ donors and don't have to pay for the organ when the operation is performed.
i do not understand your second point - i do not think anyone is arguing in favor of creating a market for organs in which those on the receiving end are paying for their organ.
that was meant for RE
Sure. Perhaps I'm unclear as to what exactly is being argued for. How would you see a system of compensation operating?
Yes, exactly. And the moral case for organ sales is as poor as the economic one. Please excuse the long quote. The Director of the center of Bioethics at Megan's alma mater says,
Even more important than a patent lack of enthusiasm for markets among those who wouldbe expected to serve them, major religions and cultural views in the developed world will notcountenance a market in living body parts (20–22). Various popes, for example, have made quiteclear the Catholic Church’s aversion to markets in organs. Anglo-American law, ever since thedays in which markets in body parts resulted in graveyards being stripped to supply medicalschools with teaching materials, has not recognized any property interest in the human body andits organs (22). Alienating religions and cultures, which do not view the body as property, wouldhave a devastating impact on the supply of organs available. Indeed, some sub-populations in theUnited States, particularly AfricanAmericans, are as likely to be turned off by the institution of amarket in body parts because of their historical experiences with slavery and a keen distrust ofmedicine, as they are to be motivated to become sellers to the rich (23–26).The argument that increasing the supply of organs through sales will be efficient and cost-effective is not persuasive. It will take real and expensive resources to try to regulate and police a market in organs. Since markets, even regulated ones, would shift the supply of organs toward those who can afford to buy them, those who cannot might well withdraw from participation in the deceased donor organ system, thereby putting in peril any overall increase in the pool of organs available to transplant.
That was also meant to reply to RE.
Those ethics arguments are a bit disingenuous, because the exact same arguments could be made against organ transplants generally. Yet we don't let that get in our way. If people don't want to participate, they don't have to.
But we don't use this donation approach to any other part of medicine. Regarding the initial quote from the National Kidney Foundation, there are doctors who work for organizations like Doctors Without Borders who are making quite a sacrifice; does that make $500K+ a year surgeons disrespectful? With regard to the quote above, we have allocated real and expensive resources to regulate the medical industry; wouldn't this be an extension of what we already do? I'm not saying all this clearly points to having an organ market, but we do need to question whether or not the feeling of aversion to the idea is overtaking the potential good that could come out of it. People on donation waiting lists agonize over the potential that they may or may not get what they need. All the nightmare situations mentioned in the above quote seem to conveniently leave out the number of people who will die using our current donation approach.
Um, lots of slaves escaped to northern USA with the intent of selling their labour to the rich. There's a massive moral difference between being a slave and selling things for money.
And judging by birth rates in countries like Italy, the Catholic Church has a rather limited ability to affect the actual behaviour of its members.
As others have said, paying for organs would presumably be included in the cost of the operation, which is normally covered by insurance, and is offset by the savings in spending on dialysis.
Ah, so you're saying that the moral case is very strong, since it will save lots of lives. Since after all the economic case is very, very strong. Paying for kidney donations would save everyone, including the insurance companies, the government, and the sufferers, money, since paying $10k for a kidney plus the (much greater) cost of surgery is still less than the cost of dialysis. From Virginia Postrel's article:
Eliminating the waiting list would thus save taxpayers $8 billion, or $4 billion if each living donor received a lump-sum payment of $50,000.
That purely financial estimate ignores the enormous benefits for the patients’ quality of life, of course. It also excludes the economic gains from returning to productive work—only about 10 percent of dialysis patients are employed even part-time—and the fiscal effects of paying taxes rather than receiving disability payments.
So Susan, how many people must you kill and how much more expensive must you make it for sufferers of kidney disease (and everybody else)?
Opposing organ sales is absolutely immoral in my opinion. The case for banning organ sales is as morally bankrupt as it is economically wasteful and expensive.
Ummm...don't hospitals buy plasma? Don't the rent whole bodies for medical testing?
Be careful what you wish for. Does extrinsic motivation always trump intrinsic? It's very common in many areas of life from relationships to work that once you change the rules of the game and reward behavior with money, the money becomes the focus and the reason for the behavior.
I am worried a market for organs would forever (or at least for a generation or two) alter the motivating factors for organ donations. People might scoff at the price if they feel it is too low, indeed I expect this to be the case.
In the labor market there is a plethora of research that once you pay someone for behavior, the payment not only becomes expected, but it's quickly seen as not enough. Don't believe me? What % of people feel they should be paid more for their job?
So you're suggesting that if we stopped paying employees, they would feel less discontent about their jobs?
