- Huffy declarations that anyone who disagrees with you must be amoral
- Appeals to the fact that many other people are also against organ donation
- Invoking the infamous "ick" factor involved in selling a body part
« What are You Saying, Paul? | Main | Department of Non-Leading Indicators: Special Health Care Reform Edition » Moral Quandaries that Aren't24 Jul 2009 11:04 am
Roy Edroso unctuously asks for someone to defend the Brooklyn chap who was just arrested for selling organs. I'd rather see him justify not paying for kidneys, when this is the result of the shortage. Justify driving organ sales to the black market, where the brokers get rich, the sellers get a pittance, and only the rich can afford them, rather than taking the money we currently spend on dialysis to compensate those who are willing to help provide the gift of a dialysis-free life to others. Bonus question: explain why we should prevent people from voluntarily donating a kidney when living kidney donors do not appear to have an elevated risk of kidney failure without resorting to any of the following
TrackBackListed below are links to weblogs that reference Moral Quandaries that Aren't:
» Save a Life! Sell Your Kidney! from Libertarian Girl Comments (109)Comments on this entry have been closed. |
Today's Headlines From The Atlantic |
Copyright © 2010 by The Atlantic Monthly Group. All rights reserved.
Just out of interest, assuming a legal market, how much would the donor (Well, can't really call them that anymore) get paid for his kidney?
It is enough for someone to get a college degree that would not otherwise be able to afford it?
Postrel was suggesting something around $50,000 (with major net savings on dialysis to the government). I've seen higher figures. So, yeah, quite plausibly.
In that case, it sounds like a great tool for the de-stratification of America!
Hey zic, this disperse the concentration of wealth!
I recommend a ebay-style auction system run by the people who maintain the current list.
The rich will pay huge amounts to get first access to organs that wouldn't be available without the system. The high prices will drive doners into the market (including family members of non-living doners). Then the price will come down to cheapest level that fits the demand.
It's crazy to place on arbitrary value on an organ which might be higher than necessary or be so low that it doesn't bring in enough doners to meet the demand.
"On the third hand, he's clearly not acting out of any sense of moral duty."
Any system dependent on the moral duty of actors is doomed to failure.
My biggest concern with selling organs (and with organ transplant policy in general) is that nobody should ever be compelled to give up their organ. I do think it's reasonable for people to be compensated for the time and risk associated with giving up an organ, I just want to be sure that whatever policy is put in place will mitigate the compulsion to give. Obviously if you are paying significant amounts of money for organs, some people will feel compelled just because they need money badly. This is unavoidable but something we should consider, IMO.
A sale is a voluntary exchange made by two consenting parties.
If someone needs money bad enough to sell a kidney, you're going to stop them? How nice of you to leave them worse off than they would be with the voluntary exchange.
While we're at it, lets outlaw working for money. When you sign an employment contract, you are signing away your very autonomy.
Obviously if you are paying significant amounts of money for someone's autonomy, some people will feel compelled just because they need money badly. This is unavoidable but something we should consider, IMO.
How much of a slippery slop is ti until we start allowing people to be declared blighted, divvy up their organs and give them to rich / well connected people? To say that some other person will produce more taxable income and therefore is more entitled to that 'extra' kidney?
Under your logic, we shouldn't allow people to own real or personal property, either.
Eminent Domain does exist, and is even discussed in the constitution, but we still have private property, real and otherwise. We have agreed, as a Nation, that some cases there is a public interest in forcing someone to sell their private property for public purposes. I feel confident in stating this as a fact.
Lately, I have seen where eminent domain has been (in appearance at least) abused to profit large corporations or well connected, politically powerful people.
So my question is, if we allow people to productize their redundant body parts, how do we KNOW that some future health care reform won't allow (or require) the government to force transactions to occur via eminent domain or analogous legal theory?
A fine argument against eminent domain, but not voluntary transactions. The state could make it mandatory to harvest organs without making it legal to pay people for the privilege.
Kristian:
Yeah, with the Government able to take your property at will(see Kelo v. New London).
Well, one, we don't know that any future health reform won't establish eminent domain over body parts and going up or down the slippery slope doesn't change that, and, two, we as a nation haven't agreed on anything.
Well despite people being able to sell their labour, we have moved away from legal slavery (the move was terribly slow, and bloody, but it was a move). So I don't think there's much of a slippery slope involved.
A hypothetical I asked on the earlier thread.
For anyone whose big concern is the fear that poor people will be exploited, 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.
Anyone in favor of this? If not, why not?
Because the purpose of providing a payment opportunity for an organ is to provide an incentive to expand the supply side. A monetary incentive is focused on those who would benefit from the money. Including the poor.
Why exactly would an income-test be a smart idea in this instance? Because of fear of exploitation of the poor? That seems like poor logic to me, as it just prevents an opportunity for the poor and reduces their resources.