I believe the point is that a larger percentage of young women will sleep with their boyfriends for free than are willing to sleep with a man for money. And if their boyfriend started paying them, they would throw his money in his face and walk out.
But this is an empirical question. Sex gets more people without payment, most jobs get more people if they do pay. You probably can't tell which is which until you try.
It's not an either/or thing, the operative connector is "and." The equation isn't "is X > Y", it's "is X+Y > X".
The equation isn't "is X > Y", it's "is X+Y > X".
Only if you can separate the X people and the Y people without the X people knowing what is going on.
The equation is "is X(y)+Y > X(not y)".
Because otherwise you have to identify those people who would donate for free, but are insulted by an offer of money, and then somehow not offer them money when you are offering it to everyone else.
So we are back to it being an empirical question: Just how many people have a weird hangup about accepting money for body parts, and are those people the sort who would donate otherwise?
If you believe this, then presumably you oppose paying medical staff for their work.
So how do you suppose things would things work out if an extra $10k contribution from me got my hernia operation bumped ahead of a guy needing a triple bypass or a woman with a severely inflamed ovarian cyst?
Are you suggesting that this doesn't happen currently? That ability to pay, and ability to fly anywhere in the country (or the world) or to see the best doctors doesn't help people (like Steve Jobs) currently?
But in any case, that's a strawman argument. Does, e.g., Virginia Postrel's article suggest that patients should pay donors directly? It's not necessary, because every donation saves the government $100K in dialysis payments from Medicare. The government could directly pay donors $50K and still save a tremendous amount of money. The recipients don't have to pay a thing for it to be worth it.
It will always happen to some extent because the rich will always have access to greater opportunities and resources. However, at present such a process is not institutionalized in the US healthcare system and access remains at least somewhat egalitarian. Also, let's not confuse a reasonable compensation system operated within the existing framework, with an outright open market. Both are possibilities, they are not the same thing, and they might produce different results.
At any rate, you missed the point of why I brought up that example. TracyW chose to make the fallacious comparison of suggesting that permanently giving up a major organ of one's body for non-corrective reasons was equal in all respects to being paid for ordinary labor, and a great many people will say it is not. I was countering that with an analogy that I feel is more germane.
Really? Judging from the number of celebrities and the wealthy who "just happen" to get kidney and liver donations, jumping the list, I really doubt that it's not institutionalized.
Too bad then that the National Kidney Foundation confuses the two. They oppose *all* compensation for donors as an "affront" that "cheapens the gift."
Certainly. Your choice of career has a far greater long term effect on your life than giving one kidney, though. And the time you spend performing labor instead of doing something else you'd want to do isn't something you can get back either.
Really? Judging from the number of celebrities and the wealthy who "just happen" to get kidney and liver donations, jumping the list, I really doubt that it's not institutionalized.
Well, not formally, and there is still a queue list that benefits a lot of people who are not the rich and well-connected, so I refuse your anecdotal evidence.
Certainly. Your choice of career has a far greater long term effect on your life than giving one kidney, though. And the time you spend performing labor instead of doing something else you'd want to do isn't something you can get back either.
So life has choices and consequences, you say -- a valid, but mundane and exceedingly general, observation.
But one that applies to kidney donation as well. The consequences of career choice are larger than donating a kidney or blood. Surely that's relevant.
The consequences of my preferred toilet paper choice may also have a longer lifetime impact than a kidney donation, but I think if I made that argument as a favorable claim for an unrestricted organ market, a person with better sense might well point out that I am comparing two very different fields of argument impinging upon vastly different healthcare, ethical, and social concerns.
Yes, certainly. Toilet paper has little bearing on that. Kidney compensation saves money, reduces pain and suffering, increases human dignity, and saves and prolongs lives, as I've pointed out. There are certainly very large healthcare, ethical, and social concerns with banning them.
Sheesh, are you guys denying there is such a thing as intrinsic motivation and that at times it is better than extrinsic motivation? Comparisons to removing all pay for labor is ridiculous and I never suggested it.
I'm saying it's irrelevant in this case. Under any vaguely reasonable assumptions, the number of donations that don't happen because of reduced "intrinsic motivation" would be dwarfed by the increased number of paid donors.
A market in organs would also create a pretty hefty opportunity cost for someone who was willing to give his kidney to an acquaintance also, wouldn't it?
You could still donate for free if you wanted. I think the benefit would be to increase the possible supply. Right now you are limited to dead organ donors and compatible family members. There was a transplant surgeon who was actually against living donor transplants from family members. He argued that you really can't have informed consent when impending death of a loved one has such a coercive impact on the decision process.
Susan:
I'm curious how broadly you would apply the principle of your quote, which basically seems to say that we ought not to arrange our medical system in ways that offend too many world religions. A great many patients at abortion clinics and fertility clinics might also like to know. (And we can leave aside, for the moment, those hoping for new treatments from stem cells. And those hoping for effective treatments for STDs like HIV/AIDS and herpes.)
That's not what it says. What is says is that if you reorganize a presently-functional subset of the medical system in a way that offends too many religions, you could get fewer participants than you have now, with the net result that only the rich and well-connected are able to participate and society overall is worse off because fewer organs are available.
I'm surprised Megan isn't making or at least exploring this connection before making flat assertions that Change Is Needed And It Looks Like This, given how many healthcare related posts she has dedicated to the idea that Obama's good intenioned rush to do something in the broader healthcare market may lead to worse outcomes than the admittedly imperfect status quo.
Virginia Postrel's article already has discussions of research. This assertion just isn't true. The exact reverse is true. The existing ban on organ sells overwhelmingly favors the rich and well-connected.
Okay, Megan, so you don't view the internal components of the human body as bioethically difference from the external components, which may already be freely used in service and industry. However, could you and would you acknowledge at least this much:
1) Unlike e.g. a kidney, it is not the usual thing for a person giving the capabilities of their body to a service or industry to permanently forfeit a member in exchange, placing this, and that, in different categories of study?
2) A very large number of people who are not Megan McArdle do see a distinction between the organs of the human body and all external contributions a body may give, and are uncomfortable enough with the idea of market organ sales that they may completely throw the dynamics of the market once it is established? (I.e., "cheapening the gift" may be a real problem with real consequences.)
3) Unlike yourself, Virginia Postrel does have first-hand experience with the procedure in question? I mean, hey, it's great that you've done your share of good works, and no doubt many people benefited by them. However, that record of achievements doesn't really differentiate you from a great many of your commenters, and moreover, there may be a small difference in scale between donating a few hours of your life to a cause, and putting your whole life literally under a knife in order to save the quantity and/or quality of someone else's.
I didn't say that there were no good arguments against paying organ donors; I said that this particular argument is stupid. It's not noticeably true that charity and markets cannot exist alongside each other.
Fair enough, and I should have specified that while Postrel isn't opposed to compensation generally (nor am I, if it is designed to assist with the reasonable discomfort, loss of income and/or leisure time associated with making such a donation), I'm not convinced the market approach you have previously advocated is going to lead to a better outcome than what we presently have.
You also, um, forgot to link to what the National Kidney Foundations real agument was -
http://www.kidney.org/news/newsroom/positionpaper03.cfm
Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save. Providing any form of compensation for organs may be an affront to the thousands of donor families and living donors who have already made an altruistic gift of life and it could alienate Americans who are prepared to donate life-saving organs out of humanitarian concern. In addition, it disregards families who are unable to donate organs but do consent to tissue donation.
Offering money for organs can be viewed as an attempt to coerce economically disadvantaged Americans to participate in organ donation. Furthermore, since the economically disadvantaged have been shown to be less likely to be organ transplant candidates, financial incentives for organ donation could be characterized as exploitation.
there's much more there that I didn't paste, but I guess that going to the source isn't what journalists do.
Precisely because the economically disadvantaged are less likely to receive organs under the current shortage than someone like Steve Jobs who can register everywhere, the economically disadvantage patient with kidney disease who benefit even more from a greater supply.
The NKF is willing to waste a lot of money and have a lot of people live shorter, poorer lives, and calls it dignity.
If you want to go through their paper & disagree with it, fine.
What Megan did was post a critique based on 4 words without any sign she read the actual paper. That's not so fine.
What Megan did was criticize one particular argument in the paper for being stupid, yes. And now you're criticizing her for addressing only that one stupid argument, ignoring the better arguments in the better.
But Megan has addressed the other issues before, and she's linked to articles (such as those by Virginia Postrel) that address the other arguments. Not every single post on a blog can address all arguments.
In any case, tu quoque. Aren't you just criticizing Megan on the basis of one comment of hers without responding to or acknowledging her entire body of work on the subject? I certainly think you are being hypocritical.
What Downpuppy did was post a critique based on one post without any sign that it is familiar with Megan's other posts on the topic. That's not so fine.
Offering money for organs can be viewed as an attempt to coerce economically disadvantaged Americans to participate in organ donation.
Replace "organ donation" with any other noun and the argument is just as (in)valid. According to many on the left, not having a draft "coerces" the poor into the military because they don't have better options.
aMouseforallSeasons, I don't understand the relevance of this point since Virginia Postrel agrees with Megan, not you.