TreeJoe,
Sure, I agree with you, but that's not the question -- I'm asking anyone who actually is opposed to organ markets because they think the poor will be exploited. It seems to me that if someone honestly had that objection, they ought to get behind a "money for donors who aren't poor" proposal. Anyone?
He is looking at it from the perspective of a moral dillemma. You then put forth a purely utilitarian argument that necessarily increases inequality of opportunity, and expect that to be a logical solution...how?
Because you and others complain that poor people will donate too much and for the wrong reasons, he asks if you would complain if poor people were banned from doing so. It hardly seems extreme as a solution to your objection, even though I'd oppose the solution in an ideal world.
Your argument, mouse and TreeJoe, seems to be illogical. You seem to argue that it's wrong both if the poor are allowed to donate and if they are not. Logically, that means that you don't really consider the poor donating the problem; your objection lies elsewhere.
John Thacker, that's exactly what I meant. Thanks. I should've known the rhetorical danger with making an argument by contradiction.
Actually, I merely asked a question. Possibly I should have also specified that there is an often irreconcilable difference between deontological and utilitarian logic, hence answering an argument of one type with a counterargument framed solely in the other, rarely tends to advance the debate.
As for the rest, Kreskin, perhaps you can specify what it was that I argued, since you apparently have access to my unwritten thoughts. Go on, it should be entertaining.
aMouseforallSeasons,
I don't think I'm following you. Why is my suggestion framed incorrectly? Some people say paying the poor for their kidneys is exploitation -- I'm saying, okay, if that's the problem, why not advocate just excluding the poor. If someone says "don't legalize X and Y, because X is bad", why isn't it a logical response to say "okay, so let's just legalize Y"?
I don't see how I'm specifying any particular moral framework not implied by the original critique. And I also don't understand how an inequality argument works here: if anything, it seems to me that if someone is arguing we shouldn't allow the poor to do something for monetary gain but only for free, they're already implying that the problems of poverty & inequality aren't that much of a concern.
The idea that the poor would be "exploited" by having access to an economic opportunity must be indivisibly rooted in the idea that there is a moral element to said opportunity, in this case physically and irreversibly removing an organ or organ section from a person's body, correct? (Comparatively, I doubt anyone would support legislation banning people from holding two or more jobs in spite of the poor taking more advantage of the opportunity to do so.)
But your counterargument was essentially utilitarian: we can gain the desired organs by opening the market to only middle-class wage earners and higher, with no risk of the poor being exploited. But this doesn't resolve the moral aspect of removing an organ or an organ section from a person's body, while also adding more conflict (deliberately cutting off the poor from economic opportunity solely by virtue of being poor).
Or, as a thought experiment, substitute "prostitution" for "organ donation" in the above sequence of events and I wager the exact same problem occurs...
I have to disagree with you, Mouse. The argument Ryan is responding to doesn't make a deontological argument about selling organs per se. Rather, it makes a weighted utilitarian argument -- allowing for a market for organs is wrong because it would exploit the poor (I call this a "weighted utilitarian" argument because it is fundamentally not deontological, unless the underlying moral criteria is concerned with -- and only with -- the poor.) But either way, Ryan's response removes the poor from the argument, which was the central point of that particular argument. I don't see how you can ascribe this as a utilitarian response to a deontological argument.
Mouse, if someone told me their objection to legalized prostitution was that poor people would be exploited, yes, I would ask if they'd be okay with legalizing prostitution for the non-poor so long as we just made sure poor people did their hooking in the back-alley. [Hey, if someone says "X is bad because it hurts poor people," I think it's pretty natural, if not logically necessary, to assume they don't think X hurts non-poor people. So, yeah, I think my proposal ought to solve the claimed problem.]
This suggests to me a deep confusion about what compulsion is.
That aside, I'm not sure I see the exact nature of your concern. Your argument seems to be: Some people are so poor that they might feel they had no choice but to sell a kidney if it were legal. Therefore we should deny them that choice altogether.
That only makes sense if you assume that the poor are not smart enough to be given this choice. Is that the basis for your concern? If not, what is? Because I can't think of any other way to make the above make any sense at all.
Obviously if you are paying significant amounts of money for organs, some people will feel compelled just because they need money badly.
What goes unsaid is those who would be most likely to sell their organs are people with significant impulse control and substance abuse problems.
I assume that people with substance abuse problems are unlikely to have organs that are suitable for donation.
Arlancas - I'd say that's a very erroneous statement.
Jmo3 - What is wrong with people with impulse control and substance abuse problems donating a healthy kidney? Because they have problems? They can greatly improve the life of another human being, and they'll either still have their problem or they'll be faced with an opportunity to correct the action. The extra money might facilitate some binging, excess, etc.....but the same happens with the lottery, estates, and other sudden influxes when combined with people who have such problems.
To me, there's only win in this situation.
First off Megan, three hands? You need to donate one of those. :)
Since I am absolutely FOR the opportunity to donate, free or for money, any organ of your choosing, I won't attempt to justify why one shouldn't be able to do that.