They maybe excessively euphemistic in making the argument but it's far from bizarre, unlike what I guess are supposed to pass for your counter-arguments.
If they were blunt, the statement would be that if we’re paying people to donate an organ, say kidneys, then two things are going to happen. The number of people, including but probably especially those controlling what happens to another person’s body after death, who are willing to donate kidneys without compensation is going to drop dramatically. So now you don’t only have a situation where people are engaging in bidding wars to buy a kidney from people willing to sell, you are going to have fights over who gets the small number of kidneys donated without compensation. Second, once a market for any one organ is established, the number of people willing to voluntarily donate any other organ without compensation is also going to fall until those people are also enticed into donating. Wash. Rinse. Repeat.
Your counter-arguments compare apples to oranges. In housing, homeless shelters, and soup kitchens, we’ve already determined that the recipients of the aid are there because they don’t have the ability to pay Friendly’s, Toll Brothers, or Marriott for what are usually vastly superior products. Those businesses are already established and providing products to paying customers for profit, not trying to kick start an organization by displacing something done voluntarily.
Which doesn't matter, if you look at Virginia Postrel's article.
Compared with dialysis payments, every transplant from a living, unrelated donor saves an expected present value of almost $100,000 in medical costs, according to a 2003 American Journal of Transplantation article by Matas and Mark Schnitzler, an economist then at Washington University in St. Louis and now at the Saint Louis University Center for Outcomes Research.
That means that even if every single current donor demanded payment up to $100k it would still save everyone money.
You completely underestimate the cost, as well as pain, suffering, and inconvenience of dialysis.
I will be donating a kidney to my mother in August. She has seven children, three of which are healthy enough to donate. Of those three, two are prohibited by the cost of taking time off for work. That leaves me. I have a job with enough paid vacation. Also, I happen to live in Utah where the state offers an income tax credit for expenses related to donating a kidney. In other words, I will receive compensation for time off work and travel expenses.
My mother is fortunate, but almost wasn't. I may not have been a good match for blood type. Her blood may also have had anti-bodies against mine. I may have had some other health problem. I may not have been willing. I may have been in a different job situation that made it financially very difficult. You get the picture.
A system described by Virginia Postrel that compensated living donors out of the savings of transplant vs. dialysis; that is not paid for by transplant recipients (and therefore not slanted to benefit the wealthy) seems to me worth consideration. At least in our case, my mother would have had two other possible donors just among her children, and possibly more among more distant relatives and friends.
Obviously, I would be donating anyway. But it was a difficult decision. Perhaps more so for my wife. Financial compensation would not necessarily cheapen the gift. It would help many on the margins to lean towards donating that are close to doing it but not quite there. And I doubt very much that a kidney recipient would care all that much that their donor was also compensated. They just want and need a kidney.
As Virginia Postrel indicated, a great many people in need of a new kidney are suffering and dying because of our society's insistence on pure motives.
I think the idea of selling organs runs up against two entirely different objections that are outside the realm of rational argument. (That doesn't mean they're wrong, it means they're not really suited to being argued about as a way of resolving them.)
a. Many people just have a visceral revulsion at the *idea* of people selling organs. Yuck.
b. Many people have a revulsion at the idea of a flow of organs from poor people (who are willing to sell a kidney in order to get food for their kids) to rich people, which seems pretty-much inevitable.
This kind of revulsion isn't the sort of thing you can be argued out of. I don't really share the revulsion, but I can see it.
The arguments I've seen against selling organs are almost always very weak, I think because the arguments are entirely backfilled from the visceral reaction to it. For example, the prominent two arguments raised/quoted here (many religious authorities and communities would disapprove[1]; payment would cheapen the motivation for donating organs[2]) are really weak, and they'd never be accepted even by the people making them, in other areas of medicine or life.
[1] See my previous post.
[2] Gee, doesn't it kinda cheapen things to have that surgeon get paid a lot of money to do organ transplants? Shouldn't he really be doing it just for the good feelings it gives him?
Why do the pro-compensation posters, some having interesting points and good evidence to go with them, keep sabotaging their credibility by making comparisons to removing all pay for labor?
I can pay you to use your arms for work, productive or not, but I can't pay you any amount of money to run your arm across my spinning table saw, not even if I have the money and you are willing to take it. There's an obvious difference between those two cases, both in terms of personal perception and in terms of a broad range of social and legal structures, that voids any facile attempt to blithely substitute one case for the other.
Probably because the anti-compensation posters keep making points that apply equally well to pay for labor. The comparison to pay for labor doesn't answer all points, granted, but it surely answers some of them.