Our body, our choice. Right?
I'm able to get compensated for donating blood, plasma, marrow, eggs (which are finite), and sperm. If I am able to donate a lung or kidney for compensation, why shouldn't I be able too? Why not an eye if the surgical capability was there?
It's my life and it's my body.
Joe
P.s. If I wanted to go down the absolute extreme of the argument, I could say that women should be able to grow a baby to almost full term, have an abortion, and then be able to sell the organs.
But apparently it's better to waste the millions of aborted bodies than possibly yield a benefit from it.
P.p.s. Just in case you were wondering, I'm against all forms of abortion. But I don't understand why the millions of abortions aren't utilized for organ harvesting or other benefits....it's almost as if there is a stigma associated with the abortion by-product.
TreeJoe, you're able to donate both eggs and sperm? Talk about being a cash cow! Er, I mean bull? ...Cash earthworm?
It's the secret to my success. Along with a long pause before I speak.
It's the secret to my success. Along with a long pause before I speak.
I'm not sure, but I don't think there's much demand for infant-sized organs.
So what's the problem?
That can be dealt with by either putting restrictions on how the money is to be spent, or paying it out over a long time rather than a lump sum.
What you are talking about is basically the same problem for hire militaries faced, and US seemed to have solved it nicely.
Ha.
So libertarians are in favor of organ harvesting because the big bad federal government has no right to tell its citizens it can't, but the big bad federal government is allowed to "put[] restrictions on how the money is to be spent"?
What was the name of that popular Alanis Morrisette song again?
Abe - I think he was actually in favor of staggered payments rather than a lump sum format.
And I think that's a good idea, carefully structured.
Hand in my pocket?
Isn't it ironic that none of the things in Alanis Morrisette's song are actually ironic? They just suck, that's all.
Libertarians aren't in favor of the restrictions in general, but some are looking for compromises because they feel that allowing voluntary transfer of money with limitations is better than not allowing voluntary transfer at all. It's no more ridiculous than people who favor drug legalization being willing to accept decriminalization or medical marijuana as better than the Drug War, or people who favor free liquor sales preferring government regulated privatized liquor stores to government ABC stores.
I suppose it applies, since both you and Alanis evidently have no idea what "ironic" means.
You don't really own anything unless you have the right to sell it or trade it for something else of value.
You're really just borrowing it.
So, it it is possible to sell a kidney, does that mean that one can take out a loan with a kidney collateral?
On one hand, ...
On the other hand, ...
On the Gripping Hand, ...
That book has burned into my mind the expression "Rape my lizard"
Oh, let me add one thing. Currently, a woman can get paid to be a surrogate mother. This involves permanent physiological changes as well as a substantial increase in certain risks, especially during the labor/delivery portion.
And that involves a 9-month (or longer) process and a staggered payment system.
I don't think that's a fair assessment. True, he was charging $160,000, a tremendous amount of money. But, it's also pretty likely that a large portion of that went into the pockets of others: the donor, medical personnel, perhaps customs workers in both the US and Israel (if the organs were really from there), as well as who knows whoever else might have to be paid.
Furthermore, getting paid for doing the right thing does not make it less right. At one time, it was a crime to harbor a fugitive slave. Though it is certainly true that many who assisted in the Underground Railroad did so for purely altruistic motives, there were also those who got paid, and that fact did not make their actions immoral.
With Dialysis costs approaching, if I recall correctly, $80,000 per year, PLUS hours of freedom lost each week, I would imagine the demand side of the equation could put the cost of a kidney up into the $200-300k range. I think we'd have to see how much people value their own second kidney to figure how much the supply could pull that down.
Fair enough, but prices generally aren't equal to the top of the demand curve; that's how we get consumer surplus. (What's your maximum willingness to pay for water?) The fact that people would value kidneys that much tells you the potential gain of a policy, not the potential cost.
I'd further note that it's hard to imagine that legalization would drive prices up rather than down.
And I guess taking this to an extreme, could a poor father sell his body parts to support his family (i.e., all parts and effectively killing himself)? I guess this gets into whether suicide is legal as well.
There are people and places that have supposedly done that, but it's illegal everywhere that I know about...
One of the limits to this is legal procedures....a doctor can't, in this country, assist you in suicide. And as far as I know, it's illegal to remove a live person's heart without certain conditions being met.
But aside from those limitations, yes, I think what we are talking about is the possibility of people selling a kidney or lung to support their family on the low-income side. And the possibility of a low or middle-income person being able to afford a house/college education/pay off debt by donating such an organ. Or just socking it away in savings and doing it because they feel it's the right thing to do.
Joe
It also gets into situations of whether taking a highly paid but risky job to support one's family is legal. Plenty of people serve in war zones (military or contractor) for hazard pay.
Why not just allow donor chaining, since one of the big problems is finding somebody willing and a match?