However, you can pay people to donate blood, which to me is a much closer analogy than cutting off an arm and not using it for anything. You're correct that there is an objection to cutting off an arm and not using it for anything, and that it's grounded in moral repugnance, something that our legal system as well recognizes-- just as it did when it allowed laws criminalizing consensual gay sex.
Okay, so you seem to be using productive output as a measure of whether an organ transfer is permissible as a matter of an ordinary market contract. Problem: I can write up a contract to pay you a market wage to dig holes and fill them back up again for my personal amusement, achieving no externally productive work, and nobody cares so long as we both fulfill our parts of the contract. If either one of us breaches the contract, the courts will uphold the contract, not on the basis of whether there was productive work, but on the basis of whether there was a legally binding contract. Yet I cannot draw up a legally binding contract allowing you to saw off your arm for my amusement, not even if both of us are able and willing to fulfill it in such a way that otherwise preserves your life.
I have no idea how you jumped the Grand Canyon from that, to gay sex, but maybe we can clarify something to avoid talking past each other: Do you favor or oppose a reduced role for government regulation of the markets such that I could contract with you for a sawn-off arm regardless of purpose or use, provided you were not harmed beyond the scope of the contract?
As I see it, blood donation is a somewhat different type of thing because the body is constantly producing more and very rapidly recovers from a loss. The effects are generally no different than if I paid you for that hole digging/filling job -- you lose and must replenish a lot of body fluid, you go to bed tired, and you fully recover in a day or two.
No, I'm not. I'm sorry you misunderstood my argument. I was saying that productive output was a strong reason why organ compensation is quite different from other things banned on the basis of moral repugnance, and a reason that I don't find organ compensation a close analogy to cutting off an arm. I'll clarify below.
Yes, I favor a reduced role for government there. I admit that I personally view laws banning that, or banning compensation for organ donations, as absolutely no different from laws banning consensual gay sex or prostitution. They're all based on repugnance.
I certainly admit that our legal system bans some of these things, but the argument that "X is banned on the basis of moral repugnance, therefore we should ban Y" holds no weight with me. The things banned on the basis of repugnance can change, and there's no guarantee of consistency. Gay sex was banned using the same type of arguments you make now; now it is legal, but without prostitution and sawing off arms becoming legal.
Therefore, in the same way, we certainly could legalize organ compensation without legalizing sawing off arms. It is possible to distinguish them. If one were to view on the basis of freedom and consensual activity alone, all the activities would be legal. Since they are not, the basis for comparison by society must be something different, like a utilitarian or cost-benefit analysis. But the cost-benefit analysis and utilitarian reasons overwhelmingly favor kidney compensation in a way that they do not favor sawing off limbs. Organ compensation would save lives, money, and enhance dignity and reduce human suffering.
As Virginia Postrel, who has donated a kidney, sees it, a kidney donation has no long term effects on the one donating. You fully recover quickly. Again from her article:
Therefore, according to someone who has actually given a kidney, kidney donation is exactly like how you describe blood donation or the ditch digging job.
Obviously different organs are different, but how can you still oppose kidney compensation on those grounds?
Therefore, in the same way, we certainly could legalize organ compensation without legalizing sawing off arms. It is possible to distinguish them. If one were to view on the basis of freedom and consensual activity alone, all the activities would be legal. Since they are not, the basis for comparison by society must be something different, like a utilitarian or cost-benefit analysis. But the cost-benefit analysis and utilitarian reasons overwhelmingly favor kidney compensation in a way that they do not favor sawing off limbs.
Your arguments are perfectly fair, but what the above section tells me is that you want to define the limits where you want to define the limits, suggesting you recognize a variance of opinion or Ick Factor or whatever that is defined at a point somewhere other than unrestricted individual or consensual liberty.
Fine; but what if other people than you happen to define the limits differently than yourself? What differentiates your opinion such that it should prevail over theirs, especially if theirs contains elements that are not swayed by purely utilitarian arguments?
No, I don't want to define the limits, but I recognize that society does and will. While I am in favor of consensual liberty, society is not.
They are free to make their argument; I am free to disagree with it. Since I cannot convince solely on liberty grounds, I have made arguments on both utilitarian grounds as well as moral grounds. Saving lives and easing suffering are profound moral imperatives, and kidney compensation does that. I also have endeavored to demonstrate in this thread that your reasoning seems to be based on incorrect factual assumptions, such as assuming that the long-term impact of kidney donation is very severe, when Virginia Postrel, a kidney donor, argues that the surgery is not invasive, the recovery time short, and the long-term impact close to nil.
A Mouse For All Seasons writes:
Why do the pro-compensation posters, some having interesting points and good evidence to go with them, keep sabotaging their credibility by making comparisons to removing all pay for labor?
I think there are two different arguments here.
The first, which appears several times earlier in the thread, is approximately that to pay organ donors for their organs is to somehow cheapen the process, to move them from people acting out of genuine human kindness to people acting out of an expectation of getting paid. Now, that objection seems frankly silly to me, because we don't accept it anywhere else in this process--we don't expect the surgeon applying his rare and expensively-acquired skills to do the transplant out of the goodness of his heart, for example.
Now, I think you're making a second, somewhat different argument--approximately that selling a part of yourself is so fundamentally different from selling hours of your labor or body products that will self-replentish, that we can't really apply the same rules or moral intuitions to the two cases. (Am I understanding your argument here?)
I agree the cases aren't parallel, FWIW. Selling a body part is not the same as selling blood, and not the same as selling your labor, though it has some stuff in common with each. Are there other legal or illegal transactions that would be a better analogy?
a. Slavery or indentured servitude seems like a very bad analogy for, say, getting paid to sell a kidney--these two seem wildly different. With kidney donation, once you're done with the operation and recovery, you're done, and there's no coercion applied at any point. (You can walk out of the hospital the day of the planned kidney removal, right?)
b. Taking a job with a lot of physical risk and unpleasantness seems somewhat closer. We let people take jobs as coal miners and linemen and such, despite the physical unpleasantness and genuine risks involved, though we also limit those risks to some extent.
c. Maybe the closest analogy involves jobs that we know do some level of damage, over time. This seems common in professional sports--different sports (or positions) tend to develop specific injuries, and repeated injuries will often do lasting damage. Maybe the most disturbing example of this is in boxing, which I believe is pretty sure to cause a certain amount of cumulative brain damage over time.
One problem with both (b) and (c) is that the bad parts of the jobs aren't what the employer actually wants. The crowd would pay just as much to watch boxing if some safety gear or medical treatment would eliminate the cumulative brain damage; the power company doesn't want you electrocuted, they just want the lights back on during the thunderstorm.
I mentioned below the comparison with surrogate mothers - that seems to me to be the closest in terms of time, risk, bodily involvement and various ethical/emotional issues.
Mouse-
I can pay you to use your arms for work, productive or not, but I can't pay you any amount of money to run your arm across my spinning table saw, not even if I have the money and you are willing to take it.
Why not?
There are people that currently pay to have an (ahem!) "organ" removed.
Receiving money for the removal sounds like a better deal to me.
I'd agree with you about the objections, my discomfort would stem precisely from the points you outline, in particular the second.
I'd disagree entirely though that these objections are outside the realm of rational argument, perhaps they lie outside the realms of a strictly economic argument.
I think there is noting irrational about resisting the notion that all interactions be reduced to a transaction, and that a persons organs (not to mention whatever else someone night care to buy - a persons dignity, sex, vote or freedom for example)exist at some point on a demand curve.
There is, if people will excuse me for saying it, a particularly American fetish for discussing healthcare in strictly economic terms, there are wider issues of human dignity involved that are overlooked.
No, I will not excuse you for saying it. How does any country discuss health care in less economic terms? Government insurers view health care benefits in economic terms just as much as American insurers. If anything, Americans discuss some issues that some view as healthcare (abortion, Plan B, etc.) in anything but economic terms.
So in the interest of avoiding that the rich get the limited supply of kidneys and the poor get nothing, neither kidneys nor compensation?
Not to mention that this completely ignores the reality of kidney donation, as donor Virginia Postrel noted:
"the notion that all interactions be reduced to a transaction"
What about the notion that human life is precious? You talk about human dignity, but how many others would you condemn to death for the sake of your own personal notion of "dignity"? How do you weigh the suffering of the people on dialysis, much less that of the families of those that die waiting for a transplant, against your own personal preferences?
The particularly American fetish that you're really referring to is the one about getting things done, rather than standing around talking about high-sounding ideals while ignoring the practical implications of humoring your own whims. You've offered no suggestions towards actually fixing the problem - the only concern you've shown is towards your own private discomfort.
My preference is that the poor don't become spare parts for the rich, is that really a "high sounding ideal"?
So in the interest of getting things done the poor become spare parts for the rich?
Do you favor a military draft for the same reasons?
So in the interest of getting things done the poor become spare parts for the rich?
1. Even if this caricature is accurate, you really prefer the current scenario where the rich die and the poor stay poor?