First off, let's acknowledge that both of your extra credit assignments are forms of moral bullying.
But to the meat of the matter:
There are currently two legal means of donating vital organs (let's leave non-vital donations aside for the moment). You can sign a donor registration form (eg, the back of your driver's license) that offers your organs for donation upon your death; or you can volunteer to donate a redundant or divisible organ (a kidney or a portion of your liver) while you're still alive.
For the most part, donations of the first type become part of an anonymous donor registry, by which donations are matched with recipients by way of a complex, ethically rigorous (but morally neutral) matrix of factors designed to make the best use of the organs. "Best use" in this case entails balancing efficacy considerations (finding recipients whose lives are most likely to be saved or improved by the organ), considerations of recipient need, and the amount of time the potential recipient has been waiting for a donation. The system, overall, is designed to protect health practitioners from being forced to make a Sophie's choice (ie, to choose which of two recipients is more worthy of being saved).
Donations of the second type normally entail the donor choosing who will receive the organ. In a simple case, a friend or family member is compatible with a patient in need, and the organ is transplanted directly. In more complicated cases, incompatibility prevents this direct donation, but a kind of chain reaction can be arranged, whereby donor A donates to patient B and donor B donates to patient A. I have heard of such chain-reaction donations being as long as eight links.
With the two existing markets in place and both of them serving vital ethical functions (the first based on the current state of medical knowledge and temporal fairness, the second based on considerations of donors' choice), introducing a third, money-based program could seriously disrupt the first two. The upside to the third way would be that more people might be induced to donate.* But the downside would be that it would draw donors out of the first and, to a lesser degree, the second (namely, the chain reaction programs). Considerations of need, efficacy, and non-induced choice would be severely undermined and replaced by the ability of recipients to pay. Especially with respect to efficacy and need, this is a clear public bad. Organs would go to people who needed them less and also to people for whom they would do less good.
* I tend to agree with a previous commenter that the "quality" of donations among these new donors would suffer by comparison with the current donor pool. Money is a stronger inducement for the poor, who tend to be less healthy than the general public, so the upside would be attenuated.
I actually disagree with your * statement, but hear me out.
First off, remove anyone who would disqualify for normal organ donation via the currently accepted routes.
Now, you've got a poor population that has already been excluded for certain uncontrolled diseases or unhealthy organs.
What you are left with is a poor population with healthy organs. All you've done is say that in the poor population, the pool of viable, healthy organs is slightly smaller due to a larger population of either uncontrolled disease or exclusionary disease severity.
Since we are primarily talking about Kidney disease, and since doctor's already make a disconnected choice in the evaluation of a patient's severity (albeit, through a list of accepted criteria), I think what'd you see is a decrease in the waiting time on the list of "free" organs.
I understand, to a point, why you think this process might disrupt the current system. But I feel it might also make the current systems vastly more time-effective by reducing the size of the pool substantially.
Or it could simply serve to increase the effectiveness of the current systems, in the same ranking system takes place but you've simply introduced alot more organs into the mix. This, of course, would depend upon who is doing the paying.
I do think that there would be an overall increase in acceptable donations by adding a pay-for-parts system to the two existing methods, but that the increase would be attenuated by the very mechanism you identify: that poor quality parts would be rejected. However, I also think that adding a pay-for-parts program would draw donors out of the existing programs, which is the reason I gave for rejecting the proposal.
Pickabone,
For the overall outcome to be worse, you would have to make the assumption that paying for organs would make the supply less than it would otherwise be. This is certainly a false assumption. As far as I can tell, you are arguing that paying for the organs will lead to a disruption of the priority listing of recipients, but this need not be true. Also, it need not be true that the overall quality of the organs in a larger pool will be less. It is just as likely to be higher, especially if there are more live donors than dead ones.
Let me explain the rather simple mechanism. Currently, some people donate their organs for free. Adding a pay-for-parts program would yield donors from two groups: 1) new donors, and 2) current donors. It is precisely the second group I'm most worried about. When faced with a choice between receiving no payment and some payment, some (or many, or most) people would choose the latter. These organs would shift from the "free" registry to the pay-for-parts system, thus reducing the supply to the existing programs.
In other words, I do not assume a reduction in supply. I only assume that, all else equal, people would choose some financial reward over no financial reward, something I can't imagine a supporter of markets would reject. The decrease in supply to existing programs is an expectation I deduce from this assumption.
But that is my point, there is no need for payment to change the supply to existing programs. Properly structured, payments from the present system could be used to increase supply to them. Almost everyone in need of organs are already on waiting lists in these systems, so an increased supply is a direct benefit to the people within the system.
Yancey,
I think we need to clarify how paid donors would receive their funds and how recipients would receive their parts. A basic market matches buyers and sellers. It seems that you don't complete the system. Their are sellers, but no buyers. I guess it depends on what you mean by "properly structured." It doesn't sound like you propose an actual market, but something else.