2. Of course, this caricature is not remotely accurate. The rich today can use their resources to game the system (e.g. Steve Jobs), so an increased supply would primarily benefit the non-rich.
What's being debated here is whether the government and/or insurance agencies can pay donors, just as insurance pays the surgeons and others involved in the transplant. Yes, there are some poor that don't have insurance, but that's a different subject. What's being debated is that everyone who is currently given dialysis would also have a chance at getting one of these kidneys. What objection do you have to that?
John, I not sure what point you are make regarding a draft - can you elaborate.
"What's being debated here is whether the government and/or insurance agencies can pay donors, just as insurance pays the surgeons and others involved in the transplant. Yes, there are some poor that don't have insurance, but that's a different subject. What's being debated is that everyone who is currently given dialysis would also have a chance at getting one of these kidneys. What objection do you have to that?"
You are glossing over where these organs are to come from. A market for organs is not going to be supplied by the wealthy it will be supplied by people driven by desperation and poverty to sell an organ.
Personally I think that is unacceptable.
RE, I think Thacker's earlier point about the draft is that poor(er) people end up putting their lives on the line for the benefit of everyone, since the very rich rarely join the military. So unless you're in favor of a draft, you are supporting exactly the same thing -- the less wealthy putting body parts on the line for the wealthy (among others), in return for pay.
I'd also like to repeat his earlier question: exactly how many lives are you willing to sacrifice because of something you find personally unacceptable? Because that's what this is about. Pay donors, you save lives; don't pay, and lives are lost.
Your objections sound the same to me as people who oppose a military draft, claiming that a paid armed forces encourages poor people to sign up and get killed. Rep. Charles Rangel (D-NY) has repeatedly sponsored a bill to bring back the draft for that reason. How is your argument different from one arguing that paying the military encourages the poor to die for the wars of the rich? (Sure, the rich could get out of the draft, but the same accusations about the waiting lists for organs exist now.)
You think it's acceptable to let them stay in poverty? You're sure they won't turn to something even worse? (And any argument that this would make selling kidneys mandatory to stay out of poverty doesn't work, since the need for kidneys is on the order of tens of thousands, much smaller than the number of people in poverty.) The problem is the desperation and the poverty, not the kidneys.
You think it's acceptable that people stay poor and other people die, and even if they don't die, they suffer needlessly? I think that that's unacceptable.
I actually disagree with your main point; I think that some people in the middle and upper class would indeed be more willing to give organs if they were compensated for their time and effort.
MDF,
I figured that was point John was making. Seeing it presented as if the notion I might support a draft were outlandish, surprised me into thinking he had something else in mind.
I don't think it so odd that if a nation decides to go to war then burden should not fall solely on the poor. Then again I live in a neutral country so this is an issue that could never realistically affect me personally.
When you ask how many lives would I be prepared to accept. I don't agree that the question is a valid one. I don't regard the poor as a commodity to be utilized in this manner. I think all of the libertarian and free market arguments which present this as a straightforward transaction between seller and buyer are deliberately blind to the reality that there is no market for middle class kidneys. To what extent can there be true willing consent when poverty compels someone to sell?
If you see this as a purely economic question would you think it OK for example to outsource the transaction? For example we could fly people in from third world countries, whip out a kidney at an attractive discount and have them back home for tea.
"I don't regard the poor as a commodity to be utilized in this manner."
Boy, we really see things very differently. It seems to me that you're the one that's treating the poor as a commodity that should be subject entirely to your own personal whims and preferences. I'm talking about giving them an opportunity to do a noble thing while also profiting economically. Is saving a life somehow beneath them? And do you consider them all to be so inferior that they should never, ever be given such an option? I support treating them as if they are valid humans with a right to make their own choices in this matter, while you're saying that your opinion is so much better than theirs that you should control their lives. Is that your idea of dignity for them?
As for your question regarding people going overseas to buy organs, it's been going on for years, and I've been strongly against it throughout that time, because the "donors" had no choice in the matter. When I lived in Hong Kong, everyone knew that the best time to buy an organ from the mainland was before holidays, when they did the public executions in stadiums. Over the years, many Chinese living in the US have flown back to China to buy their new organs. As the industry has grown, China has added "just in time inventory" (for a fee, you can have your prisoner killed to order) and quality control (lethal injections in mobile vans that can be parked right outside the hospital - the old bullet-to-the-head method in the stadium sometimes damaged valuable inventory).
For me, personally, allowing people the choice of being compensated for some of the trouble and inconvenience of helping others is very, very different from the government having an economic incentive to round up and execute large numbers of people because they can sell the organs.
RE,
Just a hypothetical. If the problem is that you just don't want poor people being involved, would you be okay with allowing middle class & rich people to be compensated for their organs? It could be like applying for a mortgage: the government will cut you a $50,000 check in exchange for your kidney, just so long as you provide proof of sufficient income.
So you'd be in favor of this, right?
Clarification: I was not at all saying those objections were irrational. I was saying I don't think we can come to agree with one another via a rational argument, w.r.t. those objections, because those objections are more like a moral premise than like a positive statement about the universe.
To the extent that your objections or my acceptance is due to some moral reasoning, rather than a basic rejection or acceptance of the idea, rational discussion between us may bring us together. But to the extent it's a kind of basic, given thing--the way I feel about torture, say--rational discussion seems very unlikely to bring us together.
(To be fair, it might bring us together by convincing me, since I don't have some visceral love of organ markets, just a strong suspicion that they would cause a huge drop in human suffering. Dialysis is ugly.)
Ha! That is funny! Also funny, how you completely ignore any argument that's actually well thought out! Strawbabies!!!!!!!
Is "strawbaby" supposed to be a new term for something different than a strawman argument? A strawman argument would be if she were disputing something that the NKF never said. That's different from simply criticizing someone's weakest arguments while not addressing the strongest point. (Something that would make a difference in a full debate on the topic, but is relatively unimportant as one short blog post by someone who has made others fully addressing the other points and linking to articles doing the same.)
I'm glad you concede that the NKF puts supporting arguments in their press releases that aren't "actually well thought out!"
John Thacker brought up the comparison that I was thinking of - selling blood. Has that cheapened the gift and led people to stop donating? When I donate blood, it doesn't bother me a bit that I'm giving it away for free while others may be compensated. I don't do it for the money but have no objections to others doing so. Why shouldn't they be compensated for their trouble?
Another example of people "selling body parts" is selling their hair. There've been many stories of people donating their hair to make wigs for those going through chemotherapy, even though the practice of selling hair for wigs is very old.
Yes, I know that the risks of surgery when donating an organ are very different from getting one's hair cut. But this idea that there's something sacred about cells that were once part of your body doesn't seem to make sense to me. Do these people save all of their toenail clippings?
So can kidneys be removed noninvasively and without physical trauma, and then grow back in a few days or weeks?
Actually, basically yes. Laparoscopic surgery means that the incisions are much smaller and recovery time is much lower than it used to be. The other kidney grows to compensate.
Again, Virginia Postrel's article:
"And I doubt very much that a kidney recipient would care all that much that their donor was also compensated."
This comment made me think about the feelings of the recipients - surely most of them would prefer to know that their donor was getting something in compensation for their time, pain, risk, lost work income, etc., wouldn't they? How many people who finally get a kidney say "and the best part is that the person that went through that operation in order to save my life got nothing! Isn't that great? I really love the idea that I got my life back and they didn't get a penny, since their only reward should be the pleasure of knowing that they were allowed to serve me."
Also, I can't help wondering whether the people that are against paying organ donors are also against paying surrogate mothers.
Ann,
Thanks. You expounded a little and expressed my thoughts. My mother would be consoled some if I were compensated for the risk, etc, rather than being offended that I was bribed.
Thank you for your comments, Rob, since you and your mother understand this issue in a way that probably none of the rest of us can. I hope that things go very smoothly for both of you.
The idea that both sides benefit, at least somewhat, seems desirable to me. Is it a religious thing that some people firmly believe that helping others must really, really hurt? These people aren't saying that donations shouldn't be allowed, just that it would be wrong to do something nice for those that donate. If someone is sacrificing time and taking a risk in order to help others, why is it so horrible for society to try to offset that cost at least partially?
Wasn't there also a concern, in India, that those who sold kidneys typically ended up just as desperately poor a few years later? The US equivalent might well be somebody's who $100k down on his or her mortgage, sells a kidney hoping to save the unsustainable lifestyle, but a few years later still loses the house and files for bankruptcy.
It can probably be structured to avoid some of those concerns, but I think part of the concern is exploiting economic desperation by also false hope of a way out.
You'd want a very structured informed consent process.
Also, I work in health care and have seen not a few people who lost one kidney to renal artery occlusion. The donor is taking a risk (kidneys, like hearts and brains, are supplied by arteries, and thus vulnerable to the equivalent of heart attack or stroke).
ouch, that first also was intended to be "offering." wonky keyboard keeps jumping my cursor and messing with my editing. Do not buy floor model laptop! anyway, just to clarify, NOT S Palin, despite the alsos, too.