For your system to work, it seems to me that it would require one or more collective fund sources available to hospitals out of which to pay potential donors. Where does this money come from? Do patients in need pay into the fund to get onto the registry? Do they get special consideration for paying more? If so, how is this consideration balanced against current considerations of need and efficacy? If not, how would a price be set for the potential recipient?
PS - if you haven't seen it already, one of the Daily Dish visiting bloggers posted a link regarding the Iranian pay-for-parts program. It's a useful empirical contribution to the debate (for which I have little ready data). I tend to think that the most critical question remains unanswered in the Iranian study: how the outcomes in their pay-for-parts system compare with those in the abandoned waiting list system. Without comparative analysis of outcomes, we don't know how well the Iranian system has fared with respect to factors of need and efficacy.
So what, as long as it leads to more kidneys available for transplant?
The costs of dialysis appear very high, and no critic of paying for kidneys has disagreed with said costs. As I understand it, whoever is currently covering the costs of dialysis would finanically benefit significantly from a kidney transplant instead, so they could cover the payment side.
So, if paying for kidneys increases the supply of kidneys, then this does help meet the considerations of need and efficacy, which is the *opposite* of undermining them.
As for non-induced choice, if we are going to worry about that, why stop with kidney patients? Should we be paying medical staff for their jobs? Does not this risk inducing them to make choices that may be bad for themselves, for example having contact with infectious patients, or patients who are violent for whatever reason (eg hallucinations, lack of impulse control caused by brain injury)?
Megan to Roy Edroso, as done by Daniel Day Lewis as the Bill the Butcher:
Here's the thing... I don't give a ten-penny fuck about your moral conundrum, you meat-headed shit-sack... That's pretty much the thing.
A possible answer to the bonus question:
The voluntary sale of kidneys is problematic, not due to the immorality of the act itself, but due to the unintended consequences.
Once we set up a legitimate system for the selling of organs, we magnify the black market problem greatly. Currently, the the black market for organs is almost totally independent of the legal medical system, and every participant is criminally liable if caught. If we legalized organ sales, there would be many points of insertion for illegally-obtained organs. There would be a great deal of plausible deniablity. Arguably, a good regulatory system could solve this problem, but I don't have much faith in such systems when competing against the profit motive.
A large black market for organs, of course, would be very bad.
Secondly, although I don't anticipate this being a problem in most Western countries, there are informal methods of coercion. A family in debt may pressure the children to sell their kidneys (in a market-based system, one would expect younger kidneys to fetch a higher price). Developing countries with legalized prostitution face already face analogous problems.
Ah yes, legalizing alcohol certainly helped the market for moonshine, didn't it?
The markets for alcohol and organs are not analogous. The profit margins on alcohol are too low to make for an attractive black market product.
Unless you expect the market price of kidneys to fall below that of the cost of blackmailing someone into signing away a kidney, the black market for kidneys will thrive.
Ah yes, the legal sale of used bicycles certainly helps the black market for stolen bikes, doesn't it? Why yes, it does.
The profits on alcohol are too low to support a black market? They seemed to have supported Capone and his many friends very well.
Altoids,
I am just not sure I buy this argument from a logical standpoint. Most (all?) black markets arise and grow when commerce in a demanded product is made illegal, and those black markets fade away when commerce is made legal.
I don't understand it from a profit perspective.
If you are offered $50,000 for one of your kidneys in a legitimate setting, where does the black market set up? They offer you $70,000? Why? You would still need to be matched up to a viable candidate, which takes a vast network to check against. It's not like you want to keep a kidney out of the body for awhile, so they can't stockpile it.
What would be the black market incentive to offer more money than the legitimate system for a kidney?
I don't see it.
You maybe need to do more reading, then:
http://www.medpagetoday.com/Nephrology/GeneralNephrology/3814
Mouse,
You may need to check your reading comprehension. The article was written under the current system. I am asking the question under the proposed system where you could LEGALLY BUY a confirmed viable kidney for a set price.
Hell, even your article says, ""Obviously if we more had more donations in this country, we would have less transplant tourism," commented Arthur Matas, M.D."
So my question remains, What is the incentive to have a black market for kidney systems whereby you'd need to offer transplantees more money than the legal system and transplantees either less money or a wider array of viable kidneys?
The second part of that statement kinda seals the fate of any black market kidney transplant....because you couldn't offer a wider array of viable kidneys when and if the donation became incentivized and nationalized.
Of couse, you could lie about the viability and keep the costs low. But that's not a long-term viable black market model. That's just the usual fraud stuff that happens in every market.
TreeJoe -- I meant to respond to a specific claim in your post, which was:
"You would still need to be matched up to a viable candidate, which takes a vast network to check against. It's not like you want to keep a kidney out of the body for awhile..."
Clearly, the black market can and does meet this objection.
Moreover, the cited cases in that article were people who got tired of waiting in the legitimate diagnostic/transplant queues. Will compensation and/or markets for organs actually satisfy all of the demand for transplants? If not, then scarcity could make the blackmarket viable at prices that outbid the legitimate market. Think of it (loosely) in terms of ticket scalping or loan sharking.
The black market perspective is - I hire a guy to kill/kidnap homeless people in Latin America, I hire another guy to take out their kidneys, I hire another guy to smuggle it to the US, and I do it for less that 50k per kidney. I'm sure drug lords would be happy to diversify their businesses.
I'm not sure what specifics are on transplant-compatibility, but if I were running a illegal organ harvesting operation, I'd have a large client base waiting for organs, large enough that any incoming organs would have a X% probability of finding a client, where X is determined by profit margin.
If transplant-compatibility is so specific as to make this strategy untenable, then they would have to be done on a contract basis. This would involve criminal liability on the part of the organ-recipient, so my guess is this type of illegal behavior would be very rare.
This is the most serious objection I've heard (far better than the "oh my good, some rich people might benefit!).
Against this though is the current serious costs of the existing system.
As for family in debt pressuring children to sell a kidney, there's already a lot of ways that families can put pressure on children. In NZ the department that pays state pensions and benefits has a serious on-going problem. They hire a lot of people straight out of university, often the first in their family to have gone to university, to assess benefit claims. Some of these new graduates are then put under serious pressure by older family members to create fake claims, with the money going to said family members. The department often catches these fake claims (it's had a lot of experience), and has to prosecute the graduate, who winds up with a criminal conviction and severely reduced employment prospects for the rest of their lives, outcomes which strike me as bad as selling a kidney. Should the NZ government cut off all benefit payments and pension payments? Or should the department only hire graduates who are either from rich families or are entirely orphans?
Is it morally preferable to save more people overall even if the "better off" get saved first?
Or is it better to ensure equal chances of death among all those who need transplants regardless of income status even though it means more deaths overall?
Nelson,
This, I think, is the real objection, though largely unvoiced by opponents, to paying for organs- that it might lead to outcomes that are unequal due to differences in means of payment.
This need not lead to more unequal treatment, but even if it did, and still lead to more lives being saved, I would have to say the result is more just.
I'm OK with unequal outcomes. If I were a poor person selling my kidney I'd want the highest price. Of course, if I were a poor person needing the kidney I'd probably feel different. Oh well, life isn't fair regardless.
Also, this point comes up a lot with health care coverage in general. Why should the rich (countries or people, depending on context) get drugs/better treatments first? Because they're the ones paying for them. Everyone benefits after the patents expire through competition. Some people die in between discovery and patent expiration, but overall, this is the least costly model and allows greater R&D, and more saved lives, than would otherwise occur.
As far as I can tell, the view of the typical opponent of organ sales is that that it's worth saving fewer people overall as long as this increases the absolute number of rich people who die.
Incidentally, the question of whether organs should be sold on the open market is entirely distinct from the question of whether donors should be compensated. That is, there's no reason we can't have a system where donors are compensated $50k (or whatever) per kidney, but the organs are still allocated the same way they currently are. A lot of people seem to be operating on the assumption that the two are logically inseparable.
Altoids:
In order for black market insertion to be profitable, the black market costs of obtaining a kidney will have to be significantly lower than the legally bought kidney (The difference has to be enough to cover the risk for everyone involved). Assuming the market is somewhat regulated, there is also the cost of faking the paper trail. I believe that this market will self regulate even in the absence of gov't regulation (but I don't believe in that absence) because the involved parties will be liable for selling an un-traced, defective organ.
In short, I don't see how the black market could compete with a legal one.
A different ethics question. If organ sales are legal, can a bankruptcy judge require ones organs to be sold to satisfy outstanding debt?
Perhaps of some interest theoretically, but certainly not in reality. Have you ever heard of a bankruptcy judge ordering a woman to sell her eggs, or someone to sell blood plasma? I would be utterly shocked were the situations treated any differently.
Agreed. In countries with legal prostitution, indebted people are not required to become prostitutes to pay their debts. Bankruptcy courts have very limited powers that stop well-short of organ sales.
Bankruptcy, no. Welfare benefits, maybe. I can't find the original story but here's a blog archive of a case in Germany that comes too close for comfort:
http://www.feministing.com/archives/002374.html
For prisoners on death row or with life sentences, can we compel the prisoner to donate an organ or two?
How long before jaywalking and bike theft receive the death penalty?
For prisoners on death row or with life sentences, can we compel the prisoner to donate an organ or two?
No, that would be double jeopardy.
People already on death row are safe (if you could call it that) because their sentence didn't include taking their organs as well as their life. We'd have to find convicts that haven't been sentenced yet if we want to include that feature.
China has been selling the organs of executed prisoners for well over a decade. In the case of unwanted infants, the ability to sell them to foreign families has led China to take much better care of them than before. But to sell the prisoners piecemeal, they have to be executed first, leading to some nasty incentives.
People die waiting for kidneys who wouldn't die if there were a legal market for kidneys. It saddens and amazes me that this is considered 'moral.'
If we allow people to sell body parts, will we allow them to bequeath them as part of an estate?
Kristian - We already do....but only in the situations whereby someone in the immediate family needs the organ and there is viability.
In the absence of that, it's a moot point. Organs don't just sit around on shelves waiting for the right person to show up. They are living (and dying) tissue.
So no, you couldn't will an organ unless there was a situation specific enough to allow it. Otherwise, you are just an organ donor or not an organ donor.
This is an asset only when there is an viable partner recipient and you are alive and willing to donate.
Three cheers Megan!
Well said.
Ms M --
Your challenge is rigged, in that any sentiment following from anyone else's morality can simply be derided as that person's "ick factor" and so discounted. Once you a priori rule out anyone's morality other than your own then you've given up on conversation.
Nonetheless, I will give it a shot. The simple reason to keep organ donation for pay illegal, is that once you make bodies completely fungible for money then there is no natural stopping point before poor people simply become body farms for the rich. If you can't see why this outcome is unacceptable, then there's no hope for you.
Regarding your extra credit challenges, and the general subject of how many people may suffer or die due to this or that policy choice: why don't you sit down and explain to someone who is sick but can't afford health insurance why you oppose taxing some rich people, who will never miss the money, to help pay for their medical care? I dare say that low taxes kill far more people than missing donations.
why don't you sit down and explain to someone who is sick but can't afford health insurance why you oppose taxing some rich people, who will never miss the money, to help pay for their medical care?
It's easy to tax someone's money if that someone isn't you, isn't it? Wouldn't it be more fair to just ask the rich person whether or not to donate? Or maybe paying for it yourself since you seem so concerned?
My grammar failed in that post but you get the point.
"there is no natural stopping point before poor people simply become body farms for the rich."
Untrue. The natural stopping point is the number of people willing to do it without coersion. Body farms for the rich don't actually agree to become body farms.
That's like saying there's no natural stopping point between wage labor and slavery. There clearly is, because we've found it.
"The simple reason to keep organ donation for pay illegal, is that once you make bodies completely fungible for money then there is no natural stopping point before poor people simply become body farms for the rich. If you can't see why this outcome is unacceptable, then there's no hope for you."
Either we've already passed this point by allowing people to sell blood, plasma, and eggs, or we won't pass this point just by making it legal to sell kidneys.
"why don't you sit down and explain to someone who is sick but can't afford health insurance why you oppose taxing some rich people, who will never miss the money, to help pay for their medical care?"
Why doesn't the government just take one kidney from healthy people with two kidneys (who will never miss the extra kidney) and give it to people who they think need/deserve it more. Taking time from somebody is somewhat different from taking an organ from them, but opposing forced organ "donation" while supporting taking people's time is closer to being logically inconsistent than supporting a market for organ donation and believing that people's time should be their own (or at least taken on a proportionate basis)
The fact that government action could lead to even worse nightmares is a big reason why the taboo against trading body parts for money should remain in place. Once the idea that bodies and money are interchangeable becomes accepted -- I think the fancy philosophy word is "normalized" -- then, as several commenters above have touched on, what is to prevent the government from levying its taxes in the form of organs? I should think libertarians should be especially horrified at this prospect.
If you want a glimpse at what bodies-for-money will arrive at once the government gets into the act, read the famous short story "The Jigsaw Man" by Larry Niven. (I don't know if it's still in print, but you can cheat an look here http://en.wikipedia.org/wiki/The_Jigsaw_Man .)
Landru - Why do you think rich people won't miss the money? Do you think they just pile it up in the basement? Rich people typically use their money. Either they spend on things they want (or things their family and friends want) or they invest it. Rich people don't usually get rich by being careless with their money.
No, it isn't. Really, go back and think again.
But since you've brought it up, I will point out that if we have found a stopping point between wage labor and slavery (and I'm not convinced that we have, entirely) then it's largely because libertarians like you are not (solely) in charge. To wit:
In any bargaining action, if human compassion is not involved then it will always be to either party's advantage if they can, through some mechanism, make the other party desperate and insecure; people on the verge of starvation will bargain whatever they have pretty cheaply. As such, if the non-poor want to bargain with the poor for something that both have in equal measure -- time, attention, votes, body parts -- then it will be in the interests of the non-poor to do whatever they can, perhaps through impersonal mechanisms like the government, to drive the poor toward desperation and insecurity (at least, until they start to riot). This is simple economics, and to my mind it has always been the biggest drawback to a laissez-faire arrangement: it gives the non-poor, and especially the rich, the wrong incentive to make the poor as wretched as possible. Clearly, adding organ donations for pay only amplifies this problem (and, as I said, if you can't see it as a problem then...).
As such, if the non-poor want to bargain with the poor for something that both have in equal measure -- time, attention, votes, body parts -- then it will be in the interests of the non-poor to do whatever they can, perhaps through impersonal mechanisms like the government, to drive the poor toward desperation and insecurity
We shouldn't pay poor people for their time because that will drive them towards desperation and insecurity?
This is only true if the cost of making people desperate and insecure is less than the discount provided. You assume that those costs are nil, but there is absolutely no reason to believe that.
Your first statement is, of course, correct; but in the second you are giving me too much credit. I'm not claiming much about the opportunities for the rich to enwretchify (how's that for a coinage?) the poor; it may be cost-effective to do so, or not, at any moment in history. All I'm saying is that without societal controls, the rich have _more_ incentive to do so; and once buying organs becomes legal then the rich with have a _great deal_ more incentive to do so.
Keep in mind that costs can be kept low per beneficiary through coherent, widespread action. For example, suppose that at some point in time personal bankruptcy laws provide some safety net which is relatively more valuable for poorer people than for richer people. The richer people can improve their bargaining position vis-a-vis the poor across the board, simply by buying up enough legislators to change the law to be of less help to poor people. Those poorer people will now have greater insecurity, and so less ability to demand higher wages. It's a bargain, really, when you think about it: you could probably swing the election of an entire US Congress for a few hundred million dollars, which the owners of the business community (what used to be called "capital") can make back in a year if the effective reduction in wages is just pennies an hour. Now, this is just an example that I made up; what do you think actual rich people, with small armies of very smart lawyers and accountants at their command, could cook up? Do you have any reason to believe that that's not what they're doing right now?
Landru, if your theory is true, why hasn't it already happened?
For example, take the 2005 bankruptcy bill. Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 (BAPCPA). Under this, people who declare bankruptcy are only subject to a means test if their income is above the median for their state. Why would this law have been passed in this form, if the rich people want to change the law to be *less* help to poor people?
This is the strongest reason I know of to believe that that's not what they're doing right now - the fact that reality contradicts your argument.
For what it's worth, I also believe in gravity because things fall down when I let go of them and they have no other means of support.
But in capitalist democracies we observe the opposite happening. For example, the idea that slavery was bad developed in England, (admittedly a rather limited democracy at the time, but still far more democratic than most countries in the world). We also saw in Britain the first development of an improvement in the living standards of the ordinary mass of people, read for example Adam Smith where he talks about the spread of shoe-wearing amongst the Scottish poor.
There may be a collective advantage to the non-poor in making the poor badly off, but under laissez-faire the individual advantages of making the poor better off appear to, over time, outweigh the collective advantage. For example, Henry Ford raised the pay of his workers to $5 a day to reduce the rate at which workers left his employment and thus improve his profits. Apparently for him the individual benefits of making his workers better-off outweighed the collective benefits of making them worse off. Presumably Wilbur Wilberforce's moral gain from the fight against slavery was enough to him to outweigh the possible benefits from poor people being worse off.
and, as I said, if you can't see it as a problem then...).
In other words, you are so sure that you are right that you think that the only reason someone could disagree with you is that they're mistaken? I do not share your belief in your fundamental rightness. I may be wrong, but if you want to convince me I'm wrong you need to actually come out with decent arguments, I've occasionally been wrong in the past on matters in which I was totally convinced I was right, so I don't see anything compelling about your overconfidence.
Landru - And you think the government is going to solve this some how? Don't the people in power just end up effectively being the non-poor and then will seek to drive those who aren't running things into desperation and insecurity.
Hmm...
As you can see from my reply to Johnson_85 above, I don't have a lot of faith in "government" just as an abstract, unqualified notion. Governments reflect their people, in some way, and can be used by people for good or for ill. Generally, I believe that if the government is controlled by the broad range of citizens with decent moral values, then government will tend to prevent nightmare scenarios. On the other hand, if government comes to be controlled by a tiny, selfish oligarchy then one shouldn't be surprised to see the many get shafted to enrich the few.
If the law is immoral, why not break it?
If the law is immoral, why not change it?
If the majority is in favor of it, it can't be changed.
Yes - organs are free because state and federal laws say they are free. What most people don't know is that organ procurement organizations and tissue banks can make up to $2 million off a donated whole body. This is a $20 billion a year business in the United States. If we were talking about copper and Bolivia, the issues would be crystal clear. The current system is unjust and immoral.
If you live in a state that has adopted the 2006 Uniform Anatomical Gift Act, it is presumed that you are an organ donor until they can find evidence of a contrary position. This includes hooking you up to life support systems even if you have an Advanced Healthcare Directive that says otherwise. They can keep your body alive until they can talk to your family to find out what your true intentions were.
Under this new Act, you have the right to refuse to participate in an organ harvesting procedure, but you must register your desire with a known organ registry. There is only one organ registry in operation that allows you to record your preferences, including allowing for the contingency that just compensation might become legal at some future date.
Check out www.DoNotTransplant.com to learn more about your rights under the law.